本文選題：一主二輔 + 安全分娩項(xiàng)目��； 參考：《昆明醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的本研究主要評(píng)價(jià)云南藏區(qū)試點(diǎn)“一主二輔”的安全分娩服務(wù)模式對(duì)改善項(xiàng)目地區(qū)孕產(chǎn)期保健服務(wù)利用的效果,總結(jié)項(xiàng)目實(shí)施過(guò)程中的經(jīng)驗(yàn)與問(wèn)題,為在更多的同類地區(qū)推廣和實(shí)施提供科學(xué)依據(jù)。方法本研究以健康促進(jìn)的生態(tài)學(xué)模型作為理論框架,采用定性與定量相結(jié)合的方法開展調(diào)查。本研究為準(zhǔn)試驗(yàn)設(shè)計(jì)中設(shè)有對(duì)照組的前后對(duì)比設(shè)計(jì),維西縣白濟(jì)汛鄉(xiāng)和康普鄉(xiāng)接受項(xiàng)目干預(yù)作為干預(yù)組,選取與干預(yù)組地理位置靠近的中路鄉(xiāng)和攀天閣鄉(xiāng)為對(duì)照組,不接受項(xiàng)目干預(yù)措施。以分層整群抽樣的方法選取4個(gè)鄉(xiāng)的育齡婦女作為研究對(duì)象。基線調(diào)查于2011年開展,2015年以基本相同的調(diào)查工具在項(xiàng)目地區(qū)開展終末調(diào)查。使用雙重差分法評(píng)估干預(yù)措施的凈效應(yīng)。結(jié)果(1)孕產(chǎn)期保健知識(shí)水平提高。在反映研究對(duì)象孕產(chǎn)期保健知識(shí)的題目中,干預(yù)組和對(duì)照組在終末調(diào)查中均有不同程度的改善,且干預(yù)組在干預(yù)后對(duì)于孕產(chǎn)期保健知識(shí)的掌握普遍優(yōu)于對(duì)照組。其中干預(yù)組認(rèn)為需要5次以上產(chǎn)前檢查的由干預(yù)前的60%上升至87.2%,雙重差分法對(duì)研究對(duì)象孕產(chǎn)期保健知識(shí)的評(píng)估結(jié)果也顯示,孕期需做產(chǎn)檢數(shù)干預(yù)和時(shí)間的交互項(xiàng)系數(shù)為1.338,OR=3.811,P0.01,是否知道住院分娩好的交互系數(shù)為1.222,OR=3.395,P=0.025,說(shuō)明干預(yù)措施對(duì)提升育齡婦女孕期需做產(chǎn)檢次數(shù)的知識(shí)水平以及住院分娩的知曉情況具有明顯效果。(2)在孕產(chǎn)期保健態(tài)度方面,干預(yù)組和對(duì)照組終末調(diào)查孕期7項(xiàng)危險(xiǎn)情況需要就醫(yī)的態(tài)度明顯提升,干預(yù)組干預(yù)后選擇視情況而定和在家生的明顯減少,其中選擇在家生的由9.1%下降為2.1%,而對(duì)照組選擇在家生的情況終末比基線略有增加�；貧w結(jié)果顯示,孕期什么情況會(huì)就醫(yī)、如果懷孕會(huì)選擇哪里分娩的凈效應(yīng)項(xiàng)系數(shù)分別為(P=1.565,1.239),且P0.05,說(shuō)明干預(yù)措施對(duì)于改善育齡婦女孕產(chǎn)期保健的態(tài)度有顯著效果。(3)干預(yù)組終末調(diào)查顯示孕產(chǎn)期保健服務(wù)利用有明顯改善,對(duì)照組雖也有進(jìn)步,但其提升遠(yuǎn)不及干預(yù)組明顯。干預(yù)組研究對(duì)象在干預(yù)前的早檢率為81.8%,干預(yù)后95.8%,提升近14個(gè)百分點(diǎn),對(duì)照組早檢率基線和終末分別為84.8%,89.3%。5次以上產(chǎn)檢率干預(yù)組由66.0%上升為81.6%,對(duì)照組由69.0%提升為71.4%。干預(yù)組的住院分娩率在干預(yù)前后有一定改善,分別為91.9%,98.3%,而對(duì)照組的住院分娩率兩次調(diào)查均在94.0%左右。雙重差分法結(jié)果顯示,懷孕早期是否做產(chǎn)檢、是否5次及以上產(chǎn)檢、是否住院分娩干預(yù)和時(shí)間交互項(xiàng)的系數(shù)分別為β=1.243,0.761,2.117;OR=3.466,2.139,8.305;P 值均小于 0.05。這說(shuō)明干預(yù)措施對(duì)于改善早檢、5次及以上產(chǎn)檢和住院分娩等孕產(chǎn)期保健行為具有明顯的促進(jìn)作用。結(jié)論研究結(jié)果表明,“一主二輔”安全分娩模式的干預(yù)措施能夠使育齡婦女掌握更多的孕產(chǎn)期保健知識(shí),對(duì)孕產(chǎn)期保健積極態(tài)度的形成具有促進(jìn)作用,并在很大程度上改善了育齡婦女孕產(chǎn)期保健的行為,其中早檢率、5次及以上產(chǎn)檢率和住院分娩率等重要指標(biāo)均有明顯提升,并且雙重差分法結(jié)果顯示干預(yù)措施有意義。以上說(shuō)明“一主二輔”的安全分娩服務(wù)模式在云南藏區(qū)有效可行,對(duì)該地區(qū)育齡婦女孕產(chǎn)期保健服務(wù)的利用能產(chǎn)生積極作用。建議(1)促進(jìn)項(xiàng)目各利益相關(guān)方,特別是社區(qū)力量參與到項(xiàng)目的設(shè)計(jì)、執(zhí)行與評(píng)估中,是項(xiàng)目順利實(shí)施的關(guān)鍵。(2)基層?jì)D幼衛(wèi)生服務(wù)提供方也是“弱勢(shì)人群”,需要充分尊重和理解。(3)基層的婦女組織,特別是自然村級(jí)的婦女小組長(zhǎng)是可以依靠的力量。(4)可考慮在偏遠(yuǎn)行政村建待產(chǎn)室。(5)孕產(chǎn)期保健服務(wù)與移動(dòng)健康的展望。
[Abstract]:Objective the purpose of this study was to evaluate the effect of the safe delivery service model of "one main two auxiliary" in Yunnan Tibetan area to improve the utilization of pregnancy and maternity care service in the project area, summarize the experience and problems in the process of project implementation, and provide scientific basis for the promotion and Implementation of more similar areas. As a theoretical framework, the model is investigated by the combination of qualitative and quantitative methods. In this study, the comparative design of the control group is designed in the quasi experimental design. The intervention group is taken as the intervention group in the Bai Ji flood Township and komp Township in Wei Xi county, and the control group is selected as the control group, which is close to the geographical position of the intervention group, and does not accept the item. Target intervention measures were selected by stratified cluster sampling in 4 rural women of childbearing age. The baseline survey was carried out in 2011. In 2015, the final survey was carried out in the project area with the same basic survey tools. The net effect of the intervention measures was evaluated using the double difference method. Results (1) the health knowledge level of pregnancy and maternity was improved. Among the subjects of prenatal health care, the intervention group and the control group had different degrees of improvement in the final survey, and the intervention group was generally superior to the control group in the mastery of pregnancy and maternity health knowledge in the intervention group. The intervention group believed