發(fā)布時(shí)間：2018-06-28 01:24

  本文選題：母乳喂養(yǎng) + 干預(yù)��； 參考：《復(fù)旦大學(xué)》2012年碩士論文

【摘要】：研究背景 母乳是新生兒及嬰兒最理想的食物。嬰幼兒喂養(yǎng)全球戰(zhàn)略明確指出：在最初6個(gè)月應(yīng)對嬰兒進(jìn)行純母乳喂養(yǎng),以實(shí)現(xiàn)嬰兒的最佳生長、發(fā)育和健康,并繼續(xù)母乳喂養(yǎng)至兩歲或以上。然而,我國的母乳喂養(yǎng)狀況并不太理想,2008年第四次全國衛(wèi)生服務(wù)調(diào)查報(bào)告顯示,0～6月齡兒童純母乳喂養(yǎng)率僅為27.6%,城市地區(qū)為15.8%,顯著低于農(nóng)村地區(qū)30.3%。世界衛(wèi)生組織(WHO)指出,如果獲得正確的信息,有來自家庭、衛(wèi)生保健系統(tǒng)以及整個(gè)社會的支持,所有的母親都可以哺乳。研究表明,母乳喂養(yǎng)干預(yù)較常規(guī)服務(wù)可以更有效地提高母乳喂養(yǎng)率[19] 近年來,手機(jī)和因特網(wǎng)以其便捷,隨時(shí)隨地?zé)o障礙溝通的特性,已經(jīng)逐漸成為人際交往的主要形式,同時(shí)也為各類健康行為的干預(yù)帶來了機(jī)遇。研究發(fā)現(xiàn)通過因特網(wǎng)來促進(jìn)母乳喂養(yǎng)可能是一般費(fèi)時(shí)、費(fèi)錢的母乳喂養(yǎng)健康教育和支持的另一個(gè)選擇[39]。 研究目的 基于上�，F(xiàn)有社區(qū)婦幼保健服務(wù),探索利用手機(jī)短信和因特網(wǎng)進(jìn)行母乳喂養(yǎng)干預(yù)的模式,并對干預(yù)效果進(jìn)行評價(jià)。 研究方法 本研究為基于社區(qū)的準(zhǔn)試驗(yàn)研究,是雀巢項(xiàng)目“利用手機(jī)短信和因特網(wǎng)促進(jìn)嬰兒合理喂養(yǎng)以預(yù)防兒童肥胖的社區(qū)干預(yù)研究”(編號：FN4042)的一部分,隨訪干預(yù)結(jié)果到嬰兒出生后4個(gè)月。 研究現(xiàn)場為上海市徐匯區(qū)龍華、漕河汗社區(qū)衛(wèi)生服務(wù)中心和閔行區(qū)梅隴、莘莊社區(qū)衛(wèi)生服務(wù)中心。研究對象為2010年9月至2011年2月到研究現(xiàn)場建小卡并符合納入條件的641名孕婦,其中干預(yù)組308名,對照組333名。 在干預(yù)前定性訪談和基線調(diào)查的基礎(chǔ)上,召開專家組會議形成干預(yù)的具體方案和內(nèi)容。干預(yù)方案：1.利用飛信/Frontline SMS每周發(fā)送一條干預(yù)短信；2.利用短信/飛信/QQ進(jìn)行咨詢,實(shí)現(xiàn)一對一的即時(shí)溝通；3.創(chuàng)建QQ媽媽群,實(shí)現(xiàn)同伴間交流；4.利用QQ空間傳播知識；5.定期詢問母乳喂養(yǎng)狀況,并給予鼓勵(lì)。干預(yù)從孕28周開始直至嬰兒1歲。對照組接受孕產(chǎn)保健服務(wù)中的常規(guī)保健。 在產(chǎn)后1個(gè)月內(nèi)家庭訪視時(shí)對所有對象進(jìn)行隨訪,填寫母乳喂養(yǎng)自我效能量表,同時(shí)收集分娩相關(guān)情況；隨訪所有對象1、2、4個(gè)月兒保體檢時(shí)母乳喂養(yǎng)情況。評價(jià)干預(yù)對產(chǎn)后訪視時(shí)母乳喂養(yǎng)率,對1、2、4個(gè)月兒保體檢時(shí)純／母乳喂養(yǎng)率的影響。本研究純母乳喂養(yǎng)包括純母乳喂養(yǎng)和幾乎純母乳喂養(yǎng),母乳喂養(yǎng)包括純母乳喂養(yǎng)和混合喂養(yǎng)。另外,對部分干預(yù)組對象進(jìn)行定性訪談,以進(jìn)一步了解干預(yù)的效果和項(xiàng)目參與者對項(xiàng)目的評價(jià)和建議。 研究結(jié)果 1.隨訪情況 基線調(diào)查時(shí)共納入對象641人,其中干預(yù)組308人,對照組333人。產(chǎn)后訪視時(shí)隨訪率為87.05%,產(chǎn)后1個(gè)月兒保體檢時(shí)隨訪率為90.64%,產(chǎn)后2、4個(gè)月兒保體檢時(shí)隨訪率為90.02%。 2.利用手機(jī)短信和因特網(wǎng)作為干預(yù)工具促進(jìn)母乳喂養(yǎng)的可行性和可接受性 96.3%的孕婦可以在家或在單位使用電腦上網(wǎng),83.8%的孕婦使用網(wǎng)絡(luò)聊天軟件,其中80.4%愿意接受因特網(wǎng)干預(yù)；94.5%的孕婦妊娠后繼續(xù)使用手機(jī),86.0%調(diào)查對象愿意接受手機(jī)短信干預(yù)。 3.干預(yù)對產(chǎn)后訪視時(shí)母乳喂養(yǎng)率的影響 產(chǎn)后訪視時(shí)母乳喂養(yǎng)率干預(yù)組為98.5%,對照組為98.3%;產(chǎn)后訪視時(shí)純母乳喂養(yǎng)率干預(yù)組為52.4%,對照組為46.7%,干預(yù)組均高于對照組。單因素logistic回歸顯示,粗OR為1.255,95%CI為0.898-1.756。多因素logistic回歸分析顯示,控制了兩組不平衡因素和產(chǎn)后是否上班后,產(chǎn)后訪視時(shí)純母乳喂養(yǎng)率干預(yù)組高于對照組,校正OR值為2.27,95%CI為1.439～3.593。 4.干預(yù)對1、2、4個(gè)月兒保體檢時(shí)母乳喂養(yǎng)率的影響 1個(gè)月兒保體檢時(shí)母乳喂養(yǎng)率干預(yù)組為95.8%,對照組為96.6%；2個(gè)月兒保體檢時(shí)母乳喂養(yǎng)率干預(yù)組為90.3%,對照組為93.3%；4個(gè)月兒保體檢時(shí)母乳喂養(yǎng)率干預(yù)組為83.2%,對照組為80.9%,單因素分析提示兩組無統(tǒng)計(jì)學(xué)差異。 1、2、4個(gè)月兒保體檢時(shí)母乳喂養(yǎng)率的廣義估計(jì)方程分析結(jié)果顯示：控制了時(shí)間趨勢、產(chǎn)后是否上班和兩組不平衡因素后,干預(yù)組母乳喂養(yǎng)率高于對照組,OR值為2.078,95%CI為1.201-3.596。 5.干預(yù)對1、2、4個(gè)月兒保體檢時(shí)純母乳喂養(yǎng)率的影響 1個(gè)月兒保體檢時(shí)純母乳喂養(yǎng)率干預(yù)組為59.4%,對照組為53.0%；2個(gè)月兒保體檢時(shí)純母乳喂養(yǎng)率干預(yù)組為58.1%,對照組為50.3%；4個(gè)月兒保體檢時(shí)純母乳喂養(yǎng)率干預(yù)組為48.0%,對照組為41.6%,干預(yù)組均高于對照組,單因素分析提示兩組無統(tǒng)計(jì)學(xué)差異。 1、2、4個(gè)月兒保體檢時(shí)純母乳喂養(yǎng)率的廣義估計(jì)方程分析結(jié)果顯示：控制了時(shí)間趨勢、產(chǎn)后是否上班和兩組不平衡因素后,干預(yù)組純母乳喂養(yǎng)率高于對照組,OR值為1.767,95%CI為1.260～2.478。 結(jié)論 利用手機(jī)短信和因特網(wǎng)進(jìn)行母乳喂養(yǎng)干預(yù)可行和可接受；利用手機(jī)短信和因特網(wǎng)進(jìn)行母乳喂養(yǎng)干預(yù)能有效提高母乳喂養(yǎng)率和純母乳喂養(yǎng)率。
[Abstract]:Research background
