上海市流动育龄女性避孕节育知情选择干预研究

发布时间：2018-07-25 15:02

【摘要】：[研究背景]《中国流动人口发展报告2012》显示,截至2011年,我国流动人口总量已接近2.3亿,占全国总人口的17%,其平均年龄为28岁,“80后”新生代农民工已占劳动年龄流动人口的近一半。这些年轻的流动人口处于性成熟期,他们远离了原居住地风俗习惯和道德的约束,正在经受新环境带来的种种诱惑和冲击,性观念和性行为发生了巨大变化,表现为性观念开放、婚前性行为发生率高、性行为安全意识差等特点,这些使得该群体中发生较多的意外妊娠、性病／艾滋病感染等生殖健康方面的问题。要解决这些问题,在流动人口中开展以避孕节育知情选择为核心的计划生育优质服务是一个非常重要的措施。但是由于流动人口分布广、流动性大、人员组成复杂、居住地点、从业处所和计划生育信息变化快等因素,致使在流动人口中开展避孕节育知情选择存在一些困难和障碍。在中国稳定低生育水平的形势下,如何有效地开展知情选择已经成为计划生育工作转变的一个重要课题。当前在国内流动人口中开展避孕节育知情选择的研究还很少,对这一特殊群体实施知情选择的效果及实施过程中可能产生的问题及如何解决还缺乏系统深入的研究。[研究目的]本研究在了解流动育龄女性避孕节育现状、生育意愿、避孕节育／生殖健康知识现况以及服务需求的基础上,制定针对性的综合干预方案,开展流动育龄女性避孕节育知情选择优质服务干预研究,评估干预效果,探讨适宜流动人口的避孕节育知情选择优质服务模式,供我国政府制定流动人口避孕节育干预策略提供参考。[研究方法]本研究设计为流行病学社区干预研究。本研究在上海市徐汇区13个街道,随机分配一定数量的街道到干预组和对照组。在干预街道被随机抽取的居委会实施避孕节育知情选择优质服务综合干预方案,对照街道被随机抽取的居委会开展常规计划生育工作,通过基线调查和终末评估调查比较项目实施期间干预组和对照组避孕节育知情选择知识、态度、信念和行为的变化来评估干预的效果及影响因素；探讨适合流动人口避孕节育知情选择的推广模式。[统计分析方法]主要包括卡方检验、t检验、一般线性模型、广义线性模型、多水平模型等。[研究结果]1、基本情况基线调查中共调查流动育龄女性1763人,其中干预组861人,对照组902人。终末评估调查中调查对象人数为1686人,其中干预组838人,对照组848人。2、研究对象的一般特征研究对象的平均年龄为28.0(±6.0)岁,25～34岁者所占比重最大；已婚或有性生活对象为主,共1733人(98.3%)；学历以初中为主,占45.2%；户口以农业户口为主,占2/3。干预组和对照组年龄、学历、户口等构成均无统计学差异。研究对象每年在现居住地居住时间大于等于11个月的比例高达90%以上,来现居地的主要原因是劳务／工作,大约3/4的研究对象在现居住地已经超过4年；约90%的对象是与配偶／性伴在现居住地生活；期望子女数为2个的最多,大约占75%。大部分个体没有明显的性别倾向；有1个子女的对象大约占64%,2个子女的约18%。3、干预活动提高了流动育龄女性避孕节育知识水平研究结果显示,干预活动后,干预组的得分均值从基线调查的51.7分上升到终末调查的65.1分。经方差成分模型分析,干预组对对照组的系数值为6.30。不同避孕方法知晓率均提高15%以上。提高幅度最大的是女用安全套知晓率(31.3%),其次为紧急避孕(27.1%),体外排精和男性安全套的提高最低,分别为16.6%和16.8%。4、干预活动提高了流动育龄女性避孕节育知情选择知晓水平、促进了研究对象知情选择态度的转变调查显示,在避孕节育知情选择的知晓上,干预后干预组知晓人数占93.0%,比干预前提高了近13%。干预组对对照组的OR值为3.32,95%可信区间3.22—3.46。赞同避孕节育知情选择的对象,干预组从基线调查的81.7%上升到终末调查的93.9%,反对的构成从6.9%下降到1.1%。5、干预活动改变了流动育龄女性现在避孕措施的构成,提高了避孕方法使用满意度干预期间干预组的避孕率从80.7%上升到91.1%,干预组男用安全套的使用构成从干预前约45.7%上升到干预后的54.8%,而流动人口采用宫内节育的比例几乎没有变化。干预促进了研究对象选择可逆性避孕措施,干预组对对照组的OR值为2.54。终末调查干预组研究对象对现用避孕方法满意度(91.5%)高于基线调查干预对象的(80.3%),而对照组对象干预前后满意度差别不大。干预组对对照组的OR值为2.46,95%可信区间1.69-3.58。6、干预提高了流动育龄女性自主选择避孕方法终末调查显示,干预组调查对象避孕措施由其他人决定的构成明显下降(5.5%),双方共同决定从对照组的61.7%上升到干预组的69.6%。多水平模型分析避孕方法自主选择(本人、对方、双方共同决定)的影响因素发现,干预组对对照组的OR值为3.38,95%可信区间2.42-4.84。7、干预促进了流动育龄女性主动寻求咨询服务,提高了咨询的满意度基线调查中干预组和对照组均有20%的研究对象在现居住地寻求过咨询服务,终末调查中,干预组大约40%的对象获得过咨询服务,高于对照组的17.9%。多水平模型分析发现,干预组对对照组的OR值为3.96,95%可信区间3.05—5.16。终末调查的研究对象表示咨询满意的比例从对照组的71.7%上升到干预组的78.8%,基本满意的比例在两组相同。8、流动育龄女性接受计划生育管理和服务的比例不高,表现出较多的服务需求基线调查显示,大约有20%的对象未办理过《流动人口婚育证明》；流动人口在现居住地寻求计生检查和面对面咨询等服务的比例都不高。流动人口在现居住地对免费避孕药具、避孕方法、知情选择、发放性与生殖健康知识的宣传材料、孕期保健、定期举办性与生殖健康知识、讲座、查环、生殖道感染防治和性伴／艾滋病防治服务都表现出不同程度的需求。9、开展避孕节育知情选择的优势和障碍在管理、服务和群众层面都存在影响避孕节育知情选择开展的优势和障碍。主要优势包括：计生人员服务周到；流动人口集中,便于宣传教育；各年龄层次的人都有,宣传面广；流入地计划生育服务种类多；避孕药具种类齐全；计生部门与医院合作工作的基础好；宣传资料充足。开展避孕节育知情选择和咨询服务的障碍包括：计生人员专业知识欠缺；流动人口避孕节育知识欠缺,保护意识差；缺少计生服务人员；政策执行不到位；缺少必要的硬件；政策法规不了解：宣传力度不够；检查收费；缺乏与户籍地的沟通联。[结论]综上所述,知情选择干预方案的实施可以提高流动育龄女性避孕节育知识水平,提高了研究对象避孕节育知情选择知晓水平,促进了研究对象知情选择态度的转变,改变了流动育龄女性现用避孕措施的构成,提高了避孕方法使用满意度,促进了流动育龄女性主动寻求咨询服务,提高了咨询的满意度,增强了流动育龄女性自主选择避孕方法的能力。应积极在流动人口中开展计划生育优质服务——避孕节育知情选择,提高计划生育服务水平和流动女性避孕节育知情选择的能力,为进一步促进流动女性性与生殖健康服务。
[Abstract]:[research background] China Mobile Population Development Report 2012> shows that as of 2011, the total amount of floating population in China is close to 230 million, accounting for 17% of the total population of the country. The average age of the population is 28 years old. The new generation of migrant workers in the "post-1980s" have already accounted for nearly half of the working age of the migrant workers. These young migrants are in sexual maturity and they are far from the original residence. The local customs and moral constraints are undergoing various temptations and shocks brought by the new environment. There are great changes in sexual concepts and sexual behavior, which are characterized by open sexual concepts, high incidence of premarital sex and poor sexual behavior, which make the group more accidental pregnancy, STD / AIDS infection and so on. In order to solve these problems, to solve these problems, it is a very important measure to carry out the quality of family planning service at the core of the informed choice of contraception and birth control in the floating population. However, there are many factors, such as the wide distribution of the floating population, the high mobility, the complex composition of the personnel, the place of residence, the place of employment and the rapid change of family planning information. There are some difficulties and obstacles in carrying out the informed choice of contraception in the floating population. In the situation of stable low fertility level in China, how to effectively carry out informed choice has become an important subject in the change of family planning work. The effect of this special group on the implementation