利用手机短信和因特网促进母乳喂养的社区干预研究

发布时间：2018-06-28 01:24

本文选题：母乳喂养 + 干预　；参考：《复旦大学》2012年硕士论文

【摘要】：研究背景母乳是新生儿及婴儿最理想的食物。婴幼儿喂养全球战略明确指出：在最初6个月应对婴儿进行纯母乳喂养,以实现婴儿的最佳生长、发育和健康,并继续母乳喂养至两岁或以上。然而,我国的母乳喂养状况并不太理想,2008年第四次全国卫生服务调查报告显示,0～6月龄儿童纯母乳喂养率仅为27.6%,城市地区为15.8%,显著低于农村地区30.3%。世界卫生组织(WHO)指出,如果获得正确的信息,有来自家庭、卫生保健系统以及整个社会的支持,所有的母亲都可以哺乳。研究表明,母乳喂养干预较常规服务可以更有效地提高母乳喂养率[19] 近年来,手机和因特网以其便捷,随时随地无障碍沟通的特性,已经逐渐成为人际交往的主要形式,同时也为各类健康行为的干预带来了机遇。研究发现通过因特网来促进母乳喂养可能是一般费时、费钱的母乳喂养健康教育和支持的另一个选择[39]。研究目的基于上海现有社区妇幼保健服务,探索利用手机短信和因特网进行母乳喂养干预的模式,并对干预效果进行评价。研究方法本研究为基于社区的准试验研究,是雀巢项目“利用手机短信和因特网促进婴儿合理喂养以预防儿童肥胖的社区干预研究”(编号：FN4042)的一部分,随访干预结果到婴儿出生后4个月。研究现场为上海市徐汇区龙华、漕河汗社区卫生服务中心和闵行区梅陇、莘庄社区卫生服务中心。研究对象为2010年9月至2011年2月到研究现场建小卡并符合纳入条件的641名孕妇,其中干预组308名,对照组333名。在干预前定性访谈和基线调查的基础上,召开专家组会议形成干预的具体方案和内容。干预方案：1.利用飞信/Frontline SMS每周发送一条干预短信；2.利用短信/飞信/QQ进行咨询,实现一对一的即时沟通；3.创建QQ妈妈群,实现同伴间交流；4.利用QQ空间传播知识；5.定期询问母乳喂养状况,并给予鼓励。干预从孕28周开始直至婴儿1岁。对照组接受孕产保健服务中的常规保健。在产后1个月内家庭访视时对所有对象进行随访,填写母乳喂养自我效能量表,同时收集分娩相关情况；随访所有对象1、2、4个月儿保体检时母乳喂养情况。评价干预对产后访视时母乳喂养率,对1、2、4个月儿保体检时纯／母乳喂养率的影响。本研究纯母乳喂养包括纯母乳喂养和几乎纯母乳喂养,母乳喂养包括纯母乳喂养和混合喂养。另外,对部分干预组对象进行定性访谈,以进一步了解干预的效果和项目参与者对项目的评价和建议。研究结果 1.随访情况基线调查时共纳入对象641人,其中干预组308人,对照组333人。产后访视时随访率为87.05%,产后1个月儿保体检时随访率为90.64%,产后2、4个月儿保体检时随访率为90.02%。 2.利用手机短信和因特网作为干预工具促进母乳喂养的可行性和可接受性 96.3%的孕妇可以在家或在单位使用电脑上网,83.8%的孕妇使用网络聊天软件,其中80.4%愿意接受因特网干预；94.5%的孕妇妊娠后继续使用手机,86.0%调查对象愿意接受手机短信干预。 3.干预对产后访视时母乳喂养率的影响产后访视时母乳喂养率干预组为98.5%,对照组为98.3%;产后访视时纯母乳喂养率干预组为52.4%,对照组为46.7%,干预组均高于对照组。单因素logistic回归显示,粗OR为1.255,95%CI为0.898-1.756。多因素logistic回归分析显示,控制了两组不平衡因素和产后是否上班后,产后访视时纯母乳喂养率干预组高于对照组,校正OR值为2.27,95%CI为1.439～3.593。 4.干预对1、2、4个月儿保体检时母乳喂养率的影响 1个月儿保体检时母乳喂养率干预组为95.8%,对照组为96.6%；2个月儿保体检时母乳喂养率干预组为90.3%,对照组为93.3%；4个月儿保体检时母乳喂养率干预组为83.2%,对照组为80.9%,单因素分析提示两组无统计学差异。 1、2、4个月儿保体检时母乳喂养率的广义估计方程分析结果显示：控制了时间趋势、产后是否上班和两组不平衡因素后,干预组母乳喂养率高于对照组,OR值为2.078,95%CI为1.201-3.596。 5.干预对1、2、4个月儿保体检时纯母乳喂养率的影响 1个月儿保体检时纯母乳喂养率干预组为59.4%,对照组为53.0%；2个月儿保体检时纯母乳喂养率干预组为58.1%,对照组为50.3%；4个月儿保体检时纯母乳喂养率干预组为48.0%,对照组为41.6%,干预组均高于对照组,单因素分析提示两组无统计学差异。 1、2、4个月儿保体检时纯母乳喂养率的广义估计方程分析结果显示：控制了时间趋势、产后是否上班和两组不平衡因素后,干预组纯母乳喂养率高于对照组,OR值为1.767,95%CI为1.260～2.478。结论利用手机短信和因特网进行母乳喂养干预可行和可接受；利用手机短信和因特网进行母乳喂养干预能有效提高母乳喂养率和纯母乳喂养率。
[Abstract]:Research background
Breastfeeding is the most ideal food for newborns and babies. The global strategy for infant and infant feeding clearly states that the first 6 months should be exclusively breastfeeding to achieve the best growth, development and health of the baby, and continue to breastfeed to two years or more. However, breastfeeding in our country is not so ideal in the fourth country in 2008. The health service survey report showed that only 27.6% of 0~6 month old children were breastfed and 15.8% in urban areas, significantly lower than the 30.3%. WHO (WHO) in rural areas. If correct information was obtained, all mothers were able to breastfeed from families, health care systems and the whole society. Feeding intervention can improve breastfeeding rate more effectively than routine services [19]
In recent years, mobile phones and the Internet have become the main form of interpersonal communication with their convenience and accessibility at any time and place. It also brings opportunities for the intervention of all kinds of health behaviors. One selection of [39].
research objective
Based on the existing maternal and child health care service in Shanghai, we explored the mode of breastfeeding intervention by SMS and Internet, and evaluated the effect of intervention.
research method
The study, based on a community based quasi trial study, is part of the Nestle project "community intervention study using SMS and the Internet to promote reasonable feeding for children to prevent obesity" (number: FN4042), followed up for 4 months after the birth of the baby.
The study was conducted in Longhua, Xuhui District, Shanghai, Caohe Khan community health service center, Minhang District Meilong and Xhenzhuang community health service center. The study was conducted from September 2010 to February 2011 to 641 pregnant women, including 308 in intervention group and 333 in control group.
On the basis of qualitative interview and baseline survey before intervention, expert group meetings are convened to form specific programs and contents of intervention. 1. the intervention program: 1. use the flying letter SMS to send an intervening message every week; 2. use SMS / /QQ for consultation to realize one to one instant ditch; 3. create QQ mother group to realize communication between peers. 4. use QQ space to spread knowledge; 5. regularly inquire about breastfeeding status and give encouragement. Intervention from 28 weeks of pregnancy until the baby is 1 years old. The control group receives routine health care in the health care service of pregnant women.