Breastfeeding is the most ideal food for newborns and babies. The global strategy for infant and infant feeding clearly states that the first 6 months should be exclusively breastfeeding to achieve the best growth, development and health of the baby, and continue to breastfeed to two years or more. However, breastfeeding in our country is not so ideal in the fourth country in 2008. The health service survey report showed that only 27.6% of 0~6 month old children were breastfed and 15.8% in urban areas, significantly lower than the 30.3%. WHO (WHO) in rural areas. If correct information was obtained, all mothers were able to breastfeed from families, health care systems and the whole society. Feeding intervention can improve breastfeeding rate more effectively than routine services [19]
In recent years, mobile phones and the Internet have become the main form of interpersonal communication with their convenience and accessibility at any time and place. It also brings opportunities for the intervention of all kinds of health behaviors. One selection of [39].
research objective
Based on the existing maternal and child health care service in Shanghai, we explored the mode of breastfeeding intervention by SMS and Internet, and evaluated the effect of intervention.
research method
The study, based on a community based quasi trial study, is part of the Nestle project "community intervention study using SMS and the Internet to promote reasonable feeding for children to prevent obesity" (number: FN4042), followed up for 4 months after the birth of the baby.
The study was conducted in Longhua, Xuhui District, Shanghai, Caohe Khan community health service center, Minhang District Meilong and Xhenzhuang community health service center. The study was conducted from September 2010 to February 2011 to 641 pregnant women, including 308 in intervention group and 333 in control group.
On the basis of qualitative interview and baseline survey before intervention, expert group meetings are convened to form specific programs and contents of intervention. 1. the intervention program: 1. use the flying letter SMS to send an intervening message every week; 2. use SMS / /QQ for consultation to realize one to one instant ditch; 3. create QQ mother group to realize communication between peers. 4. use QQ space to spread knowledge; 5. regularly inquire about breastfeeding status and give encouragement. Intervention from 28 weeks of pregnancy until the baby is 1 years old. The control group receives routine health care in the health care service of pregnant women.
All the subjects were followed up during the family visit 1 months after postpartum, and the breastfeeding self-efficacy scale was filled in, and the related situation of childbirth was collected. All the subjects were followed up for 1,2,4 months to protect breastfeeding. The rate of breast-feeding during the postpartum visit was evaluated, and the pure / breastfeeding rate of 1,2,4 months after the medical examination was observed. Breastfeeding in this study includes pure breastfeeding and almost pure breastfeeding, breastfeeding, including pure breastfeeding and mixed feeding, and qualitative interviews with the participants in the intervention group to further understand the effect of the intervention and the evaluation and recommendations of the project participants.
Research results
1. follow up situation
A total of 641 subjects were included in the baseline survey, of which 308 were in the intervention group and 333 in the control group. The follow-up rate of postpartum visits was 87.05%, and the follow-up rate of postpartum 1 months after postpartum examination was 90.64%, and the follow-up rate of postpartum 2,4 months postpartum was 90.02%.
