【作者】 和霞；

【导师】 刘纯艳；

【作者基本信息】 天津医科大学 ， 护理学， 2007， 硕士

【摘要】 乳腺癌已成为全球范围内女性最常见的恶性肿瘤。目前中国乳腺发病率迅速增长，尤其在一些大城市(上海、北京、天津、广州)，每年新增患病人数多达10余万，并呈现年轻化趋势，其发病高峰在40～49岁，较西方国家提前10年，但目前尚无一公认的促进乳腺癌早期发现的可行方案，使得诊断时多数病理分期较晚，40％的乳腺癌患者会在5年内死亡。乳腺癌已经成为我国妇女健康的主要问题。大力开展乳腺癌的早期发现、早期诊断、早期治疗的预防工作，已被公认为是降低乳腺癌死亡率最有效的途径。因此做好乳腺癌的早期发现工作非常重要。美国癌症协会目前推荐并已证实乳腺自我检查(Breast Self-Examination，BSE)、乳房临床检查(Clinical Breast Examination，CBE)和X线检查是早期发现乳腺癌三种有效的方法，根据我国的国情实施BSE是最为经济可行的方法，但国内很多研究表明我国乳腺癌早期发现方法，尤其是BSE的实施现状并不乐观，因此本研究通过乳腺癌早期发现健康教育评价干预措施对妇女的知识、态度行为等的改变，并分析影响妇女实施乳腺癌早期发现健康行为-BSE、CBE和X线检查的相关因素，便于制定出有效的乳腺癌早期发现健康教育模式，以提高乳腺癌早期发现，尤其是BSE在广大妇女中的普及率。【目的】评价在天津市城乡不同地区的40岁及以上妇女中实施乳腺癌早期发现健康教育的干预效果；应用健康信念模式(Health Belief Model，HBM)，分析影响妇女实施乳腺癌早期发现健康行为—BSE、CBE和X线检查的相关因素；初步探索适合我国城乡不同地区的、有效的乳腺癌早期发现健康教育模式。【方法】本研究采用流行病学现场干预类试验研究方法，于2006年5至2007年1月，对经便利抽样获得的40岁及以上的天津城乡妇女400名，其中对照组城乡各100名，试验组城乡各100名，分别进行为期半年的不同的干预措施，试验组进行乳腺癌早期发现健康教育，对照组进行普通的保健知识健康教育，并在干预前后采用自填式问卷法对所有调查对象的乳腺防癌相关知识、态度信念和行为等进行调查，并运用t检验、卡方检验、Mann-Whitney U检验及非条件Logistic回归分析对健康教育项目的效果进行评价并分析影响妇女实施乳腺癌早期发现健康行为的相关因素。【结果】1．乳腺癌早期发现健康教育干预措施能提高妇女的知识，但知识与行为无关，说明知识不一定能带来行为的改变，而往往是形成于行为建立之后；2．健康教育能改变妇女的BSE态度，并大大提高了妇女实施BSE率，也能促进妇女进行CBE，但对妇女X线检查率未见提高，而且不同地区的妇女在教育前后实施乳腺癌早期发现健康行为不同，BSE和X线检查率农村均高于城市，CBE城乡无差别；3．应用健康信念模式(HBM)分析影响妇女实施BSE、CBE、X线检查的相关因素，经多因素Logistic逐步回归分析基线资料结果为：①影响妇女定期BSE的因素为职业、城乡分布(OR=3.891，95％CI：1.055～14.354)和“感知到的障碍(OR=1.115，95％CI：1.033～1.203)”；②影响妇女过去1-2年内实施CBE的因素有乳腺检查卫生资源可及性(OR=2.779，95％CI：1.693～4.560)、家庭／社会支持(OR=2.008，95％CI：1.233～3.272)、媒体可及性(OR=2.639，95％CI：1.487～4.683)、“感知到的易感性”(OR=1.078，95％CI：1.000～1.163)和职业；③妇女过去1-2年内实施X线检查和城乡分布(OR=2.313，95％CI：1.162～4.602)、家庭／社会支持(OR=3.324，95％CI：1.862～5.936)、媒体可及性(OR=2.514，95％CI：1.197～5.283)、职业和自我感觉健康状况(OR=2.081，95％CI：1.211～3.577)有统计学关联。【结论】妇女实施BSE、CBE和X线检查率低下，掌握的乳腺防癌知识存在一定不足；但针对性的乳腺癌早期发现健康教育近期内能提高妇女的知识水平和BSE、CBE的健康行为依从性；通过应用HBM分析了影响妇女实施BSE、CBE和X线检查的相关因素，从而制定出积极有效的健康教育模式，在实施干预时注重影响因素，才能促使其采纳健康行为，做到持之以恒实施早期发现健康行为，从而有效开展乳腺癌早期发现工作。更多还原

