【摘要】：[研究背景]《中國流動人口發(fā)展報告2012》顯示,截至2011年,我國流動人口總量已接近2.3億,占全國總?cè)丝诘?7%,其平均年齡為28歲,“80后”新生代農(nóng)民工已占勞動年齡流動人口的近一半。這些年輕的流動人口處于性成熟期,他們遠離了原居住地風俗習慣和道德的約束,正在經(jīng)受新環(huán)境帶來的種種誘惑和沖擊,性觀念和性行為發(fā)生了巨大變化,表現(xiàn)為性觀念開放、婚前性行為發(fā)生率高、性行為安全意識差等特點,這些使得該群體中發(fā)生較多的意外妊娠、性�。滩「腥镜壬辰】捣矫娴膯栴}。要解決這些問題,在流動人口中開展以避孕節(jié)育知情選擇為核心的計劃生育優(yōu)質(zhì)服務是一個非常重要的措施。但是由于流動人口分布廣、流動性大、人員組成復雜、居住地點、從業(yè)處所和計劃生育信息變化快等因素,致使在流動人口中開展避孕節(jié)育知情選擇存在一些困難和障礙。在中國穩(wěn)定低生育水平的形勢下,如何有效地開展知情選擇已經(jīng)成為計劃生育工作轉(zhuǎn)變的一個重要課題。當前在國內(nèi)流動人口中開展避孕節(jié)育知情選擇的研究還很少,對這一特殊群體實施知情選擇的效果及實施過程中可能產(chǎn)生的問題及如何解決還缺乏系統(tǒng)深入的研究。[研究目的]本研究在了解流動育齡女性避孕節(jié)育現(xiàn)狀、生育意愿、避孕節(jié)育／生殖健康知識現(xiàn)況以及服務需求的基礎上,制定針對性的綜合干預方案,開展流動育齡女性避孕節(jié)育知情選擇優(yōu)質(zhì)服務干預研究,評估干預效果,探討適宜流動人口的避孕節(jié)育知情選擇優(yōu)質(zhì)服務模式,供我國政府制定流動人口避孕節(jié)育干預策略提供參考。[研究方法]本研究設計為流行病學社區(qū)干預研究。本研究在上海市徐匯區(qū)13個街道,隨機分配一定數(shù)量的街道到干預組和對照組。在干預街道被隨機抽取的居委會實施避孕節(jié)育知情選擇優(yōu)質(zhì)服務綜合干預方案,對照街道被隨機抽取的居委會開展常規(guī)計劃生育工作,通過基線調(diào)查和終末評估調(diào)查比較項目實施期間干預組和對照組避孕節(jié)育知情選擇知識、態(tài)度、信念和行為的變化來評估干預的效果及影響因素；探討適合流動人口避孕節(jié)育知情選擇的推廣模式。[統(tǒng)計分析方法]主要包括卡方檢驗、t檢驗、一般線性模型、廣義線性模型、多水平模型等。[研究結(jié)果]1、基本情況基線調(diào)查中共調(diào)查流動育齡女性1763人,其中干預組861人,對照組902人。終末評估調(diào)查中調(diào)查對象人數(shù)為1686人,其中干預組838人,對照組848人。2、研究對象的一般特征研究對象的平均年齡為28.0(±6.0)歲,25～34歲者所占比重最大；已婚或有性生活對象為主,共1733人(98.3%)；學歷以初中為主,占45.2%；戶口以農(nóng)業(yè)戶口為主,占2/3。干預組和對照組年齡、學歷、戶口等構(gòu)成均無統(tǒng)計學差異。研究對象每年在現(xiàn)居住地居住時間大于等于11個月的比例高達90%以上,來現(xiàn)居地的主要原因是勞務／工作,大約3/4的研究對象在現(xiàn)居住地已經(jīng)超過4年；約90%的對象是與配偶／性伴在現(xiàn)居住地生活；期望子女數(shù)為2個的最多,大約占75%。大部分個體沒有明顯的性別傾向；有1個子女的對象大約占64%,2個子女的約18%。3、干預活動提高了流動育齡女性避孕節(jié)育知識水平研究結(jié)果顯示,干預活動后,干預組的得分均值從基線調(diào)查的51.7分上升到終末調(diào)查的65.1分。經(jīng)方差成分模型分析,干預組對對照組的系數(shù)值為6.30。不同避孕方法知曉率均提高15%以上。提高幅度最大的是女用安全套知曉率(31.3%),其次為緊急避孕(27.1%),體外排精和男性安全套的提高最低,分別為16.6%和16.8%。4、干預活動提高了流動育齡女性避孕節(jié)育知情選擇知曉水平、促進了研究對象知情選擇態(tài)度的轉(zhuǎn)變調(diào)查顯示,在避孕節(jié)育知情選擇的知曉上,干預后干預組知曉人數(shù)占93.0%,比干預前提高了近13%。干預組對對照組的OR值為3.32,95%可信區(qū)間3.22—3.46。贊同避孕節(jié)育知情選擇的對象,干預組從基線調(diào)查的81.7%上升到終末調(diào)查的93.9%,反對的構(gòu)成從6.9%下降到1.1%。5、干預活動改變了流動育齡女性現(xiàn)在避孕措施的構(gòu)成,提高了避孕方法使用滿意度干預期間干預組的避孕率從80.7%上升到91.1%,干預組男用安全套的使用構(gòu)成從干預前約45.7%上升到干預后的54.8%,而流動人口采用宮內(nèi)節(jié)育的比例幾乎沒有變化。干預促進了研究對象選擇可逆性避孕措施,干預組對對照組的OR值為2.54。終末調(diào)查干預組研究對象對現(xiàn)用避孕方法滿意度(91.5%)高于基線調(diào)查干預對象的(80.3%),而對照組對象干預前后滿意度差別不大。干預組對對照組的OR值為2.46,95%可信區(qū)間1.69-3.58。6、干預提高了流動育齡女性自主選擇避孕方法終末調(diào)查顯示,干預組調(diào)查對象避孕措施由其他人決定的構(gòu)成明顯下降(5.5%),雙方共同決定從對照組的61.7%上升到干預組的69.6%。多水平模型分析避孕方法自主選擇(本人、對方、雙方共同決定)的影響因素發(fā)現(xiàn),干預組對對照組的OR值為3.38,95%可信區(qū)間2.42-4.84。7、干預促進了流動育齡女性主動尋求咨詢服務,提高了咨詢的滿意度基線調(diào)查中干預組和對照組均有20%的研究對象在現(xiàn)居住地尋求過咨詢服務,終末調(diào)查中,干預組大約40%的對象獲得過咨詢服務,高于對照組的17.9%。多水平模型分析發(fā)現(xiàn),干預組對對照組的OR值為3.96,95%可信區(qū)間3.05—5.16。終末調(diào)查的研究對象表示咨詢滿意的比例從對照組的71.7%上升到干預組的78.8%,基本滿意的比例在兩組相同。8、流動育齡女性接受計劃生育管理和服務的比例不高,表現(xiàn)出較多的服務需求基線調(diào)查顯示,大約有20%的對象未辦理過《流動人口婚育證明》；流動人口在現(xiàn)居住地尋求計生檢查和面對面咨詢等服務的比例都不高。流動人口在現(xiàn)居住地對免費避孕藥具、避孕方法、知情選擇、發(fā)放性與生殖健康知識的宣傳材料、孕期保健、定期舉辦性與生殖健康知識、講座、查環(huán)、生殖道感染防治和性伴／艾滋病防治服務都表現(xiàn)出不同程度的需求。9、開展避孕節(jié)育知情選擇的優(yōu)勢和障礙在管理、服務和群眾層面都存在影響避孕節(jié)育知情選擇開展的優(yōu)勢和障礙。主要優(yōu)勢包括：計生人員服務周到；流動人口集中,便于宣傳教育；各年齡層次的人都有,宣傳面廣；流入地計劃生育服務種類多；避孕藥具種類齊全；計生部門與醫(yī)院合作工作的基礎好；宣傳資料充足。開展避孕節(jié)育知情選擇和咨詢服務的障礙包括：計生人員專業(yè)知識欠缺；流動人口避孕節(jié)育知識欠缺,保護意識差；缺少計生服務人員；政策執(zhí)行不到位；缺少必要的硬件；政策法規(guī)不了解：宣傳力度不夠；檢查收費；缺乏與戶籍地的溝通聯(lián)。[結(jié)論]綜上所述,知情選擇干預方案的實施可以提高流動育齡女性避孕節(jié)育知識水平,提高了研究對象避孕節(jié)育知情選擇知曉水平,促進了研究對象知情選擇態(tài)度的轉(zhuǎn)變,改變了流動育齡女性現(xiàn)用避孕措施的構(gòu)成,提高了避孕方法使用滿意度,促進了流動育齡女性主動尋求咨詢服務,提高了咨詢的滿意度,增強了流動育齡女性自主選擇避孕方法的能力。應積極在流動人口中開展計劃生育優(yōu)質(zhì)服務——避孕節(jié)育知情選擇,提高計劃生育服務水平和流動女性避孕節(jié)育知情選擇的能力,為進一步促進流動女性性與生殖健康服務。
