本文選題：孕婦 + 妊娠晚期��； 參考：《第二軍醫(yī)大學(xué)》2017年碩士論文

【摘要】：目的胎動(dòng)是孕婦對(duì)胎兒宮內(nèi)健康狀況最直觀的感受,研究發(fā)現(xiàn),孕婦在妊娠晚期堅(jiān)持進(jìn)行胎動(dòng)自我監(jiān)測(cè)能有效降低死胎等不良妊娠結(jié)局的發(fā)生率,現(xiàn)有指南均推薦孕婦在妊娠晚期每天計(jì)數(shù)胎動(dòng)并在感知到胎動(dòng)異常后當(dāng)天就醫(yī)。但有限的研究顯示我國(guó)孕婦胎動(dòng)自我監(jiān)測(cè)行為水平較低,且原因不明。因此,本研究擬在計(jì)劃行為理論、健康信念模式等健康行為理論的指導(dǎo)下,對(duì)妊娠晚期婦女胎動(dòng)自我監(jiān)測(cè)行為現(xiàn)狀進(jìn)行調(diào)查,科學(xué)系統(tǒng)地探索行為影響因素。為日后構(gòu)建干預(yù)方案提供依據(jù),以期切實(shí)提高胎動(dòng)自我監(jiān)測(cè)行為水平,從而降低死胎等不良妊娠結(jié)局的發(fā)生率。方法本研究結(jié)合理論和文獻(xiàn)研究,形成計(jì)劃行為理論和健康信念模式的整合概念框架作為指導(dǎo),具體研究分為兩部分:第一部分:妊娠晚期婦女胎動(dòng)自我監(jiān)測(cè)行為調(diào)查問(wèn)卷的編制。在整合概念框架指導(dǎo)下,通過(guò)質(zhì)性研究提取理論維度的突顯信念,作為問(wèn)卷部分條目來(lái)源。結(jié)合理論研究、文獻(xiàn)回顧和質(zhì)性訪談結(jié)果,形成問(wèn)卷初稿,進(jìn)行專家咨詢。對(duì)問(wèn)卷進(jìn)行初步修訂后,實(shí)施預(yù)調(diào)查,采用項(xiàng)目分析、內(nèi)部一致性系數(shù)、重測(cè)信度和探索性因子分析對(duì)問(wèn)卷信效度進(jìn)行檢驗(yàn)。第二部分:妊娠晚期婦女胎動(dòng)自我監(jiān)測(cè)行為及影響因素的調(diào)查。采用方便抽樣法,以前期形成的調(diào)查問(wèn)卷為工具,對(duì)上海市兩家三甲醫(yī)院產(chǎn)科病房共310名產(chǎn)婦實(shí)施問(wèn)卷調(diào)查。采用描述性分析探究妊娠晚期婦女胎動(dòng)自我監(jiān)測(cè)行為現(xiàn)狀,采用單因素分析、多元回歸分析以及l(fā)ogistic回歸分析對(duì)胎動(dòng)自我監(jiān)測(cè)行為意向及行為結(jié)果的影響因素進(jìn)行研究。結(jié)果通過(guò)半結(jié)構(gòu)式個(gè)人訪談,在理論演繹出的6個(gè)分析類目下,共提取21個(gè)突顯信念。結(jié)合理論研究和文獻(xiàn)研究結(jié)果,編制《孕晚期婦女胎動(dòng)自我監(jiān)測(cè)行為調(diào)查問(wèn)卷》,由社會(huì)人口學(xué)資料、胎動(dòng)自我監(jiān)測(cè)行為基本情況、知識(shí)水平、健康經(jīng)歷和健康信念5部分構(gòu)成。問(wèn)卷信效度檢驗(yàn)結(jié)果顯示,各條目?jī)?nèi)容效度指數(shù)均0.78,分問(wèn)卷總體內(nèi)容效度指數(shù)均0.80,問(wèn)卷內(nèi)容效度良好。知識(shí)和健康信念問(wèn)卷?xiàng)l目鑒別度良好。依據(jù)問(wèn)卷特點(diǎn)僅對(duì)健康信念問(wèn)卷進(jìn)行結(jié)構(gòu)效度檢驗(yàn),探索性因子分析結(jié)果顯示,問(wèn)卷由主觀規(guī)范、知覺(jué)行為控制、正性態(tài)度、負(fù)性態(tài)度和疾病威脅感知5個(gè)維度構(gòu)成,累積解釋方差變異量62.55%,各條目維度歸屬基本與理論構(gòu)想一致,僅兩個(gè)條目維度歸屬不一致。知識(shí)問(wèn)卷內(nèi)部一致性Cronbach's α系數(shù)0.601,重測(cè)信度0.900;健康經(jīng)歷問(wèn)卷重測(cè)信度0.960;健康信念問(wèn)卷Cronbach's α系數(shù)0.860,重測(cè)信度0.925,問(wèn)卷信效度良好。對(duì)上海市兩家三甲醫(yī)院產(chǎn)科病房310名產(chǎn)婦的調(diào)查結(jié)果顯示,78.7%妊娠晚期婦女具備胎動(dòng)計(jì)數(shù)行為意向,行為意向良好。其行為結(jié)果標(biāo)準(zhǔn)化后的平均得分(-0.187±2.80)分,行為水平較低。在未出現(xiàn)過(guò)胎動(dòng)異常的257名研究對(duì)象中有85.6%的婦女打算在胎動(dòng)異常后當(dāng)天就醫(yī),行為意向良好。研究對(duì)象對(duì)提示因素的接觸量水平較高,但行為經(jīng)驗(yàn)水平一般。妊娠晚期婦女胎動(dòng)自我監(jiān)測(cè)知識(shí)水平總分10分,平均(6.62±2.371)分,主要來(lái)源于醫(yī)護(hù)人員和網(wǎng)絡(luò)信息。研究對(duì)象健康信念得分情況為,主觀規(guī)范4～20分,平均(16.13±0.168)分;正性態(tài)度4～20分,平均(16.69±0.133)分;負(fù)性態(tài)度3～15分,平均(8.42±2.212)分;知覺(jué)行為控制7～35分,平均(25.85±3.680)分;疾病威脅感知3～15分,平均(10.08±2.221)分,可見(jiàn)其負(fù)性態(tài)度較為顯著。將單因素分析有統(tǒng)計(jì)學(xué)意義(P0.05)的影響因素納入進(jìn)入多因素分析,結(jié)果提示,長(zhǎng)期居住地、正性態(tài)度、主觀規(guī)范和感知易患性變量進(jìn)入胎動(dòng)計(jì)數(shù)行為意向的logistic回歸方程,長(zhǎng)期居住于城鎮(zhèn)、胎動(dòng)計(jì)數(shù)的正性態(tài)度、主觀規(guī)范和感知易患性水平越高的婦女,越會(huì)具備在妊娠晚期進(jìn)行胎動(dòng)計(jì)數(shù)的行為意向;胎動(dòng)計(jì)數(shù)行為意向、感知嚴(yán)重性、知覺(jué)力和主觀規(guī)范4個(gè)變量依次進(jìn)入胎動(dòng)計(jì)數(shù)行為結(jié)果的多元回歸方程,具備胎動(dòng)計(jì)數(shù)行為意向、感知嚴(yán)重性、知覺(jué)力和主觀規(guī)范水平越高的婦女胎動(dòng)計(jì)數(shù)行為水平越高;知覺(jué)行為控制和感知易患性2個(gè)變量進(jìn)入胎動(dòng)異常后就醫(yī)行為意向的非條件logistic回歸方程,知覺(jué)行為控制和感知易患性水平越高的婦女,越會(huì)具備胎動(dòng)異常后當(dāng)天就醫(yī)的行為意向。結(jié)論自行研制的妊娠晚期婦女胎動(dòng)自我監(jiān)測(cè)行為及影響因素問(wèn)卷信效度良好,可用于胎動(dòng)自我監(jiān)測(cè)行為相關(guān)研究。妊娠晚期孕婦胎動(dòng)自我監(jiān)測(cè)行為意向較好,但行為水平不佳。行為結(jié)果除了受行為意向影響外,還受到主觀規(guī)范、知覺(jué)力、感知嚴(yán)重性等多種因素的影響。研究提示醫(yī)務(wù)人員在今后對(duì)胎動(dòng)自我監(jiān)測(cè)行為的干預(yù)中應(yīng)重點(diǎn)關(guān)注農(nóng)村婦女,宣教應(yīng)有針對(duì)性,培養(yǎng)孕婦對(duì)胎動(dòng)自我監(jiān)測(cè)的積極認(rèn)識(shí)和危險(xiǎn)感知,并鼓勵(lì)孕婦家屬督促并參與自數(shù)胎動(dòng)活動(dòng)。
