【作者】 李静；

【导师】 孙忠；

【作者基本信息】 天津医科大学 ， 流行病与卫生统计学， 2010， 硕士

【摘要】 目的增强农民多吃蔬菜水果、少吃盐、加强体育锻炼等健康意识并促进其向健康行为的转变,降低慢性疾病的行为危险因素水平,提高农民的健康水平；掌握应用行为阶段改变(Stage of change)简称SOC模型进行营养干预和效果评估的方法；通过开展各种干预活动及多种健康宣传教育方式的结合,探索科学高效的适合农民的营养干预模式。方法本研究于2007年11月～2009年1月选取天津市某构成相近的两个农村社区,津南和武清区农民分别为干预社区与对照社区各500人作为研究对象；分别于2007年12月、2008年6月、2008年12月,采用问卷调查的方法进行基线和干预后的两次评估调查；收集并分析基线调查数据,应用SOC模型将研究人群分成5个阶段,在干预社区将多吃蔬菜水果、少吃盐、加强体育锻炼等的相关健康知识以讲座、海报、宣传折页、知识问答、推广低钠盐到每户、现场健康菜肴制作方法培训、包素陷饺子竞赛活动等的多种方式进行宣传,并专门针对干预社区5阶段农民人群发放有针对性的宣传材料,进行有针对性的健康教育及指导；对照社区不采取任何措施。结果应用SOC模型分析,干预后,干预社区农民对多吃蔬菜水果、加强体育锻炼方面的行为阶段分布构成发生了变化(P<0.05)：行为阶段前移,多吃蔬菜水果行为的准备期、行动期、维持期阶段人群比例分别增加了15.1%、20.7%和16.1%,加强体育锻炼行为上分别增加了17.8%、21.2%和9.8%；农民的营养、运动及慢性疾病方面健康知识的知晓率提高、态度好转(P<0.05)；农民每天蔬菜、水果摄入量分别由原来的206克、150克增加到251克、168克,而油脂、食盐摄入量分别由原来的48克、10克减少到42克、8克(P<0.05),与此同时,随着农民膳食结构的改变,平均每天营养素摄入量出现了相应改变：膳食纤维、维生素C、钾上升,钠下降(P<0.05)；干预后农民相关健康及生化指标得到改善(P<0.05)：农民BMI指数、血压、总胆固醇、同型半胱氨酸及尿钠危险因素水平均下降；而叶酸、尿钾明显上升。而且以上这些变化均早在半年干预中期后就已经开始出现了。干预社区农民的健康知识知晓率,每天蔬菜、水果的摄入量,叶酸、尿钾水平随着行为阶段的上升逐渐增加,而食盐摄入量,舒张压、同型半胱氨酸、尿钠水平随着行为阶段的上升而逐渐降低(P<0.05)；健康知识获得途径以电视为第一位,宣传折页／小手册、张贴海报、专家讲座或咨询的干预方式也易被农民接受,而且宣传折页／小册子是无打算、准备、行动、维持阶段人群最容易接受的干预方式、打算阶段人群是海报／宣传画；干预社区中的大多数农民认为所宣传的营养知识内容不难,能够理解；干预社区农民对开展的营养干预活动的内容及形式满意度分别达100%、97.7%,参与率也高达90%以上；有将近100%的人群都收到过所发放的低钠盐、盐勺、宣传折页,近一半人群看过张贴的宣传海报内容。结论1.掌握了应用SOC模型进行营养干预和效果评估的方法：应用SOC模型将研究对象划分为不同阶段人群,进行针对性的营养宣教,干预后应用SOC模型进行营养干预效果的评估,农民对多吃蔬菜水果、加强体育锻炼方面的健康行为表现发生了由无打算阶段转变为行动、维持阶段的变化,并取得了行为阶段前移或上升的直观干预效果,营养干预措施对促进农民多吃蔬菜水果、加强体育锻炼的健康行为向更高阶段发展起到了积极推动作用；2.农民的营养等健康知识水平提高,态度好转；农民的膳食行为发生改变：每天摄入蔬菜、水果增加,而油脂、食盐减少,相应膳食纤维、维生素C、钾上升,钠下降,说明农民已经开始逐渐树立了多吃蔬菜水果、少吃盐的意识并付诸于行动；3.随着农民健康意识及行为的好转,其BMI指数、血压、总胆固醇、同型半胱氨酸及尿钠危险因素水平均随之降低；而可以降低心脑血管疾病的危险因素同型半胱氨酸水平,并具有保护作用的叶酸、可以保护血压的尿钾水平均升高,其健康水平得到了改善；4.处在行动、维持高阶段的人群确实要比低阶段的人群具有较高的健康知识水平、积极的健康信念和态度、健康的膳食及体力活动行为、较低的慢性疾病危险因素水平；5.干预过程中发现了适合农民及不同阶段农民人群喜好的干预方式,宣传的营养等健康知识内容通俗易懂,被大多数农民所接受,这些可以保证农民接受营养干预的依从性,便于营养等健康知识的宣传普及,提高干预效果；6.通过开展多样形式的立体宣传,收到了良好的效果；各种干预活动及多种健康宣传教育方式的结合,己初步探索出科学高效的适合农民的营养干预模式。更多还原