【Abstract】 Breast cancer has globally been the most common malignant tumor in women.There has been rapid increase in breast cancer incidence in China, especially inseveral big cities (Shanghai, Beijing, Tianjin and Guangzhou), with there now beingmore than 100,000 new cases per year. It shows a younger age for highest incidentrate with the peak age at 40-49 which is 10 years younger than western countries. YetChina has no nationally recognized guidelines for screening, so 40% of breast cancerpatients would die in 5 years because of diagnosis at a later stage. Breast cancer hasbecome the significant issue of health care in Chinese women, so it is very importantto implement breast caner early detection. As three effective ways to early detection,breast self-examination(BSE), clinical breast examination(CBE) and mammographyhas been recommended and validated by American Cancer Society. Given theconcrete condition of China, it is reasonable to carry through BSE. Nevertheless,many studies concerning the implementing of breast cancer early detection methodsdemonstrate that these health-promoting programs are regrettably underutilized. Thisstudy therefore evaluated the intervention effects on knowledge, attitude andbehaviors after education on breast cancer early detection, and health belief model(HBM) were introduced to analyse’the factor influencing the practice of BSE, CBEand mammography in order to promote the early detection of breast cancer andincrease the utilizations of breast cancer early detection, in particular the practice ofBSE, in the future breast cancer early detection education model.Purpose:To evaluate the effectiveness of the health educational program of breast cancerearly detection among women ages 40 and older in rural and urban of Tianjin. HBMwas introduced to analyse to identify the factors influencing breast cancer earlydetection behaviors. To explore and provide a productive health education model forChinese women who live in different residential areas in future health-promotingactivities.Methods: During May of 2006 and January of 2007, a quasi-experiment design of fieldepidemiology intervention was conducted among a convenient sample of 400 womenages 40 and older recruited from urban and rural areas of Tianjin, who were dividedinto two groups. 200 Women, 100 from urban and rural respectively, assigned to theintervention group will experience innovative breast cancer early detection educationand promotion,the other 200 Women, 100 from urban and rural respectively, assignedto the control groups will experience health education only. Data were collectedthrough a self-administered questionnaire both at baseline and six months follow-up.T-test、Chi-square test、Mann-Whitney U test and unconditional logistic regressionanalyses were performed throughout the date analyses.Results:1. Significant improvement was observed concerning the knowledge through theinnovative breast cancer education and promotion. However findings showed that theknowledge was not indicative of screening practice, which means mastery of relevantknowledge may not change behavior, on the contrary, behaviors usually precedeknowledge.2. The significantly increase utilizations by intervention was observed in attitudeof BSE and behaviors of BSE and CBE except mammography. Also we can see thestatistically significant difference in BSE and mammography between rural and urbanareas after intervention, those Who lived in rural area has higher compliance rate thanthose in urban, while CBE remains similar in these two areas.3. Guided by HBM as the theoretical framework, the Multi-Logistic regressionwas used to analyze factor influencing compliance of early detection practice:①thestatistically significant predictors of regularly BSE at baseline are occupation, rural orurban (OR3.891,95% confidence interval:1.055～14.354) and perceivedbarrier(OR1.115,95% confidence interval:1.033～1.203).②having a CBE previous1-2 years ago has associated with access to health resource(OR2.779,95% confidenceinterval:1.693～4.560), family and social support (OR2.008,95% confidenceinterval: 1.233～3.272), access to media (OR2.639,95% confidence interval: 1.487～4.683)、"perceived susceptibility" (OR1.078,95% confidence interval: 1.000～1.163) and occupation.③rural or urban (OR2.313,95% confidence interval: 1.162～4.602),family and social support (OR3.324,95% confidence interval:1.862～5.936), accessto media (OR2.514,95% confidence interval:1.197～5.283), occupation andperceived health status (OR=2.081,95% confidence interval:1.211～3.577)werestatistically associated with mammography in previous 1-2 years.Conclusions:Breast cancer early detection is underutilized among women, and they are lackof sufficiency knowledge. But an innovative health and promotion intervention canimprove women’s knowledge and increase compliance on breast cancer earlydetection. While HBM was be introduced and utilized as a guide for the analysis ofthe factor that influence the adoption of and compliance with early detectionbehaviors, we can develop and carry out education model efficiently to promotedetection performance regularly only through fully understanding the related factorsconcerning health behavior.更多还原