[Abstract]:Objective fetal movement is the most intuitionistic feeling for pregnant women's intrauterine health. It is found that pregnant women persisting in fetal movement self-monitoring in the late pregnancy can effectively reduce the incidence of undesirable pregnancy outcomes, such as stillbirth. The existing guidelines recommend that pregnant women count the fetal movement every day in the late pregnancy and go to the doctor on the same day after the perception of abnormal fetal movement. The study shows that the maternal fetal movement self monitoring behavior in our country is low and the cause is unknown. Therefore, under the guidance of healthy behavior theory such as planned behavior theory and health belief model, this study is to investigate the status of fetal dynamic self monitoring behavior in late pregnant women and explore the influencing factors scientifically and systematically. The scheme provides a basis to effectively improve the level of self monitoring behavior of fetal movement, thus reducing the incidence of undesirable pregnancy outcomes, such as stillbirth. Methods this study combines theory and literature research, and forms the integrated conceptual framework of planned behavior theory and health belief model as guidance. The study is divided into two parts: the first part: the late pregnancy women. Under the guidance of the integrated conceptual framework, it extracts the explicit belief of the theoretical dimension through qualitative research, which is used as a part of the questionnaire. It combines theoretical research, literature review and qualitative interview results to form a preliminary draft of the questionnaire and carry out a specialist consultation. After the preliminary revision of the questionnaire, the preliminary adjustment is carried out. A survey of reliability and validity of the questionnaire was carried out by project analysis, internal consistency coefficient, retest reliability and exploratory factor analysis. The second part was the investigation of the self monitoring behavior and influencing factors of women in the late pregnancy. A questionnaire survey was carried out in 310 women. A descriptive analysis was used to explore the status of fetal dynamic self monitoring behavior in late pregnancy. The factors affecting the behavior intention and outcome of fetal dynamic self monitoring were studied by single factor analysis, multiple regression analysis and logistic regression analysis. According to the results of theoretical research and literature research, a questionnaire on fetal dynamic self monitoring behavior of women in the late pregnancy was compiled with the results of 6 analysis categories, which were composed of 5 parts: social demography data, basic situation of fetal dynamic self monitoring, knowledge level, health experience and health belief. The content validity index of each item was 0.78, the total content validity index of the questionnaire was 0.80, the content validity of the questionnaire was good. The identification of the knowledge and health belief questionnaire was good. According to the characteristics of the questionnaire, the structure validity of the health belief questionnaire was tested. The result of exploratory factor analysis showed that the questionnaire was controlled by subjective norms and perceived behavior. There were 5 dimensions of positive attitude, negative attitude and disease threat perception. The cumulative variance of variance was 62.55%. The attribution of each item dimension was basically consistent with the theory, only two item dimensions were incompatible. The internal consistency Cronbach's alpha coefficient of the knowledge questionnaire was 0.601, the retest credibility 