【作者】 黄梨煜；

【导师】 吕书红； 任学锋；

【作者基本信息】 中国疾病预防控制中心 ， 流行病与卫生统计学， 2010， 硕士

【摘要】 目的评估城市外来务工人员肺结核健康教育需求,制定适宜该人群的肺结核健康教育传播策略,为今后开展城市外来务工人员肺结核健康教育工作及相关研究提供基础数据与传播策略的参考。方法通过采用定量与定性相结合的调查方法收集城市外来务工人员肺结核防治相关知识、态度、行为(或行为意向)现况,获取肺结核防治相关信息的途径与偏好以及所在单位对待员工中肺结核患者的态度、处理办法和可利用的健康教育资源等资料,评估城市外来务工人员对肺结核健康教育需求状况,确定健康教育内容与传播途径等,制定传播策略。定量调查采用了分层整群随机抽样的方法,选择在北京、广州、西安3个城市,年满18岁、工作3个月以上外地户口的建筑工人和餐饮服务员,共1005名,采用面对面询问式的问卷调查。定性调查在开展定量调查的点选取城市外来务工人员、工作单位负责人及现患肺结核的城市外来务工人员进行。城市外来务工人员小组访谈14组(共117人),其中建筑工地工人小组访谈6组(共48人),餐饮服务员小组访谈8组(共69人)；个人深入访谈21名工作单位负责人,其中6名建筑工地负责人,15名餐饮企业负责人；个人深入访谈20名现患肺结核的城市外来务工人员。结果本研究在北京、广州、西安3个城市共收回问卷1005份,有效问卷982份,问卷的合格率97.7%。在982例调查对象中男性占较大比例,男性649例(66.1%),女性333例(33.9%)；年龄最小为18岁,最大年龄为65岁,平均年龄为31.45岁(标准差10.94岁)。了解肺结核主要症状是咳嗽的占57.症状之一是咳痰占23.7%，咯血、痰中带血丝症状占16.5%,“咳嗽、咳痰两周或两周以上应该考虑肺结核”的知晓率为14.9%。“很多人感染过肺结核菌,但不一定发病”的知晓率为38.9%。72。5%的调查对象知道肺结核是一种严重危害人类健康的传染病,33.4%的调查对象知道只有一部分肺结核患者具有传染性,4.4%的调查对象知道肺结核患者一般接受正规治疗2-3个星期,不具有传染性,29.2%的调查对象知道肺结核是通过肺结核患者咳嗽、打喷嚏或大声说话时喷出的飞沫传播。“国家免费为传染性肺结核患者提供抗结核药品和主要检查”的知晓率为39.2%。10.1%的调查对象认为自己会得肺结核。“持续咳嗽、咳痰两周或两周以上去医院看病”的行为意向持有率为79.6%,“持续咳嗽、咳痰两周或两周以上选择肺结核防治机构／结核病定点医院／当地疾病预防控制中心”的行为意向持有率为18.6%,“肺结核人经过治疗一段时间,症状消失了,不可以停药”的行为意向持有率为71.9%。两种职业之间的肺结核防治相关知识知晓率、正确态度和行为持有率的差异大部分具有统计学意义,餐饮服务员普遍高于建筑工人。定性调查揭示,由于不知道肺结核的可疑症状,有肺结核可疑症状时认为是普通感冒,同时,缺乏对肺结核的危险认识,造成不及时就医行为普遍,患者就诊延误现象严重；由于认为所有的医疗机构都可以为肺结核患者提供诊断和治疗,所以在治疗肺结核时选择非正规的医疗机构现象突出,导致患者治疗延误且不能享受国家的免费政策；由于担心被歧视和解雇,多数患者不愿意告诉别人自己是肺结核患者。29.2%的调查对象在过去一年了解过肺结核的防治相关信息,其中14.7%的调查对象通过电视电视节目、公益广告获取相关信息。有17.0%的调查对象过去一年拿到过肺结核防治相关的宣传材料,其中81.9%看完材料。81.4%的定量调查对象很愿意参与肺结核防治健康教育干预活动。开展城市外来务工人员肺结核健康教育传播的信息要点：肺结核可疑症状、传染性、传播途径、肺结核检查治疗与管理的专门机构、国家免费为传染性肺结核患者提供抗结核药品和主要的检查的政策、预防肺结核的措施及不歧视肺结核患者。利用工作场所可以利用的健康教育资源在工地公告栏、休息室及公共场所张贴图文并茂的张贴画或摆放展板、发放易携带和保存的彩色插图小册子、利用工休时间开展专题讲座或者播放公益广告、科教片,可充分利用餐饮服务员办健康证或体检的机会对该人群开展肺结核健康教育或发放宣传小手册或传单等。结论城市外来务工人员对肺结核防治相关知识知晓率低,使该人群对肺结核危险认识低,对肺结核患者歧视态度严重且对肺结核充满恐惧,阻碍该人群形成肺结核防治的正确行为。城市外来务工人员对肺结核防治知识了解的意愿较高,但是目前针对该人群的健康教育提供不足,相关部门需高度重视城市外来务工人员肺结核健康教育工作,建议日常的肺结核健康教育工作要覆盖城市外来务工人员,并且传播的信息要点与该人群的需求相符。城市外来务工人员对肺结核防治知识需求的信息要点：肺结核的危险性、症状、传染性、传播途径、国家的免费政策、专门医疗机构、治疗与预防肺结核。建筑工人适合在下班时间(或休息时间)由结核病防治专业人员、健康教育专业人员或社区卫生服务提供者等集中在工地发放宣传材料、举办讲座、张贴张贴画、摆放展板及发送手机短信等方式开展肺结核健康教育传播活动。餐饮服务员需充分利用在医疗机构体检办健康证的机会,由卫生人员对该人群进行培训并集中发放相关的宣传材料等,使餐饮服务员了解肺结核防治相关知识。长期(或定期)在城市外来务工人员的工作场所广泛而深入地开展肺结核健康教育传播活动,不仅使当前的城市外来务工人员具有一定的肺结核防治知识,而且也要保证新流入的城市外来务工人员及时获得肺结核防治知识。更多还原