[Abstract]:[research background] China Mobile Population Development Report 2012> shows that as of 2011, the total amount of floating population in China is close to 230 million, accounting for 17% of the total population of the country. The average age of the population is 28 years old. The new generation of migrant workers in the "post-1980s" have already accounted for nearly half of the working age of the migrant workers. These young migrants are in sexual maturity and they are far from the original residence. The local customs and moral constraints are undergoing various temptations and shocks brought by the new environment. There are great changes in sexual concepts and sexual behavior, which are characterized by open sexual concepts, high incidence of premarital sex and poor sexual behavior, which make the group more accidental pregnancy, STD / AIDS infection and so on. In order to solve these problems, to solve these problems, it is a very important measure to carry out the quality of family planning service at the core of the informed choice of contraception and birth control in the floating population. However, there are many factors, such as the wide distribution of the floating population, the high mobility, the complex composition of the personnel, the place of residence, the place of employment and the rapid change of family planning information. There are some difficulties and obstacles in carrying out the informed choice of contraception in the floating population. In the situation of stable low fertility level in China, how to effectively carry out informed choice has become an important subject in the change of family planning work. The effect of this special group on the implementation of informed choice and the possible problems in the implementation process and how to solve the problem are still lack of a systematic and in-depth study. [Objective] this study is based on understanding the status of contraception, fertility will, contraceptive / reproductive health knowledge and service demand in women of childbearing age. The comprehensive intervention scheme was carried out to carry out the study on the quality of service intervention in the informed choice of the mobile reproductive age women's contraception and contraception, to evaluate the effect of intervention, and to explore the good quality service model for the informed choice of contraception and contraception for the floating population, and provide reference for the government to formulate a floating population contraceptive intervention strategy. Community intervention study. In this study, a number of streets were randomly assigned to intervention groups and control groups in 13 streets of Xuhui District, Shanghai. The baseline survey and final assessment survey compared the knowledge, attitudes, beliefs and behaviors of the intervention group and the control group during the implementation of the project to assess the effect and influencing factors of the intervention, and to explore the extension model suitable for the informed choice of contraception in the floating population. [the method of unified analysis] mainly included the chi square test and the t test, General linear model, generalized