妊娠晚期妇女胎动自我监测行为及影响因素的研究

发布时间：2018-06-13 06:47

本文选题：孕妇 + 妊娠晚期　；参考：《第二军医大学》2017年硕士论文

【摘要】：目的胎动是孕妇对胎儿宫内健康状况最直观的感受,研究发现,孕妇在妊娠晚期坚持进行胎动自我监测能有效降低死胎等不良妊娠结局的发生率,现有指南均推荐孕妇在妊娠晚期每天计数胎动并在感知到胎动异常后当天就医。但有限的研究显示我国孕妇胎动自我监测行为水平较低,且原因不明。因此,本研究拟在计划行为理论、健康信念模式等健康行为理论的指导下,对妊娠晚期妇女胎动自我监测行为现状进行调查,科学系统地探索行为影响因素。为日后构建干预方案提供依据,以期切实提高胎动自我监测行为水平,从而降低死胎等不良妊娠结局的发生率。方法本研究结合理论和文献研究,形成计划行为理论和健康信念模式的整合概念框架作为指导,具体研究分为两部分:第一部分:妊娠晚期妇女胎动自我监测行为调查问卷的编制。在整合概念框架指导下,通过质性研究提取理论维度的突显信念,作为问卷部分条目来源。结合理论研究、文献回顾和质性访谈结果,形成问卷初稿,进行专家咨询。对问卷进行初步修订后,实施预调查,采用项目分析、内部一致性系数、重测信度和探索性因子分析对问卷信效度进行检验。第二部分:妊娠晚期妇女胎动自我监测行为及影响因素的调查。采用方便抽样法,以前期形成的调查问卷为工具,对上海市两家三甲医院产科病房共310名产妇实施问卷调查。采用描述性分析探究妊娠晚期妇女胎动自我监测行为现状,采用单因素分析、多元回归分析以及logistic回归分析对胎动自我监测行为意向及行为结果的影响因素进行研究。结果通过半结构式个人访谈,在理论演绎出的6个分析类目下,共提取21个突显信念。结合理论研究和文献研究结果,编制《孕晚期妇女胎动自我监测行为调查问卷》,由社会人口学资料、胎动自我监测行为基本情况、知识水平、健康经历和健康信念5部分构成。问卷信效度检验结果显示,各条目内容效度指数均0.78,分问卷总体内容效度指数均0.80,问卷内容效度良好。知识和健康信念问卷条目鉴别度良好。依据问卷特点仅对健康信念问卷进行结构效度检验,探索性因子分析结果显示,问卷由主观规范、知觉行为控制、正性态度、负性态度和疾病威胁感知5个维度构成,累积解释方差变异量62.55%,各条目维度归属基本与理论构想一致,仅两个条目维度归属不一致。知识问卷内部一致性Cronbach's α系数0.601,重测信度0.900;健康经历问卷重测信度0.960;健康信念问卷Cronbach's α系数0.860,重测信度0.925,问卷信效度良好。对上海市两家三甲医院产科病房310名产妇的调查结果显示,78.7%妊娠晚期妇女具备胎动计数行为意向,行为意向良好。其行为结果标准化后的平均得分(-0.187±2.80)分,行为水平较低。在未出现过胎动异常的257名研究对象中有85.6%的妇女打算在胎动异常后当天就医,行为意向良好。研究对象对提示因素的接触量水平较高,但行为经验水平一般。妊娠晚期妇女胎动自我监测知识水平总分10分,平均(6.62±2.371)分,主要来源于医护人员和网络信息。研究对象健康信念得分情况为,主观规范4～20分,平均(16.13±0.168)分;正性态度4～20分,平均(16.69±0.133)分;负性态度3～15分,平均(8.42±2.212)分;知觉行为控制7～35分,平均(25.85±3.680)分;疾病威胁感知3～15分,平均(10.08±2.221)分,可见其负性态度较为显著。将单因素分析有统计学意义(P0.05)的影响因素纳入进入多因素分析,结果提示,长期居住地、正性态度、主观规范和感知易患性变量进入胎动计数行为意向的logistic回归方程,长期居住于城镇、胎动计数的正性态度、主观规范和感知易患性水平越高的妇女,越会具备在妊娠晚期进行胎动计数的行为意向;胎动计数行为意向、感知严重性、知觉力和主观规范4个变量依次进入胎动计数行为结果的多元回归方程,具备胎动计数行为意向、感知严重性、知觉力和主观规范水平越高的妇女胎动计数行为水平越高;知觉行为控制和感知易患性2个变量进入胎动异常后就医行为意向的非条件logistic回归方程,知觉行为控制和感知易患性水平越高的妇女,越会具备胎动异常后当天就医的行为意向。结论自行研制的妊娠晚期妇女胎动自我监测行为及影响因素问卷信效度良好,可用于胎动自我监测行为相关研究。妊娠晚期孕妇胎动自我监测行为意向较好,但行为水平不佳。行为结果除了受行为意向影响外,还受到主观规范、知觉力、感知严重性等多种因素的影响。研究提示医务人员在今后对胎动自我监测行为的干预中应重点关注农村妇女,宣教应有针对性,培养孕妇对胎动自我监测的积极认识和危险感知,并鼓励孕妇家属督促并参与自数胎动活动。
[Abstract]:Objective fetal movement is the most intuitionistic feeling for pregnant women's intrauterine health. It is found that pregnant women persisting in fetal movement self-monitoring in the late pregnancy can effectively reduce the incidence of undesirable pregnancy outcomes, such as stillbirth. The existing guidelines recommend that pregnant women count the fetal movement every day in the late pregnancy and go to the doctor on the same day after the perception of abnormal fetal movement. The study shows that the maternal fetal movement self monitoring behavior in our country is low and the cause is unknown. Therefore, under the guidance of healthy behavior theory such as planned behavior theory and health belief model, this study is to investigate the status of fetal dynamic self monitoring behavior in late pregnant women and explore the influencing factors scientifically and systematically. The scheme provides a basis to effectively improve the level of self monitoring behavior of fetal movement, thus reducing the incidence of undesirable pregnancy outcomes, such as stillbirth. Methods this study combines theory and literature research, and forms the integrated conceptual framework of planned behavior theory and health belief model as guidance. The study is divided into two parts: the first part: the late pregnancy women. Under the guidance of the integrated conceptual framework, it extracts the explicit belief of the theoretical dimension through qualitative research, which is used as a part of the questionnaire. It combines theoretical research, literature review and qualitative interview results to form a preliminary draft of the questionnaire and carry out a specialist consultation. After the preliminary revision of the questionnaire, the preliminary adjustment is carried out. A survey of reliability and validity of the questionnaire was carried out by project analysis, internal consistency coefficient, retest reliability and exploratory factor analysis. The second part was the investigation of the self monitoring behavior and influencing factors of women in the late pregnancy. A questionnaire survey was carried out in 310 women. A descriptive analysis was used to explore the status of fetal dynamic self monitoring behavior in late pregnancy. The factors affecting the behavior intention and outcome of fetal dynamic self monitoring were studied by single factor analysis, multiple regression analysis and logistic regression analysis. According to the results of theoretical research and literature research, a questionnaire on fetal dynamic self monitoring behavior of women in the late pregnancy was compiled with