【作者】 王潇滟；

【导师】 程怡民；

【作者基本信息】 中国协和医科大学 ， 流行病学与卫生统计学， 2007， 硕士

【摘要】 研究目的：随着城市流动人口的日益增多，以及生殖健康研究领域的迅速发展。流动人口的生殖健康问题越来越得到重视，因此，本研究的总目标为：研究城市流动女性生殖健康现状及其影响因素，并探讨利用社区卫生资源对流动女性进行宣教试点的模式及效果。具体目标如下：1、研究城市流动女性生殖健康现状及影响因素。2、了解城市流动女性对生殖健康服务的需求及意愿。3、探讨为流动女性开展宣教活动的模式及效果。4、了解流动女性对宣教的满意度以及今后对生殖健康服务的需求及意愿。研究方法：本研究采用定性与定量相结合的方法进行试点的评估，定量研究对象选取北京市海淀区四个街道内符合纳入标准的城市流动女性进行封闭式问卷的调查。定性研究对象选取参加调查的流动女性及社区卫生服务站的服务提供者进行个人深入访谈和小组集中讨论。由流动女性所在街道的计划生育办公室(计生办)组织试点活动的开展及试点前后两次定量和定性的调查。通过试点前的定量和定性调查了解城市流动女性的生殖健康现状及影响因素，以及生殖健康服务的需求和意愿，然后根据流动女性的生殖健康需求，制定宣教试点措施的具体内容和活动方式。对流动女性开展包括讲座、发放宣教册及社区卫生服务卡片在内的宣教试点活动，并在试点结束后，对流动女性进行定量和定性的调查，评估宣教试点活动开展的效果，了解流动女性寻求生殖健康服务的需求和意愿。并结合试点前后对服务提供者的定性研究结果，探讨适合的宣教模式。在数据收集和处理过程中，每份问卷经过调查员、质量控制员和现场负责人的三次审核，保证问卷的质量。用EpiData3.0软件创建数据库，双人进行双次录入，并进行逻辑检错。用SPSS13统计软件进行一般统计描述和卡方检验等分析。研究结果：1．流动女性基本人口学资料流动女性的平均年龄为28.92±7.94岁，有64.8％的人来自外地农村。餐饮业服务人员占24.2％，初中文化程度占34.9％，高中及中专水平占41％。未婚者占38.1％，83.8％的已婚者生育过子女。2．流动女性生殖健康现状及影响因素(1)月经情况：36.8％的人每年有3次以上周期不到25天，有30.8％的人每年有3次行经天数＞7天或＜3天，经血中有血块者占30.8％。其中至少有一种月经问题的女性占21.9％，有两种月经问题的占29.4％。(2)避孕措施使用及人工流产现状：65.1％有性生活史，其中，未使用避孕措施的占12.1％，目前正使用避孕套的占47％。有人工流产史的占45.3％，其中，有重复流产史的为34.8％。年龄在25岁以下的占52.8％。其中因未使用任何避孕措施而流产占30.5％，避孕失败的占52.8％。避孕失败中，安全期失败占44.7％。(3)避孕节育及人工流产知识现状：避孕知识仅来源于一个渠道的，占77.5％，有41.6％的流动女性只知道一种避孕方法。40.5％的流动女性不能完全回答出避孕套的双重功能。综合知识得分方面，不及格的人群占39.1％。(4)生殖道感染／性传播疾病及艾滋病的知识、态度：有37.8％的妇女不知道任何生殖道感染的种类，只有54.8％的流动女性认为避孕套也可以预防生殖道感染。62.5％的流动女性认为被叮咬过艾滋病感染者的蚊虫叮咬可能会感染艾滋病病毒。综合知识得分方面，不及格的人群占43.2％。(5)影响因素分析：年龄是月经知识了解情况的影响因素，24岁以下年龄组中不了解月经知识的比例为66.4％，(x~2=54.215，P＜0.01)。是否主动咨询避孕方面的知识是影响避孕知识了解情况的因素，没有主动咨询避孕知识的人群中，不了解避孕知识的比例为36.4％，(x~2=96.616，P＜0.01)。知识来源渠道是影响避孕与人工流产知识综合得分的因素，知识来源仅一个渠道的人群中，避孕与人工流产综合知识不及格的比例为44.8％，(x~2=82.575，P＜0.01)。人工流产史是流动女性患生殖道感染的影响因素，有人工流产史的妇女，患生殖道感染的比例为34.1％，(x~2=7.711，P＜0.01)，居住年限是影响艾滋病知识综合得分的因素，居住年限在2年以下的流动女性中，艾滋病知识不及格的比例占54.1％，(x~2=37.669，P＜0.01)。3．流动女性对生殖健康服务的需求和意愿38.5％的流动女性曾咨询过避孕知识，购买药具时考虑的因素中，“可得到咨询”，占40.1％。有63.4％流动女性将医生作为首选咨询对象。33.7％的流动女性最希望了解生殖系统疾病及性传播疾病的知识，在最希望得到生殖健康知识的途径方面，“知识讲座”是主要的获得途径，占41.6％。71.5％听说过“社区卫生服务站，但其中仅40.5％曾经去过社区卫生服务站接受服务。4．宣教前定性研究结果流动女性认为自己在生殖健康方面的知识较缺乏，知道艾滋病是个很严重的疾病。但不知道具体的传播途径和预防措施，绝大多数流动女性表示愿意接受相关的宣教和知识讲座。从接受服务的途径来看，希望能有定期的、集中的讲座举办。社区卫生服务站的宣教人员表示愿意为当地的流动人口开展一些讲座。5．宣教后的效果研究宣教后，掌握3种以上避孕方法的人群比例由宣教前的47.1％，上升到宣教后的73.3％，(x~2=122.936，P＜0.01)。避孕节育及人工流产知识综合得分中，不及格组人群比例由宣教前的39.1％，下降到宣教后的3.6％。(x~2=489.948，P＜0.01)。认为避孕套最有效的人群比例，由宣教前的41.8％，提高到宣教后的72.3％，(x~2=145.090，P＜0.01)。艾滋病知识态度综合得分情况，不及格人群比例由宣教前的43.2％，下降到宣教后的6.8％，(x~2=413.487，P＜0.01)。6．宣教后流动女性生殖健康服务的需求和意愿以及定性研究结果宣教后，希望寻求的咨询服务提供者中，社区卫生服务站的比例由宣教前的18.6％，提高到宣教后的59.4％，(x~2=269.661，P＜0.01)。宣教后，打算去社区卫生服务站接受服务的人群比例，由宣教前的62.9％，上升到宣教后的86.3％，(x~2=110.126，P＜0.01)。定性研究的结果显示：绝大部分女性反映很满意开展这种活动的形式，同时也很满意知识讲座的内容，流动女性对于社区卫生服务站也有了更多的了解，“我们以前用避孕药具都是自己购买，以后就可以去那里领取了”!研究结论：1．研究对象的生殖健康水平不容乐观，有月经问题的人群占有一定比例，人工流产率较高，避孕措施使用失败率较高。流动女性对避孕节育、人工流产、生殖道感染、性传播疾病及艾滋病知识的掌握水平不高。年龄、文化程度、婚姻状态、居住年限、生殖健康知识来源渠道的数量、对社区卫生服务资源的利用情况是影响流动女性生殖健康现状与知识水平的主要因素。2．研究对象生殖健康知识的来源渠道狭窄，对生殖健康服务的需求较大，对社区卫生服务的知晓率低，利用率低。3．宣教活动开展以后，研究对象在经期保健、避孕措施使用、人工流产，生殖道感染／性传播疾病及艾滋病的知识掌握方面有了很大程度的提高。4．宣教活动开展以后，研究对象对于社区卫生服务的知晓率提高，服务利用的意识改变。5．由街道计生办组织本地流动女性、参与利用社区卫生服务站资源为流动女性开展的生殖健康宣教服务，能够较好的、较便捷地提高流动女性生殖健康知识水平，增加她们接近卫生服务的可能性，是一条值得推广的模式。总结论：城市流动女性生殖健康现状及知识水平不容乐观，经过宣教试点以后，生殖健康的知识水平显著提高，流动女性利用生殖健康服务的知晓率和意识有了转变。更多还原

