【作者】 苏丽丽；

【导师】 王健；

【作者基本信息】 山东大学 ， 社会医学与卫生事业管理， 2008， 硕士

【摘要】 党的十七大进一步强调:解决好农业、农村、农民问题,事关全面建设小康社会的大局,必须始终作为全党工作的重中之重。当前,随着农业生产力水平的提高和产业结构调整,男性劳动力大量外出打工,妇女、儿童和老人主要留守农村,农村劳动力呈女性化趋势。农村妇女成为新农村建设的重要力量。因此,研究农村妇女的健康相关生命质量状况,并应用于临床、预防、卫生管理及社会保险领域,既有学术意义又有社会价值。健康相关生命质量是不同的文化和价值体系中的个体对与他们的目标、期望、标准以及所关心的事情有关的生存状况的体验。它是体现生命质量的主观概念,它主要包含人们在生理、心理、社会、精神和个人角色功能的体现等多方面的完满状态。目前已报道的健康相关生命质量测量量表有数百种,其适用的对象、范围和特点各异。欧洲生存质量测定量表(EQ-5D量表)是目前国际上应用广泛的普通生命质量量表之一,它内容简洁,测量全面,进行健康相关生命质量的测量,尤其当研究对象为文化程度普遍不高,理解能力有限的农村居民时,采用EQ-5D是相对较为合适且更为可行的。目前,国内外对生命质量研究主要用于临床试验疗效的评价及某种疾病患者的健康评价。如癌症患者的生命质量的评价、精神病患者的生命质量的评价、老年人生命质量的评价等,而对一般人群的生命质量的研究国内报道较少,如有关妇女的生命质量评价及研究等。本研究的主要目的是用欧洲生存质量测定量表(EQ-5D量表)对四川安岳、安徽临泉、山东茌平和山东曹县三省四县农村妇女的健康相关生命质量进行测量,探讨农村妇女健康相关生命质量的影响因素,提出改善农民妇女健康相关生命质量的策略和措施,以期为制定农村卫生政策提供依据。本研究在四川安岳、安徽临泉、山东茌平和山东曹县三省四县进行调查。根据各地区的社会经济发展水平和地理分布,采用分层整群随机抽样的方法,共调查了1810户,2914人。调查资料为定量资料,采用单因素和多因素的分析方法进行统计分析。本研究的主要结果:①四县中,调查妇女的年龄越高,其健康相关生命质量越低。这种趋势,表现在健康相关生命质量的各个方面,无论是健康指数还是健康五维度。②疼痛/不舒服和焦虑/沮丧是四县各年龄组农村妇女HRQOL方面均存在的主要问题。农村中老年妇女的状况较为严重。她们健康保健意识较差,大多数面临子女上学或盖房、结婚等生活大事,承受了较大的经济和心理压力,存在不同程度的焦虑/沮丧等精神健康方面的问题。③通过比较分析发现,四县农村妇女的健康相关生命质量状况普遍低于男性居民,在疼痛/不舒服、焦虑/沮丧上的问题尤为严重。④从三类因素与四县农村妇女健康相关生命质量的简单相关分析发现,各类指标中,年龄和是否打工与健康指数呈负相关,文化程度、人均纯收入、生活满意度、信任指数和互惠指数与健康指数呈正相关。年龄和文化程度以及生活满意度对健康指数的影响最大。在健康五维度上,年龄与疼痛/不舒服的相关系数最大,其次是文化程度、农民人均纯收入和信任指数;生活满意度对调查妇女焦虑/沮丧状况的影响最大,其次为年龄,文化程度的影响作用较小。⑤通过多因素分析发现,健康指数的影响因素为样本县、年龄、文化程度、收入水平、生活满意度、互惠指数、有无医疗保障。健康五维度的影响因素主要包括样本县、年龄、收入水平、生活满意度、信任指数和医疗保障状况。结论与建议:①重视和创新农村教育体制,提高农村妇女的文化素质。②积极拓宽致富门路,增加农村妇女的收入。③减轻农村妇女的精神压力,改善心理健康。④增加对中老年妇女的关怀。⑤促进农村妇女新时期社会网络的形成。⑥完善与农民妇女相关的社会保障制度建设。更多还原