of informed choice and the possible problems in the implementation process and how to solve the problem are still lack of a systematic and in-depth study. [Objective] this study is based on understanding the status of contraception, fertility will, contraceptive / reproductive health knowledge and service demand in women of childbearing age. The comprehensive intervention scheme was carried out to carry out the study on the quality of service intervention in the informed choice of the mobile reproductive age women's contraception and contraception, to evaluate the effect of intervention, and to explore the good quality service model for the informed choice of contraception and contraception for the floating population, and provide reference for the government to formulate a floating population contraceptive intervention strategy. Community intervention study. In this study, a number of streets were randomly assigned to intervention groups and control groups in 13 streets of Xuhui District, Shanghai. The baseline survey and final assessment survey compared the knowledge, attitudes, beliefs and behaviors of the intervention group and the control group during the implementation of the project to assess the effect and influencing factors of the intervention, and to explore the extension model suitable for the informed choice of contraception in the floating population. [the method of unified analysis] mainly included the chi square test and the t test, General linear model, generalized linear model, multi level model and so on. [research results]1, basic situation baseline survey of 1763 women of reproductive age, 861 in the intervention group and 902 in the control group. The number of subjects in the final assessment survey is 1686, of which 838 in the intervention group and 848 in the control group, the general characteristics of the research object are studied. The average age of the image was 28 (+ 6) years, and the 25~34 year olds accounted for the largest proportion; married or sexual life was the main object, with a total of 1733 (98.3%); the educational background was dominated by junior high school, accounting for 45.2%; the household registered permanent residence, accounting for the age of the 2/3. intervention group and the control group, with no statistical difference. The proportion of the living time greater than 11 months is more than 90%. The main reason for the place to live is labor / work, and about 3/4 has been in the present place for more than 4 years; about 90% of the objects are living with a spouse / partner in the present residence; the number of children expected to be 2 is the most, and about the majority of the majority of the 75%. individuals have no obvious sex. No tendency; about 64% of children with 1 children and about 18%.3 of 2 children, intervention activities improved the level of contraceptive knowledge in women of childbearing age. The results showed that after intervention, the mean score of intervention group increased from 51.7 points of baseline survey to 65.1 points in final investigation. The awareness rate of different contraceptive methods of 6.30. increased by more than 15%. The greatest improvement was the awareness rate of female condom (31.3%), followed by emergency contraception (27.1%), in vitro sperm discharge and male condoms were the lowest, respectively 16.6% and 16.8%.4. The intervention activities raised the level of informed choice of female contraception in the flow of childbearing age. The change survey of informed choice attitude of the research subjects showed that the awareness of informed choice of contraception was 93%, and the OR value of the near 13%. intervention group was higher than that of the control group before the intervention group, and the OR value of the control group was 3.32,95% confidence interval (3.22 to 3.46.), and the intervention group was investigated from the baseline survey. 81.7% up to 93.9% of the final survey, the composition of the opposition decreased from 6.9% to 1.1%.5, and the intervention changed the composition of contraceptive measures in women of childbearing age. The contraceptive rate in the intervention group increased from 80.7% to 91.1% during the intervention period, and the use composition of the men's condom in the intervention group rose about 45.7% before the intervention. To 54.8% of the prognosis, the proportion of intrauterine birth control in the floating population was almost unchanged. The intervention promoted the study subjects to choose reversible contraceptive measures. The OR value of the intervention group was higher than that of the baseline survey intervention