【Abstract】 Objective: With the increasing number of floating population in urban area, andwith the rapid development in reproductive health research area, the reproductivehealth problem of floating population is becoming increasingly important. So, thegeneral objective is: To find out about the situation and factors that influencereproductive health among floating women, and to probe the module and efficacy ofcarrying out IEC among floating women by using the community health resources.The specific objectives are followed:1. To study the situation and factors that influence reproductive health amongfloating women in urban area.2. To know the demand and desire of reproductive health services amongfloating women in urban area.3. To probe the module and efficacy of carrying out IEC among floatingwomen.4. To know the satisfaction of IEC and to know the demand and desire ofreproductive health services among floating women in urban area in thefuture.Method: We adopt qualitative study and quantitative survey method to evaluate thepilot study. We use close questionnaire to carry out the quantitative survey amongfloating women in four streets of Haidian district in Beijing who meet the inclusioncriteria. We choose the study subjects from these floating women to do Focus GroupDiscussion(FGD)and In-depth Interview (IDI), and also include the providers ofCommunity Health Services Center. The qualitative study and quantitative survey andits relevant activities are organized by the family planning office of these four streets.We find out about the situation and factors that influence reproductive health among floating women in urban area by qualitative study and quantitative survey before pilotstudy, and also include their reproductive health demand and desire. We finalize thespecific Information, Education and Communication (IEC) contents and activitymethod according to the floating women’s reproductive health demand. We carry outIEC activities among floating women. The activities include giving lectures onreproductive health knowledge, sending out IEC leaflets, and providing a service cardof community health service center. We do the evaluation of floating population afterIEC activities. We analyze the efficacy of IEC, the demand and desire of reproductivehealth among floating women. We try to probe the IEC module by the study result offloating women and the qualitative study among providers. During the process of datacollection and processing, each questionnaire had been checked by investigator,quality controller and administrator of the field separately. The software EpiData3.0was used to found and input the database, and two staffs had entered the data into thecomputers separately. Data was analyzed by the descriptive statistics and theChi-square test with SPSS 13 statistic software.Results:1. Basic demography data of floating womenThe average age of floating women is 28.92±7.94 years old, with 64.8％coming from rural areas of other provinces. 24.2％of floating women are engage inservice industry of hotel and restaurant. 34.9％of them have completed junior schooland below, and 41％of them have finished senior school and vocational school.38.1％of respondents are unmarried, and 83.3％of married women had ever deliveredbefore.2. The situation of reproduetive health and its influence factors among floatingwomen(1) Menses illnesses: 36.8％of floating women has their period in fewer than25 days in more than 3 times a year, 30.8％of floating women has mensesdays fewer than 3 days or more than 7 days in more than 3 times a year.30.8％of them have coagulations in blood. Among these floating women,21.9％of them had experienced one kind of menses illness at least, and29.4％of them had experienced two kinds of menses illnesses. (2) The usage of contraceptives and induced abortion situation: 65.1％offloating women had sex, among them, 12.1％of them do not use anycontraceptives, and 47％of them are using condom, 45.3％of thesefloating women had induced abortion, and the repeated abortion rate are34.8％. The age of first abortion that below 25 years old account for52.8％. Among these abortion women, 30.5％of pregnancies are resultfrom not using any contraceptives, and 52.8％result from contraceptivefailures. Among these failures, 44.7％are rhythm failures.