linear model, multi level model and so on. [research results]1, basic situation baseline survey of 1763 women of reproductive age, 861 in the intervention group and 902 in the control group. The number of subjects in the final assessment survey is 1686, of which 838 in the intervention group and 848 in the control group, the general characteristics of the research object are studied. The average age of the image was 28 (+ 6) years, and the 25~34 year olds accounted for the largest proportion; married or sexual life was the main object, with a total of 1733 (98.3%); the educational background was dominated by junior high school, accounting for 45.2%; the household registered permanent residence, accounting for the age of the 2/3. intervention group and the control group, with no statistical difference. The proportion of the living time greater than 11 months is more than 90%. The main reason for the place to live is labor / work, and about 3/4 has been in the present place for more than 4 years; about 90% of the objects are living with a spouse / partner in the present residence; the number of children expected to be 2 is the most, and about the majority of the majority of the 75%. individuals have no obvious sex. No tendency; about 64% of children with 1 children and about 18%.3 of 2 children, intervention activities improved the level of contraceptive knowledge in women of childbearing age. The results showed that after intervention, the mean score of intervention group increased from 51.7 points of baseline survey to 65.1 points in final investigation. The awareness rate of different contraceptive methods of 6.30. increased by more than 15%. The greatest improvement was the awareness rate of female condom (31.3%), followed by emergency contraception (27.1%), in vitro sperm discharge and male condoms were the lowest, respectively 16.6% and 16.8%.4. The intervention activities raised the level of informed choice of female contraception in the flow of childbearing age. The change survey of informed choice attitude of the research subjects showed that the awareness of informed choice of contraception was 93%, and the OR value of the near 13%. intervention group was higher than that of the control group before the intervention group, and the OR value of the control group was 3.32,95% confidence interval (3.22 to 3.46.), and the intervention group was investigated from the baseline survey. 81.7% up to 93.9% of the final survey, the composition of the opposition decreased from 6.9% to 1.1%.5, and the intervention changed the composition of contraceptive measures in women of childbearing age. The contraceptive rate in the intervention group increased from 80.7% to 91.1% during the intervention period, and the use composition of the men's condom in the intervention group rose about 45.7% before the intervention. To 54.8% of the prognosis, the proportion of intrauterine birth control in the floating population was almost unchanged. The intervention promoted the study subjects to choose reversible contraceptive measures. The OR value of the intervention group was higher than that of the baseline survey intervention group (91.5%) (80.3%), while the control group was higher than the baseline survey intervention group (80.3%), while the control group was compared with the control group. The OR value of the intervention group to the control group was 