that 5 more prenatal examinations were increased to 87.2% from 60% before the intervention, and the dual difference method was used in the intervention group. The results of the health care knowledge of the pregnant women also showed that the interaction coefficient of intervention and time needed to be done during pregnancy was 1.338, OR=3.811, P0.01, and whether the interaction coefficient of good hospital delivery was 1.222, OR=3.395, P=0.025, indicating the level of knowledge and hospitalization of the intervention measures to improve the number of childbirth women during pregnancy. The awareness of childbirth has obvious effects. (2) in the attitude of pregnancy and maternity health care, the attitude of the intervention group and the control group at the end of the investigation of the 7 dangerous conditions of the pregnancy is obviously improved, the intervention group's choice of prognosis and the decrease of the family life are obviously reduced, among which the selection in the family from 9.1% is 2.1%, while the control group is selected at home. The end of the situation was slightly higher than that of the base line. The regression results showed that the net effect factor of pregnancy would be (P=1.565,1.239), and P0.05, indicating that the intervention measures had significant effect on improving the maternal health care of women of childbearing age. (3) the final survey of the intervention group showed the pregnancy health care. The use of service was obviously improved, although the control group was also progresses, but the improvement was far less than that in the intervention group. The early detection rate of the intervention group was 81.8% before intervention, 95.8% after intervention, 14 percentage points in the control group, the baseline and end of the control group was 84.8%, the intervention group increased from 66% to 81.6% in the control group, and the control group was 81.6%, and the control group was 66%. The rate of inpatient delivery in the 71.4%. intervention group was improved to a certain extent before and after the intervention, 91.9% and 98.3%, respectively, while the two investigation of the hospitalization rate in the control group was around 94%. The double difference method showed that whether the early pregnancy was done, whether or not 5 times and above were tested, whether the intervention of inpatient delivery and the coefficient of time interaction were divided. Not for beta =1.243,0.761,2.117; OR=3.466,2.139,8.305; P values are less than 0.05., indicating that intervention measures have a significant effect on improving early detection, 5 times and above production and hospitalization and childbirth. Conclusion the results show that the intervention measures of "one main two auxiliary" safe delivery mode can make women of childbearing age master. More pregnant and maternity health care knowledge can promote the formation of positive attitude of pregnancy and maternity care, and to a great extent improve the behavior of pregnant women of childbearing age. The early detection rate, 5 times and above and the rate of inpatient delivery have obviously improved, and the result of double difference method shows that the intervention measures are intentional. It shows that the safe delivery service mode of "one main two auxiliary" is effective and feasible in Yunnan Tibetan area, and has a positive effect on the utilization of pregnant and maternity care service for women of childbearing age in this area. (1) promote the project of all stakeholders, especially the community strength to participate in the project planning, implementation and evaluation, which is the successful implementation of the project. Key. (2) the grass-roots maternal and child health service provider is also a "vulnerable group", which needs to be fully respected and understood. (3) the women's organizations at the grass-roots level, especially the women's group at the natural village level, are the power to rely on. (4) the labour room can be considered in the remote administrative village. (5) the outlook of health care service and mobile health in the maternity period.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R715.3

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本文編號(hào)：1990645