the results of 6 analysis categories, which were composed of 5 parts: social demography data, basic situation of fetal dynamic self monitoring, knowledge level, health experience and health belief. The content validity index of each item was 0.78, the total content validity index of the questionnaire was 0.80, the content validity of the questionnaire was good. The identification of the knowledge and health belief questionnaire was good. According to the characteristics of the questionnaire, the structure validity of the health belief questionnaire was tested. The result of exploratory factor analysis showed that the questionnaire was controlled by subjective norms and perceived behavior. There were 5 dimensions of positive attitude, negative attitude and disease threat perception. The cumulative variance of variance was 62.55%. The attribution of each item dimension was basically consistent with the theory, only two item dimensions were incompatible. The internal consistency Cronbach's alpha coefficient of the knowledge questionnaire was 0.601, the retest credibility 0.900, the health experience questionnaire retest reliability 0.960; Health letter. The questionnaire Cronbach's alpha coefficient was 0.860, the retest reliability was 0.925, and the reliability and validity of the questionnaire were good. The results of 310 parturients in the maternity ward of two three a hospital in Shanghai city showed that the women in the third trimester of pregnancy had the behavior intention of fetal movement counting and the good behavior intention. The average score after the standardized behavior results (-0.187 + 2.80) and the behavior level were more than that of the women. Low. Among the 257 subjects who had not had abnormal fetal movements, 85.6% of the women intended to be hospitalized on the same day after abnormal fetal movement, and their behavioral intention was good. The level of exposure to the factors was higher, but the level of behavioral experience was general. The total score of self-monitoring knowledge of fetal movement in late pregnancy was 10 points, the average (6.62 + 2.371) scores. The score of health belief was 4~20 points, average (16.13 + 0.168), positive attitude 4~20, average (16.69 + 0.133), negative attitude 3~15, average (8.42 + 2.212), perception behavior 7~35, average (25.85 + 3.680); disease threat 3~15, 3~15, flat. The negative attitude was significant (10.08 + 2.221), and the factors of the single factor analysis (P0.05) were included into the multi factor analysis. The results suggested that the logistic regression equation of the long-term residence, positive attitude, subjective norm and perceptive variable entered the action intention of fetal movement counting, and lived in town and fetus for a long time. The more positive attitude, the subjective norm and the higher level of perceived susceptibility, the more women with the higher level of perceived susceptibility, the more they have the behavior intention of the fetal movement count in the late pregnancy; the 4 variables of the fetal movement count behavior intention, the perceived severity, the perceptual force and the subjective norm, in turn, enter the multiple regression equation of the result of the gestational count behavior, and have the action meaning of the fetal movement count. The higher the level of women's fetal movement counts, the higher the level of perceived severity, perception and subjective standard, the unconditional logistic regression equation for perceived behavioral control and perceived susceptibility to the abnormality of medical behavior after the abnormality of fetal movement. The more women with perceived behavioral control and perceived ease of susceptibility, the more likely they were after fetal movements. Conclusion the self monitoring behavior and influencing factors of fetal movement self-monitoring behavior and influencing factors of pregnant women in late pregnancy are good, which can be used in the study of self monitoring behavior of fetal movement. The behavior intention of fetal dynamic self monitoring is good, but the behavior level is not good. The study suggests that the medical staff should focus on rural women in the future intervention on the behavior of fetal movement self monitoring. The education should be focused on the rural women, the education should be targeted, the pregnant women should develop the positive awareness of the fetal movement self monitoring and the risk perception, and encourage the family members to supervise and participate in the number of women. Fetal movement.
【学位授予单位】：第二军医大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R715.3

【参考文献】