All the subjects were followed up during the family visit 1 months after postpartum, and the breastfeeding self-efficacy scale was filled in, and the related situation of childbirth was collected. All the subjects were followed up for 1,2,4 months to protect breastfeeding. The rate of breast-feeding during the postpartum visit was evaluated, and the pure / breastfeeding rate of 1,2,4 months after the medical examination was observed. Breastfeeding in this study includes pure breastfeeding and almost pure breastfeeding, breastfeeding, including pure breastfeeding and mixed feeding, and qualitative interviews with the participants in the intervention group to further understand the effect of the intervention and the evaluation and recommendations of the project participants.
Research results
1. follow up situation
A total of 641 subjects were included in the baseline survey, of which 308 were in the intervention group and 333 in the control group. The follow-up rate of postpartum visits was 87.05%, and the follow-up rate of postpartum 1 months after postpartum examination was 90.64%, and the follow-up rate of postpartum 2,4 months postpartum was 90.02%.
2. use SMS and Internet as an intervention tool to promote the feasibility and acceptability of breastfeeding.
96.3% of pregnant women can use the Internet at home or in units, and 83.8% of pregnant women use Internet chat software, of which 80.4% are willing to accept Internet intervention; 94.5% of pregnant women continue to use mobile phones after pregnancy, and 86% are willing to receive SMS intervention.
The effect of 3. intervention on the rate of breastfeeding during postpartum visits
The breastfeeding rate in the intervention group was 98.5%, the control group was 98.3%, the pure breastfeeding rate in the intervention group was 52.4%, the control group was 46.7%, the control group was 46.7%, the intervention group was higher than the control group. The single factor Logistic regression showed that the crude OR 1.255,95%CI was 0.898-1.756. multiple factors logistic regression analysis showed that two groups of unbalance factors and production were controlled. After going to work, the rate of exclusive breastfeeding in the intervention group was higher than that in the control group, and the corrected OR value was 2.27,95%CI 1.439 to 3.593..
4. effect of intervention on breastfeeding rate during 1,2,4 months physical examination
The intervention group of breast feeding rate in 1 months was 95.8% in the intervention group and 96.6% in the control group, 90.3% in the intervention group and 93.3% in the control group at 2 months of physical examination, 83.2% in the intervention group and 80.9% in the control group at 4 months. The single factor analysis showed that there were no statistical differences in two groups.
The results of the generalized estimation of the breastfeeding rate of 1,2,4 months after the medical examination showed that the rate of breastfeeding in the intervention group was higher than that of the control group and the value of OR was 2.078,95%CI 1.201-3.596. after the control of the time trend, whether after the postpartum work and the two groups of unbalance factors.
5. effect of intervention on exclusive breastfeeding rate during 1,2,4 months physical examination
The pure breast-feeding rate in the 1 month infants was 59.4% in the intervention group and 53% in the control group, 58.1% in the pure breastfeeding rate and 50.3% in the control group in 2 months, and 48% in the intervention group for the pure breastfeeding rate in 4 months, the control group was 41.6%, and the intervention group was higher than the control group. The single factor analysis suggested that two groups were not statistically significant. The single factor analysis suggested that two groups were not statistically significant. Difference.
The results of the generalized estimation equation analysis of the pure breastfeeding rate of 1,2,4 months after the medical examination showed that the time trend was controlled. After the postpartum work and the two groups of unbalance factors, the pure breastfeeding rate of the intervention group was higher than that of the control group, and the value of OR was from 1.260 to 2.478. 1.767,95%CI.
conclusion
Breastfeeding intervention using SMS and the Internet is feasible and acceptable; breastfeeding intervention using SMS and the Internet can effectively improve breastfeeding rate and pure breastfeeding rate.
【学位授予单位】：复旦大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R174

【参考文献】