2. use SMS and Internet as an intervention tool to promote the feasibility and acceptability of breastfeeding.
96.3% of pregnant women can use the Internet at home or in units, and 83.8% of pregnant women use Internet chat software, of which 80.4% are willing to accept Internet intervention; 94.5% of pregnant women continue to use mobile phones after pregnancy, and 86% are willing to receive SMS intervention.
The effect of 3. intervention on the rate of breastfeeding during postpartum visits
The breastfeeding rate in the intervention group was 98.5%, the control group was 98.3%, the pure breastfeeding rate in the intervention group was 52.4%, the control group was 46.7%, the control group was 46.7%, the intervention group was higher than the control group. The single factor Logistic regression showed that the crude OR 1.255,95%CI was 0.898-1.756. multiple factors logistic regression analysis showed that two groups of unbalance factors and production were controlled. After going to work, the rate of exclusive breastfeeding in the intervention group was higher than that in the control group, and the corrected OR value was 2.27,95%CI 1.439 to 3.593..
4. effect of intervention on breastfeeding rate during 1,2,4 months physical examination
The intervention group of breast feeding rate in 1 months was 95.8% in the intervention group and 96.6% in the control group, 90.3% in the intervention group and 93.3% in the control group at 2 months of physical examination, 83.2% in the intervention group and 80.9% in the control group at 4 months. The single factor analysis showed that there were no statistical differences in two groups.
The results of the generalized estimation of the breastfeeding rate of 1,2,4 months after the medical examination showed that the rate of breastfeeding in the intervention group was higher than that of the control group and the value of OR was 2.078,95%CI 1.201-3.596. after the control of the time trend, whether after the postpartum work and the two groups of unbalance factors.
5. effect of intervention on exclusive breastfeeding rate during 1,2,4 months physical examination
The pure breast-feeding rate in the 1 month infants was 59.4% in the intervention group and 53% in the control group, 58.1% in the pure breastfeeding rate and 50.3% in the control group in 2 months, and 48% in the intervention group for the pure breastfeeding rate in 4 months, the control group was 41.6%, and the intervention group was higher than the control group. The single factor analysis suggested that two groups were not statistically significant. The single factor analysis suggested that two groups were not statistically significant. Difference.
The results of the generalized estimation equation analysis of the pure breastfeeding rate of 1,2,4 months after the medical examination showed that the time trend was controlled. After the postpartum work and the two groups of unbalance factors, the pure breastfeeding rate of the intervention group was higher than that of the control group, and the value of OR was from 1.260 to 2.478. 1.767,95%CI.
conclusion
Breastfeeding intervention using SMS and the Internet is feasible and acceptable; breastfeeding intervention using SMS and the Internet can effectively improve breastfeeding rate and pure breastfeeding rate.
【學(xué)位授予單位】：復(fù)旦大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R174

