基于社区参与式研究方法的农村结直肠癌筛查组织动员模式效果评价

发布时间：2018-08-01 19:12

【摘要】：目的评价基于社区参与式研究方法 (CBPR)的农村结直肠癌筛查组织动员模式的效果。方法2014年3—8月,采用目的抽样法从北京市韩村河镇的27个行政村中选取2个村(五侯村、孤山口村)作为社区干预试验现场,采用简单随机抽样法将其分为干预组(五侯村)和对照组(孤山口村)。五侯村、孤山口村分别有911、936例村民符合结直肠癌筛查要求,将其作为筛查的目标人群,采用高危因素问卷和便隐血试验(FOBT)(2次)进行初筛,对高危人群进行肠镜检查。干预组采用基于CBPR的农村结直肠癌筛查组织动员模式进行干预,对照组采用一般性组织动员模式进行干预。2014年3月,选取五侯村、孤山口村符合纳入标准的村民745例为调查对象,采用自制调查问卷进行干预前的基线调查。2014年8月,再次选取五侯村、孤山口村符合纳入标准的村民740例为调查对象,采用自制调查问卷进行干预后的终末调查。记录两组一般资料,结直肠癌筛查消息知晓率、宣传折页获得率、宣传海报关注率、知识得分、态度得分,初筛参与率,肠镜参与率。结果基线调查共发放调查问卷745份(对照组363份、干预组382份),回收有效问卷707份(对照组343份、干预组364份),有效回收率为94.9%。终末调查共发放调查问卷740份(对照组359份、干预组381份),回收有效问卷696份(对照组330份、干预组366份),有效回收率为94.1%。干预组结直肠癌筛查消息知晓率、宣传折页获得率、宣传海报关注率均高于对照组(P0.05)。两组干预后结直肠癌筛查知识得分、态度得分均高于本组干预前(P0.05);干预组干预前后结直肠癌筛查知识得分均高于对照组(P0.05);干预组干预前结直肠癌筛查态度得分与对照组比较,差异无统计学意义(P0.05);干预组干预后结直肠癌筛查态度得分高于对照组(P0.05)。独立混合横截面数据的双重差分模型分析结果显示:两组干预前后结直肠癌筛查知识得分差值比较,差异无统计学意义(P0.05);干预组干预前后结直肠癌筛查态度得分差值大于对照组(P0.05)。二分类非条件Logistic回归分析结果显示:干预组较对照组初筛参与率高23.8%(P0.05);两组肠镜参与率比较,差异无统计学意义(P0.05)。结论基于CBPR的农村结直肠癌筛查组织动员模式较大程度提高了村民结直肠癌筛查的消息知晓情况和初筛参与行为;但由于村民文化程度低等原因,其对村民的结直肠癌筛查知识掌握情况、态度影响较小。
[Abstract]:Objective to evaluate the effect of rural colorectal cancer screening organization mobilization model based on community participation method (CBPR). Methods from March to August 2014, two villages (Wuhou Village, Gushankou Village) were selected from 27 administrative villages of Hancun River Town in Beijing as the field of community intervention test. It was divided into intervention group (Wuhou village) and control group (Gushankou village) by simple random sampling. There were 911936 villagers in Wuhou village and Gushankou village, respectively, who met the requirements of colorectal cancer screening. They were used as the target population for screening. The high risk factor questionnaire and fecal occult blood test (FOBT) () were used for primary screening. The intervention group adopted the rural colorectal cancer screening organization mobilization model based on CBPR, while the control group adopted the general organization mobilization model. In March 2014, Wuhou village was selected. 745 villagers who met the inclusion criteria in Gushankou Village were selected as the survey objects, and the baseline survey before intervention was carried out by self-made questionnaire. In August 2014, Wukou Village was selected again, and 740 villagers who met the inclusion criteria in Gushankou Village were selected as the survey objects. A self-made questionnaire was used to conduct the final survey after intervention. The general data of the two groups were recorded, such as the rate of knowing the news of colorectal cancer screening, the rate of obtaining foldable propaganda, the attention rate of posters, the score of knowledge, the score of attitude, the participation rate of primary screening, and the participation rate of enteroscopy. Results A total of 745 questionnaires (363 in the control group and 382 in the intervention group) were distributed and 707 valid questionnaires (343 in the control group and 364 in the intervention group) were collected. The effective recovery rate was 94.9%. A total of 740 questionnaires (359 in the control group and 381 in the intervention group) were distributed, and 696 effective questionnaires (330 in the control group and 366 in the intervention group) were recovered. The effective recovery rate was 94.1%. In the intervention group, the rates of information awareness, foldable propaganda and poster attention were higher than those in the control group (P0.05). After intervention, the scores of knowledge and attitude of colorectal cancer screening in two groups were higher than those before intervention (P0.05); before and after intervention, the scores of knowledge of colorectal cancer screening in the intervention group were higher than those in the control group (P0.05); the scores of attitude towards colorectal cancer screening before intervention in the intervention group were higher than those in the control group. There was no significant difference (P0.05); the intervention group after the intervention of colorectal cancer screening attitude score was higher than the control group (P0.05). The results of dual differential model analysis of independent mixed cross-sectional data showed that the difference of knowledge scores in colorectal cancer screening between the two groups before and after intervention was compared. There was no significant difference between the two groups (P0.05); the difference of attitude score between the intervention group and the control group was higher than that in the control group (P0.05). The results of non-conditional Logistic regression analysis showed that the participation rate of the intervention group was 23.8% higher than that of the control group (P0.05), and there was no significant difference between the two groups (P0.05). Conclusion the mobilization model of rural colorectal cancer screening based on CBPR can improve the knowledge of information and the behavior of primary screening, but because of the low education level of villagers. It has little influence on villagers' knowledge of colorectal cancer screening.
【作者单位】：首都医科大学卫生管理与教育学院;中国医学科学院肿瘤医院内镜科;韩村河镇社区卫生服务中心;
【基金】：基金项目:北京市科学技术委员会(D121100004712001)——结肠癌早期预警及筛查规范研究
【分类号】：R735.34

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