(3) The situation of contraceptive and induced abortion knowledge: Theproportion of that contraception knowledge comes from only one channelaccount for 77.5％. 41.6％of women only know one contraceptive method.40.5％of women can not fully answer the double functions of condom.On the integrated knowledge score of contraception and induced abortion,39.1％of floating women are in the failure group.(4) The knowledge, attitude of Reproductive Track Infection (RTI)/Sexual Transmitted Infection(STI)/Acquired Immure DeficiencySyndrome (AIDS): 37.8％of floating population did not know any RTIs,only 54.8％of women deem condom can prevent themselves from beinginfect RIT. 62.5％of women deem that if a person is bitten by a gnatwhich had ever bitten AIDS/HIV patients, the person will be infected withAIDS/HIV. On the integrated knowledge score of RTI/STI/AIDS, 43.2％of floating women have failing scores.(5) Analysis of influence factors: Age influence menses knowledge. Theproportion that respondents do not know menses knowledge in the groupwhich younger than 24 years old is 66.4％(x~2=54.215, P＜0.01).Counseling contraceptive knowledge actively influence contraceptionknowledge. In thee group that respondents did not counseling contraceptiveknowledge actively, the proportion that did not know contraceptiveknowledge is 36.4％(x~2=96.616, P＜0.01). The number of sources ofreproductive health knowledge is the main influence factor to theintegrated knowledge score of contraception and induced abortion. Theproportion of failing score in the group that knowledge come from onlyone channel is 44.8％(x~2=82.575, P＜0.01). The experience of inducedabortion is the main influence factor to the RTI infections. The proportionthat floating women infect RTIs with induced abortion experience is 34.1％(x~2=7.711, P＜0.01). Living period is the main influence factor tothe score of integrated knowledge of AIDS. The proportion of failingscore in the group that living in local place within 2 years account for54.1％(x~2=37.669, P＜0.01).3. The demand and desire of reproductive health services among floatingwomen38.5％of floating women had. ever counseled contraceptive knowledge, 40.1％offloating women will first consider the factor "whether can get counseling" when theybuy contraceptives. 63.4％of floating women choose the doctor as the first choicewhen they want to do counseling. 33.7％of floating women hope to know the genitalsystem disease and STI knowledge most. "Giving lecture" is the main choice thatfloating women wants to know about reproductive health knowledge, which accountfor 41.6％. 71.5％of floating women had ever heard about "Community HealthServices Center", while only 40.5％of these floating women had ever been toCommunity Health Services Center to seek for services.4. The qualitative study result before IEC activitiesThe majority of floating women think that they lack reproductive healthknowledge. They know AIDS is a kind of serious disease, but they do not know thespecific route of transmission and prevention measures. The majority of floatingwomen hope to receive relevant IEC and periodic and local lectures. Meanwhile, theprovider of Community Health Services Center also shows