0.900, the health experience questionnaire retest reliability 0.960; Health letter. The questionnaire Cronbach's alpha coefficient was 0.860, the retest reliability was 0.925, and the reliability and validity of the questionnaire were good. The results of 310 parturients in the maternity ward of two three a hospital in Shanghai city showed that the women in the third trimester of pregnancy had the behavior intention of fetal movement counting and the good behavior intention. The average score after the standardized behavior results (-0.187 + 2.80) and the behavior level were more than that of the women. Low. Among the 257 subjects who had not had abnormal fetal movements, 85.6% of the women intended to be hospitalized on the same day after abnormal fetal movement, and their behavioral intention was good. The level of exposure to the factors was higher, but the level of behavioral experience was general. The total score of self-monitoring knowledge of fetal movement in late pregnancy was 10 points, the average (6.62 + 2.371) scores. The score of health belief was 4~20 points, average (16.13 + 0.168), positive attitude 4~20, average (16.69 + 0.133), negative attitude 3~15, average (8.42 + 2.212), perception behavior 7~35, average (25.85 + 3.680); disease threat 3~15, 3~15, flat. The negative attitude was significant (10.08 + 2.221), and the factors of the single factor analysis (P0.05) were included into the multi factor analysis. The results suggested that the logistic regression equation of the long-term residence, positive attitude, subjective norm and perceptive variable entered the action intention of fetal movement counting, and lived in town and fetus for a long time. The more positive attitude, the subjective norm and the higher level of perceived susceptibility, the more women with the higher level of perceived susceptibility, the more they have the behavior intention of the fetal movement count in the late pregnancy; the 4 variables of the fetal movement count behavior intention, the perceived severity, the perceptual force and the subjective norm, in turn, enter the multiple regression equation of the result of the gestational count behavior, and have the action meaning of the fetal movement count. The higher the level of women's fetal movement counts, the higher the level of perceived severity, perception and subjective standard, the unconditional logistic regression equation for perceived behavioral control and perceived susceptibility to the abnormality of medical behavior after the abnormality of fetal movement. The more women with perceived behavioral control and perceived ease of susceptibility, the more likely they were after fetal movements. Conclusion the self monitoring behavior and influencing factors of fetal movement self-monitoring behavior and influencing factors of pregnant women in late pregnancy are good, which can be used in the study of self monitoring behavior of fetal movement. The behavior intention of fetal dynamic self monitoring is good, but the behavior level is not good. The study suggests that the medical staff should focus on rural women in the future intervention on the behavior of fetal movement self monitoring. The education should be focused on the rural women, the education should be targeted, the pregnant women should develop the positive awareness of the fetal movement self monitoring and the risk perception, and encourage the family members to supervise and participate in the number of women. Fetal movement.
【學(xué)位授予單位】：第二軍醫(yī)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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