【Abstract】 Objective To improve the healthy awareness of eating more vegetables and fruits, eating less salts, doing more exercises etc, and to promote the change of healthy behavior. Moreover, to decrease the risk factors of chronic diseases, increase the healthy level of farmers; Learning the methods of applying Stage of Change Model to conduct nutritional intervention and to evaluate the effect of nutrition intervention; Explore the scientific and effective intervention patterns by all kinds of intervention activities and health education.Methods 500 farmers were selected randomly in Jinnan and Wuqing district respectively as trial and control group from Nov 2007 to Jan 2009. The questionnaires were used to do baseline and twice evaluation surveys on Dec 2007, Jun 2008, Dec 2008 respectively. According to baseline data to apply the stage of change model to divide the subjects into five stages, the intervention ways were used in trial group, such as holding lectures, posting pasters, sending out healthy materals, quizzs with prizes, recommending salts low in sodium to each family, training of making healthy foods by the chef, competetion of doing dumpling with vegetables and handing out the related healthy materials to five stages people respectively, but there were nothing any measures in control group.Results There were statistical significance on proportion of behavioral stages between before intervention and after intervention in trial group(P<0.05):the upgrade of behavior stages has been gained, the proportion of preparation,action, maintenance increased by 15.1%,20.7%and 16.1%for eating more vegetables and fruits, and 17.8%,21.2%and 9.8%for doing more exercises respectively; Healthy awareness and attitude on nutrition, exercises and chronic diseases had increased and related attitude had improved(P<0.05); The average daily intake of vegetables, fruits have increased from 206,150 grams to 251,168 grams respectively, but average daily intake of cooking oils and salts have decreased from 48,10 grams to 42,8 grams respectively(P<0.05). Meanwhile, with change of diet patterns on farms, the average daily intake of nutrients have changed:diet fiber, vitaminC, potassium have increased and sodium has decreased; exercise time has increased(P<0.05); There were good improvement on healthy and biochemical factors index after intervention(P<0.05): BMI, blood pressure, total cholesterol, homocysteine and urine sodium levels have decreased, folic acid, urine potassium have increased after intervention. Moreover, these change have already appeared after half of a year intervention. In trial group, with the rise of behavioral stage, the awareness rates of healthy knowledge, the average daily intake of vegetables and fruits, exercise time every time, folic acid and urine potassium levels have rised, and the average daily intake of salts, diastolic pressure, homocysteine and urine sodium levels have reduced increasingly(P<0.05). The best way to gain helthy knowledge for farmers was TV, and the brochures, posting pasters, experts lectures were also better ways, the brochures was the favorite ways for precontemplation, preparation, action, maintenance, posting pasters for contemplation; The majority of farmers in trial groups thought that the nutritional knowledge was easy to understand; The degree of siatisfactions for intervention content and intervention ways were all 100%, and the participation rate of farmers for intervention activitives was 97.7%; The nearly 100%farmers had received the salts low in sodium, salt spoons, brochures, and nearly 50%famers had watched the pasters.Conclusions 1.After intervention, through applying SOC model to analyse and show that the proportion of behavioral stages about eating more vegetables and fruits, doing more exercises on farmers have changed from precontemplation to action and maintenance, the upgrade of behavior stages has been gained, the intervention measures are good for farmers on promoting their healthy behaviors to the higher stages; 2.The awareness and attitudes of healthy knowledge have improved; The farmers have start-ed to increase the average daily intake of vegetables and fruits, to decrease the cooking oils and salts intake, Meanwhile, with the change of diet patterns on farmers, the average daily nutrients have changed, for example, diet fiber, vitaminC, potassium have increased and sodium has decreased. All these results have shown that farmers have increasingly built up the conceptions and behaviors on eating more vegetables and fruits, eating less salts; 3.So the risk factors levels of chonic diseases have decreased such as BMI, blood pressure, total cholesterol, homocysteine and urine sodium levels, protective factors levels have increased such as folic acid and urine potassium levels, so health level has improved; 4.The higher stages farmers have higher levels of heathy knowledge, more positive healthy belief and attitude, lower risk factors of chronic diseases than the lower stages farmers; 5.The favorate intervention ways for all farmers and different stages farmers in trial group have been found; The nutritional knowledge is easy to understand for a large majority of farmers, which is helpful to ensure farmers are willing to receive the nutritional interventions and healthy knowledge so as to improve intervention effect; 6.Exploring out the scientific and effecitive nutritional intervention patterns for farmers by means of all kinds of interventiona activities and health education.更多还原