【Abstract】 ObjectiveBy the survey to evaluate demand of TB health education among city immigrant workers, make a fit strategy of communication for TB health education according to the findings of baseline survey, and to provide some baseline evidence for future health education and related studies.MethodsThis study comprises two steps.The first step is a baseline survey of the knowledge, awareness,attitude and behaviors related to TB prevention and treatment city immigrant workers,and the routes of communication which they like and can acquire easily. The second step is making the strategy of communication for TB Health education among city immigrant workers according to the findings of survey such as the demand of TB knowledge,attitude and behaviors,and health education resource in city immigrant workers’ workplaces.Using the stratified cluster random sampling,the investigation was conducted in three cities which are Beijing,Guangzhou and Xi’an in China.1005 city immigrant workers were involved in questionnaire survey. The city immigrant worker include two occupations.One is the construction worker, the other is restaurant waiter.Qualitative study that FGD was applied in this study was conducted in 14 groups among 117 city immigrant workers,in-depth interview was conducted among 21 managers of city immigrant workers and 20 the city immigrant workers withTB. ResultsA total of 1,005 study subjects (male:66.1% and female:33.9%) were enrolled in questionnaire survey. The youngest age was 18 years old,and the eldest was 65 years old,with the average of 31.5(SD 10.94).Questionnaire survey was found that 57.1% of city immigrant workers know that one of the main TB symptoms is cough.23.7% of them know that one of the TB symptoms is coughing up sputum.16.5% of them know that one of the TB symptoms is coughing with blood.14.9% of them know the TB symptoms-a bad cough or coughing up blood or sputum that lasts longer than two weeks.72.5% of them know the TB is infection.33.4% of them know that some of the TB patient is source of infection.4.4% of them know that the TB patient usually can not spreads the disease,when the TB patient have been treated during 2 or 3 weeks.29.2% of them know that TB spreads through the air where infectious people they propel TB germs,known as bacilli,when they cough,sneeze, talk or spit.39.2% of them knew national policies on free of offer drug and examine for infective TB patients.10.0% of them believe that it is possibly to infect TB for everyone. 33.3% of them are willing to contact with the TB infectious people.79.6% of them go to hospital when they have a bad cough or coughing up sputum that lasts longer than two weeks.But only 18.6% of them choose Institution of TB prevention and control.Between the restaurant waiter and the construction worker there are differences of the status of TB knowledge, attitude and behaviors,which is statistical significantly. Usually, the restaurant waiter is higher than the construction worker.29.2% of them got the TB knowledge of during the last year.14.7% of them got it by TV program or public service advertising.17.0% of them got publicity materials with the TB knowledge,81.9% of which have read them.81.4% of them are willing to take part in the intervention activities of TB health education.Qualitative study found that diagnostic or treatment delays often took place among city immigrant workers with TB because most of respondents didn’t know the symptom of TB, route of transmission,the special Institution of TB diagnosis and treat, national policies on free of offer drug and examine for infective TB patients.They were lack of consciousness of TB prevention and control,stood off and discriminate against the TB patients.Some of respondents didn’t look for medical service when they were ill,but when state of sickness was more serious they had to go to hospital because of no medical insurance and low income. Key information includes TB symptoms,infectious,route of transmission,the special medical institutions for TB patient, national policies on free of offer drug and examine for infective TB patients,preventive measures and eliminating the discrimination against the TB patients.The fit routes and methods of communication include posting posters which can make good use of the workplace’s resource of health education such as announcement board,rest room and other public places,distributing (thin) booklet to city immigrant workers,playing public service advertising or VCD, organising lectures when the city immigrant workers are off duty. While,distribute (thin) booklet or leaflet to restaurant waiter, and give them TB health education when they come to hospital or CDC for physical examination or health certificate.ConclusionCity immigrant workers lack the knowledge and skills of TB prevention and treatment, which are ideal behavior barrier of TB prevention and treatment. According to the demand of knowledge,attitude and behaviors on TB prevention and treatment among city immigrant workers,we should strengthen health education on TB among them and ensure it as our routine work.We should make a good use of health education resource in workplaces of construction workers and develop the strategy of communication which construction workers like and can acquire routes of communication,such as (thin) booklet, lecture, posters,display panel,public service advertising,VCD and so on.Distribute (thin)booklet or leaflet to restaurant waiter, and give them TB health education when they come to hospital or CDC for physical examination or health certificate. Enhance health education on TB prevention and treat among city immigrant workers,no matter who arived the city long ago or lately.更多还原