【Abstract】 In the 17th National Congress of Communist Party,it’s further stressed that solving three agricultural problems have a bearing on the overall situation of building a well-off society,as the party must always take it as the most important task.At present,with the improving of agricultural productivity and industrial restructuring and large number of men on wage labor,a feminization of rural labor force becomes to emerge.Rural women become the major construction force of a new Chinese rural area.Therefore,the study of rural women’s health-related quality of life conditions, and applying to the field of clinical,prevention,health management and social insurance,can be both academic significant and social valuable.Health-related quality of life is the survival state experience of the individuals of different culture and value systems to their goals,expectations,standards and relating to the matters that they concern.It is a subjective concept of quality of life,which mainly includes the successful states of people in the physical,psychological,social, and spiritual and the embodiment of personal role in functional areas.Hundreds of health-related quality of life scales have been reported,which applies to the different target,scope and characteristics.European quality of life scale (EQ-5D Scale) is a type of general quality of life scale of the international application range,which is concise,comprehensive measurement.When measureing the health-related quality of life,especially the subjects is the rural residents who have lower education level and limited understanding capacity,EQ-5D is relatively more appropriate and feasible. At present,domestic and international study on the quality of life generally applies in clinical trials and evaluation of health assessment of patients with disease. For example,the quality of life of cancer patients assessment and the quality of life of patients with psychiatric evaluation,evaluation of the quality of life of older persons. Domestic reports of the general quality of life are rare,such as those on women’s quality of life evaluation and research.The purpose of this study is measuring the HRQOL of rural women in four countries by European quality of life scale(EQ-5D Scale),imploring the potential impact factors of rural women’s HRQOL,proposing the strategy and measures of improving rural women’s HRQOL,which aim to offer useful recommendations to improve the HRQOL of rural women.Anyue country in Sichuan,and Linquan country in Anhui,Caoxian and Chiping country in Shandong were selected as samples.According to socio-economie development levels and geographical distributions,adopting random stratified cluster sampling we investigated 1810 households and 2914 people.Survey information is quantitative data,using a single factor and multi-factor methods to complete the study objectives.The major findings of this study:①The higher of the survey women’s age,the lower of their health-related quality of life conditions.This trend embodiment on two aspects of the HRQOL,including VAS and the five health dimensions.②Pain/discomfort and anxiety/frustration are the main HRQOL problems of the rural women of different age groups.The situation of middle aged and old women in the rural areas is more serious.The awareness of their health care is poor,at the same time,they face the important life event,such as their children to school or building, marriage and so on,which leads to them bearing a greater economic and psychological pressure,possessing different levels of anxiety/frustration problem, and other mental health problems. ③With comparative analysis we found that rural women’s health-related quality of life is generally lower than the male residents in pain/discomfort in the four counties, the problem of pain/discomfort and anxiety/frustration are even more serious.④From the simple correlation analysis of factors of three categories and the rural women’s HRQOL of four counties,we found that in the various indicators,age and whether work outside with VAS are negatively correlated,education,per capita net income,life satisfaction,confidence and reciprocity index is positively correlated with VAS.Age and education level and life satisfaction are the most affected factors.In the five health dimensions,the correlation coefficient of age and pain/discomfort is the largest,followed by education level,the per capita net income and confidence index; Life satisfaction on women’s anxiety/depressing situation is of the most affected, followed by age,the effect of culture is least.⑤Through a multi-factor analysis we found that factors affecting the VAS is the sample countries,age,education level,income level,life satisfaction,and reciprocity index,the medical security situation.The main affecting factors of five health dimensions include the sample counties,age,income level,life satisfaction, confidence index and the medical security situation.Conclusions and recommendations:①Attention to rural education and innovation system in order to improve the cultural quality of rural women.②Actively widen wealth channels for the increase of rural women’s income.③Rural women’s mental stress should be alleviated to improve their mental health,④Middle aged and older women should be taken more care to enhance their HRQOL.⑤The formation of social networks of rural women in the new era should be promoted.⑥The social security system related to rural women should be improved and constructed.更多还原