安徽省城乡社区恶性胂瘤患者社会资本与生活质量关系研究

发布时间：2018-05-12 22:27

本文选题：社会资本 + 恶性肿瘤　；参考：《安徽医科大学》2015年硕士论文

【摘要】：背景:随着恶性肿瘤治疗手段和防治技术的不断进步,患者的生存期得到了显著的延长,社区成为患者康复或生活的主要场所,而生活质量指标也随之成为恶性肿瘤领域的研究热点。由于恶性肿瘤疾病的特殊性以及当前针对社区恶性肿瘤的研究较少等原因,开展对社区恶性肿瘤患者生活质量的研究具有重要的学术意义和社会意义。此外,现在越来越多的研究发现社会因素与生活质量相关,而社会资本作为探索社会因素作用于健康机制的新视角,已在卫生领域中得到一定程度的重视与应用。社会资本有助于发掘并有效利用潜在的无形资源,为探索改善恶性肿瘤患者的生活质量提供了新的方向。目的:本研究旨在从微观社会资本视角,探索城乡社区恶性肿瘤患者的社会资本现状,探讨社会资本对恶性肿瘤患者生活质量的影响。一方面在理论层面弥补现有研究的不足,另一方面从现实层面利用社会资本这一无形资源,促进社区恶性肿瘤患者控制病情、缓解症状,改善生活质量。方法:本研究采用多阶段抽样方法,首先通过综合考虑安徽省各市的地理位置和经济水平,确定铜陵市(铜官山区、铜陵县)、合肥市(包河区、肥西县)、阜阳市(颍州区、颍上县)为研究现场,然后在样本区县中再简单随机抽取1-2个居民区(行政村),最后根据选取的样本居民区(行政村)所提供的慢性病患者资料,在2014年9-11月使用自制问卷对辖区内符合纳入标准的恶性肿瘤患者进行集中或入户调查。数据分析阶段使用SPSS18.0进行描述性统计分析、因子分析、单因素相关分析和多重线性回归分析。结果:(1)恶性肿瘤患者基本特征:男性较多(64.3%),且以老年患者为主(60岁以上的占78%),文化程度偏低(文盲者最多占38.3%),职业以农民/打工者为主(57.1%),个人月收入和家庭人均月收入均较低(500元以下者最多);胃癌最多(23.3%),其次为食管癌(16.7%);确诊时间较长,1-3年的所占比例最高(28.7%),出现转移、复发和并发症的比例较低(分别为9.5%、11.2%、11.2%),疼痛的发生率为69.5%,其中轻度疼痛所占比例最高(35.4%)。城乡社区恶性肿瘤患者在文化程度、月收入、家庭成员数、职业、患病类型、合并疾病种类、疼痛和治疗情况上存在差异。(2)社会资本问卷信效度:结构效度方面,主成分分析提取出6个公因子,共解释79.190%的总变异,问卷的整体Cronbach’sα系数为0.926,6个维度Cronbach’sα系数除社会参与为0.640,其余5个维度均大于0.8。(3)社会资本现状:①社会参与:57.6%的调查对象没有参加过任何组织,77.8%的调查对象近一年没有参加过任何圈子活动,城市社区调查对象的社会参与程度高于农村社区(组织参与:46.7%VS.39%;圈子参与:26.3%VS.19%)。②信任:调查对象的信任程度普遍较高,除对家人或亲戚完全信任的比例最高(49.9%),对其他对象(陌生人、朋友、邻居、综合医院医生、社区医生、居委会/村委会工作人员)均是部分信任的比例最高,城乡社区调查对象的信任水平不存在统计学差异。③社会支持:个人支持方面,遇到困难时,53.6%的调查对象多数能获得精神支持51.9%多数能获得物质支持;组织支持方面,遇到困难时调查对象完全不会获得组织精神支持(27.7%)和物质支持(28.0%)的比例均最高。城市社区患者完全不会获得组织精神支持和物质支持的比例均要低于农村社区(18.4%VS.34.9%;19.7%VS.34.4%)。④互惠:当亲戚、邻居、朋友遇到困难时,分别有51.0%、57.3%和55.9%的调查对象选择多数会帮忙,并且城市社区患者选择完全会帮助的比例均高于农村社区(亲戚:36.2%VS.17.9%;邻居:21.1%VS.13.8%;朋友:23.0%VS.15.4%)。⑤凝聚力与归属感:46.7%的调查对象认为本社区/村人与人之间的关系较为融洽,本人(39.5%)和他人(36.3%)对居住社区/村关心程度所占比例最高的均为一般关心,69.4%的调查对象认为搬离现在的社区/村会舍不得,以上问题城乡社区之间均存在统计学差异。(4)恶性肿瘤患者生活质量现状:生理状况平均得分为19.994分,社交/家庭状况平均得分为19.867分,情绪状况平均得分为16.896分,功能状况平均得分为15.127分,整体生活质量平均得分为71.884分,城市社区患者生活质量总分及各维度得分均高于农村社区;单因素分析显示,影响恶性肿瘤患者生活质量的因素有城乡、性别、婚姻状况、文化程度、职业和月收入、恶性肿瘤确诊时间、疼痛、有无转移、复发和并发症、治疗费用来源;多重线性回归分析显示,影响因素包括年龄、家庭人均月收入、疼痛和确诊时间。(5)社会资本与生活质量关系:社会资本与生活质量的相关分析和多重线性回归结果一致。结果显示社会资本越高生活质量越好(beta=0.241,p0.01),凝聚力与归属感(beta=0.209,p0.01)、互惠(beta=0.247,p0.01)和社会参与(beta=0.096,p0.05)3个维度与生活质量总分呈显著正相关;信任因子对恶性肿瘤患者生活质量各维度均无影响;凝聚力与归属感因子与生理和功能状况成正相关;互惠因子对所有生活质量维度均有影响;组织支持因子与生理状况呈正相关;个人支持因子与社交/家庭状况呈正相关;社会参与因子与情绪状况成正相关;社会资本因子总分对所有的生活质量维度均有影响。结论:(1)本研究研制的城乡社区恶性肿瘤患者社会资本问卷具有良好的信效度;(2)城乡恶性肿瘤患者社会参与水平较低,较少能获得组织支持,但信任水平高,互惠意识强,且认为居住社区凝聚力较好,对社区有较强归属感。城市社区恶性肿瘤患者的社会资本各维度和整体因子得分均高于农村患者;(3)社会资本的提升有助于提高城乡社区恶性肿瘤患者的生活质量,除信任外,其余社会资本各因子对其生活质量都有不同程度的影响,特别是互惠因子在其中起着重要作用。建议:(1)通过健全城乡社会组织、完善恶性肿瘤患者组织支持体系建设、提高恶性肿瘤患者互惠意识、增强城乡社区恶性肿瘤患者的凝聚力与归属感等措施,提升恶性肿瘤患者社会资本,从而改善其生活质量;(2)采取因地制宜的措施,缩小城乡恶性肿瘤患者的差距。
[Abstract]:Background: with the continuous progress of the treatment and prevention technology of malignant tumor, the survival period of the patients has been greatly extended, and the community has become the main place for the patients to recover or live, and the quality of life has become a hot spot in the field of malignant tumor. There are few reasons for the study of the tumor. It is of great academic and social significance to study the quality of life of the patients with malignant tumor in the community. In addition, more and more studies have found that social factors are related to the quality of life, and social capital has been obtained in the field of health as a new perspective on the role of social factors in the health mechanism. A certain degree of attention and application. Social capital helps to explore and effectively use the potential intangible resources, and provides a new direction for the improvement of the quality of life of patients with malignant tumor. The influence of the quality of life of the patients with sexual tumor. On the one hand, the deficiency of the existing research is made up at the theoretical level. On the other hand, the