willingness to carry outlectures to floating women.5. Analysis of the efficacy of IEC activitiesAfter IEC activities, the proportion of mastering 3 kinds of contraceptive methodincreased from 47.1％of pre IEC to 73.3％of post IEC (x~2=122.936, P＜0.01). Theproportion of failure group in the integrated knowledge score of contraception andinduced abortion is decreased from 39.1％of pre IEC to 3.6％of post IEC (x~2=489.948, P＜0.01). The proportion of floating women deem that the condom is themost useful method increased from 41.8％of pre IEC to 72.3％of post IEC (x~2=145.090, P＜0.01)The proportion of failure group in the integrated knowledge scoreof AIDS is decreased from 43.2％ofpre IEC to 6.8％of post IEC(x~2=413.487, P＜0.01).6. The demand and desire of reproductive health services among floatingwomen after IEC and the qualitative study result after IEC activities.After IEC activities, among the distribution of objects that floating women wantsto counseling to, the proportion of Community Health Services Center increased from18.6％ofpre IEC to 59.4％of post IEC (x~2=269.661, P＜0.01). The proportion thatfloating women consider to go to Community Health Services Center for seekingservices is increased from 62.9％ofpre IEC to 86.3％of post IEC (x~2=110.126,P＜0.01).The result of qualitative survey showed that the majority of floating women arevery satisfy with this kind of IEC, meanwhile, they were also very satisfy with theIEC contents. Floating women know more about Community Health Services Center.They said: "we had to buy the contraceptives pay by ourselves before, from now on,we can go to Community Health Services Center to receive free contraceptives!"Conclusion:1. The reproductive health level of floating women is not optimistic, thepercentage of floating women with menses illness are relatively high.The incidence of induced abortion is very high, and the failure rate ofcontraceptives is very high. The knowledge level of floating women onthe contraceptives, induced abortion, RTI/STI/AIDS is very low. Age,education level, marriage status, living period, the channel of gettingreproductive health, and the utilization of community health resourceare the main factors that influence the floating women’s reproductivehealth level.2. The channel of receiving reproductive health knowledge is relativelynarrow. The demands of floating women to reproductive health are veryhigh. The awareness rate and the utilization rate of community healthresource are relatively low.3. After IEC activities, the changes are very significant on the floatingwomen’s knowledge of menses care, usage of contraceptives, inducedabortion, RTI/STI/AIDS. 4. After IEC activities, the knowledge of community health resources andconsciousness of service utilization increased, and the increases is verysignificant.5. Floating women are organized by local street family planning office,and to participate in the reproductive health services provided bycommunity health services center can improve their reproductive healthlevel easily and quickly. This kind of IEC module can increase floatingwomen’s possibility to access health services. And this is a suitablemodule that deserves to be popularized.General conclusion:The reproductive health situation and knowledge level of floating women is notoptimistic, after IEC activities, the increasing level of reproductive health knowledgeis very significant, and the change in the awareness of Community Health ServicesCenter and its services are very significant. The IEC activities are proved successfuland feasible.更多还原