group (91.5%) (80.3%), while the control group was higher than the baseline survey intervention group (80.3%), while the control group was compared with the control group. The OR value of the intervention group to the control group was 2.46,95% confidence interval 1.69-3.58.6, and the intervention group improved the final survey on the method of self selection contraception for women of reproductive age. The results showed that the constitution of the intervention group was significantly lower than that of other people (5.5%), and the two sides decided 61.7% from the control group. The influence factors of the 69.6%. multilevel model of the intervention group were analyzed to analyze the influence factors of the self selection of contraception methods (I, the other party, and the mutual decision). The OR value of the intervention group was 3.38,95% confidence interval 2.42-4.84.7, and the intervention promoted the active seeking counseling service for the women of childbearing age, and improved the intervention in the baseline survey of the consultation satisfaction. 20% of the subjects in the group and the control group sought counseling service in the present residence. In the final survey, about 40% of the subjects in the intervention group received counseling services. The 17.9%. multilevel model analysis of the control group showed that the OR value of the control group was full of the research object of the 3.96,95% confidence interval 3.05 to 5.16. final investigation. The proportion of meaning increased from 71.7% in the control group to 78.8% in the intervention group. The proportion of the basic satisfaction was the same in the two groups of.8. The proportion of migrant women in family planning management and service was not high. A large number of service demand baseline surveys showed that about 20% of the subjects had not passed the floating population marriage and breeding certificate; the floating population was living in the current population. There is no high proportion of services in the field of residence seeking and face-to-face consultation. The floating population is in the present residence for free contraceptives, contraception, informed choice, publicity materials for the knowledge of sexual and reproductive health, health care during pregnancy, regular and reproductive health knowledge, lectures, ring lookup, reproductive tract infection prevention and sex companion / AIDS The prevention and control services all showed different levels of demand.9, and the advantages and obstacles to develop informed choice of contraception in the management, service and the mass level had the advantages and obstacles to influence the development of informed choice of contraception. There are many people, extensive publicity, many kinds of family planning services, various kinds of contraceptives, a complete variety of contraceptives, good foundation for the cooperation of the family planning department and the hospital, sufficient publicity materials. The obstacles to the knowledge selection and consultation service of contraception include: the lack of professional knowledge of the family planning personnel, the lack of knowledge of contraception and contraception for the floating population, protection Poor consciousness; lack of family planning staff; poor policy implementation; lack of necessary hardware; lack of policies and regulations: lack of publicity; inspection fees; lack of communication with household registration. [Conclusion] the implementation of informed choice intervention can improve the knowledge level of contraceptive contraception for migrant women and improve the research. The awareness level of the informed choice of contraception and contraception has promoted the change of the attitude of the research subjects' informed choice, changed the composition of the contraceptive measures for women of childbearing age, improved the satisfaction of the use of contraception methods, promoted the women of childbearing age to seek counseling service actively, improved the satisfaction of the consultation, and enhanced the flow of women of childbearing age. The ability to choose the method of contraception should be carried out. We should actively carry out the quality of family planning service in the floating population - the informed choice of contraception and contraception, improve the level of family planning service and the ability to choose the informed choice of female contraception and birth control, in order to further promote the women's sexual and reproductive health service.
【学位授予单位】：复旦大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R169.4

【参考文献】