intangible resource of social capital is used in the practical level to promote the control of the disease, relieve the symptoms and improve the quality of life. The geographical location and economic level of each city in Huizhou Province, Tongling (Tongguan mountain, Tongling county), Hefei city (Baohe District, Feixi county), Fuyang city (Yingzhou District, Yingshang County) as the research site, and then 1-2 residential districts (administrative villages) in the sample district and county, and finally according to the selected sample residential area (administrative village). The patient's data, using a self-made questionnaire in the 9-11 month of 2014, conducted a centralized or household survey on patients who met the standard of malignant tumors within the jurisdiction. The data analysis stage used SPSS18.0 to carry out descriptive statistical analysis, factor analysis, single factor correlation analysis and multiple linear regression analysis. Results: (1) the basic characteristics of malignant tumor patients: Male More (64.3%), and the majority of the elderly (78% over 60 years of age), low cultural level (38.3% of the illiterate majority), the occupation of farmers / migrant workers (57.1%), individual monthly income and family per capita income is lower (500 yuan is the most); the most gastric cancer (23.3%), followed by esophageal cancer (16.7%), the diagnosis time is longer, 1-3 years accounted for the ratio. The highest (28.7%) cases (9.5%, 11.2%, 11.2%), the incidence of pain was 69.5%, and the proportion of mild pain was the highest (35.4%). In urban and rural community patients with malignant tumor, the degree of culture, monthly income, family membership, occupation, type of disease, type of disease, pain and treatment (2) the reliability and validity of the social capital questionnaire: the structure validity, the principal component analysis extracted 6 public factors, and explained the total variation of 79.190%. The overall Cronbach 's alpha coefficient of the questionnaire was 0.926,6 Cronbach' s alpha except for the social participation of 0.640, the other 5 dimensions were greater than 0.8. (3) social capital status: (1) social participation: 57.6 % of the respondents did not participate in any organization, 77.8% of the respondents did not participate in any circle of activities in the past year. The social participation of urban community respondents was higher than that of rural communities (organization participation: 46.7%VS.39%; circle participation: 26.3%VS.19%). The proportion of trust is the highest (49.9%). The proportion of other objects (strangers, friends, neighbors, general hospital doctors, community doctors, residents' committee / village committee staff) is the highest proportion of partial trust, and there is no statistical difference in the level of trust between urban and rural communities. Third, social support: in the case of personal support, 53.6% of the investigation is in question. The majority of the majority of the mental support can be supported by the majority of the material support; in the case of organizational support, the proportion of the respondents (27.7%) and material support (28%) is the highest in the case of difficulties. The proportion of urban community patients who do not obtain organizational mental support and material support is lower than that of the rural community (18.). 