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 郭素芳,王臨虹,趙衛(wèi)紅,郝波,吳久玲,張文坤,周敏;中國城市母乳喂養(yǎng)行為的研究[J];中國兒童保健雜志;2001年04期

2 劉愛東,翟鳳英,趙麗云;母乳喂養(yǎng)的研究現(xiàn)狀[J];國外醫(yī)學(xué)(衛(wèi)生學(xué)分冊);2004年04期

3 王茜;繩宇;;院外母乳喂養(yǎng)現(xiàn)狀及其影響因素的研究進(jìn)展[J];解放軍護(hù)理雜志;2008年20期

4 吳秀娥;邱彩鳳;謝向紅;賴月媚;陸少霞;;網(wǎng)絡(luò)孕婦學(xué)校健康教育的做法與體會[J];護(hù)理學(xué)報(bào);2007年12期

5 李希翎,徐亞琴,謝海紅,曲紅明;南京市五年間乳母放棄純母乳喂養(yǎng)原因分析[J];南京醫(yī)科大學(xué)學(xué)報(bào)(自然科學(xué)版);2005年05期

6 郭清,諶小衛(wèi),彭剛藝,吳婷,李志輝,梁浩材,鐘海翔;愛嬰醫(yī)院院內(nèi)外影響母乳喂養(yǎng)的多因素分析[J];中國全科醫(yī)學(xué);2001年11期

7 朱翠平;馮正儀;;我國嬰兒母乳喂養(yǎng)現(xiàn)狀與護(hù)理干預(yù)進(jìn)展[J];上海護(hù)理;2006年05期

8 王春霞,陳紅,劉玉珍;母乳喂養(yǎng)失敗影響因素分析及對策[J];社區(qū)醫(yī)學(xué)雜志;2005年09期

9 詹紹康,周奮,張雪君,謝玲玉,陳春巍,劉湘云,王潔芬,蔣君妹,祁秉先,李政坤;影響母乳量的社會心理學(xué)因素研究[J];生殖與避孕;1992年05期

10 熊毛弟;朱健中;;上海3～6歲幼兒出生與喂養(yǎng)狀況及體質(zhì)的調(diào)查[J];體育科研;2008年01期

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