4%VS.34.9%; 19.7%VS.34.4%). Reciprocity: when relatives, neighbors, and friends encounter difficulties, 51%, 57.3%, and 55.9% of the respondents choose the majority to help, and the proportion of urban community patients to be fully assisted is higher than that in rural communities (relatives: 36.2%VS.17.9%; neighbors: 21.1%VS.13.8%; friends: 23.0%VS.15.4%). Sense: 46.7% of the respondents believed that the relationship between the community and the people was more harmonious, and I (39.5%) and others (36.3%) were the most concerned about the proportion of the community / village, and 69.4% of the respondents believed that the community / village would be reluctant to move away from the present, and there was a statistical difference between the urban and rural communities. (4) the quality of life of the patients with malignant tumor: the average score of the physiological status was 19.994, the average score of social / family status was 19.867, the average score of the emotional state was 16.896, the average score of the functional status was 15.127, the average score of the whole life quality was 71.884, the total score of the quality of life of the urban community patients and the scores of all the dimensions were all A single factor analysis showed that the factors affecting the quality of life of patients with malignant tumors were urban and rural, sex, marital status, educational level, occupational and monthly income, time of diagnosis, pain, metastasis, recurrence and complications, and the source of cost of treatment. Multiple linear regression analysis showed that the factors included age, family per capita. Monthly income, pain and time of diagnosis. (5) the relationship between social capital and quality of life: the correlation analysis of social capital and quality of life and the results of multiple linear regression. The results show that the higher the social capital is, the better the quality of life (beta=0.241, P0.01), the cohesion and belonging (beta=0.209, P0.01), beta=0.247, P0.01 and social participation (beta=0.) 096, P0.05) there was a significant positive correlation between the 3 dimensions and the total quality of life; the confidence factor had no influence on the quality of life of the cancer patients; the cohesion and the sense of belonging were positively related to the physiological and functional status; the reciprocal factor had an influence on all the quality of life; the organizational support factor was positively related to the physiological status; There is a positive correlation between holding factor and social / family status; social participation factor is positively related to emotional state; social capital factor total score has an impact on all the quality of life. Conclusion: (1) the social capital questionnaire of patients with malignant tumor in urban and rural communities has good reliability and validity; (2) the social participation of patients with malignant tumor in urban and rural areas Low level, less organization support, but high level of trust, strong sense of reciprocity, good community cohesion and strong sense of belonging to the community. The scores of social capital and overall factor in urban community malignant tumor patients are higher than those of rural patients; (3) the promotion of social capital is helpful to improve the malignant swelling in urban and rural communities. The quality of life of the tumor patients, in addition to trust, the other social capital factors have different influence on the quality of life, especially the reciprocal factor plays an important role. (1) through the improvement of urban and rural social organizations, the construction of the organization support of the malignant tumor patients is perfected, the reciprocal consciousness of the malignant tumor patients is improved and the urban and rural areas are enhanced. The cohesiveness and sense of belonging of the patients with malignant tumor in the community can improve the social capital of the patients with malignant tumor and improve their quality of life. (2) take measures to reduce the gap between the patients with malignant tumor in urban and rural areas.

【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R73-31

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