2.46,95% confidence interval 1.69-3.58.6, and the intervention group improved the final survey on the method of self selection contraception for women of reproductive age. The results showed that the constitution of the intervention group was significantly lower than that of other people (5.5%), and the two sides decided 61.7% from the control group. The influence factors of the 69.6%. multilevel model of the intervention group were analyzed to analyze the influence factors of the self selection of contraception methods (I, the other party, and the mutual decision). The OR value of the intervention group was 3.38,95% confidence interval 2.42-4.84.7, and the intervention promoted the active seeking counseling service for the women of childbearing age, and improved the intervention in the baseline survey of the consultation satisfaction. 20% of the subjects in the group and the control group sought counseling service in the present residence. In the final survey, about 40% of the subjects in the intervention group received counseling services. The 17.9%. multilevel model analysis of the control group showed that the OR value of the control group was full of the research object of the 3.96,95% confidence interval 3.05 to 5.16. final investigation. The proportion of meaning increased from 71.7% in the control group to 78.8% in the intervention group. The proportion of the basic satisfaction was the same in the two groups of.8. The proportion of migrant women in family planning management and service was not high. A large number of service demand baseline surveys showed that about 20% of the subjects had not passed the floating population marriage and breeding certificate; the floating population was living in the current population. There is no high proportion of services in the field of residence seeking and face-to-face consultation. The floating population is in the present residence for free contraceptives, contraception, informed choice, publicity materials for the knowledge of sexual and reproductive health, health care during pregnancy, regular and reproductive health knowledge, lectures, ring lookup, reproductive tract infection prevention and sex companion / AIDS The prevention and control services all showed different levels of demand.9, and the advantages and obstacles to develop informed choice of contraception in the management, service and the mass level had the advantages and obstacles to influence the development of informed choice of contraception. There are many people, extensive publicity, many kinds of family planning services, various kinds of contraceptives, a complete variety of contraceptives, good foundation for the cooperation of the family planning department and the hospital, sufficient publicity materials. The obstacles to the knowledge selection and consultation service of contraception include: the lack of professional knowledge of the family planning personnel, the lack of knowledge of contraception and contraception for the floating population, protection Poor consciousness; lack of family planning staff; poor policy implementation; lack of necessary hardware; lack of policies and regulations: lack of publicity; inspection fees; lack of communication with household registration. [Conclusion] the implementation of informed choice intervention can improve the knowledge level of contraceptive contraception for migrant women and improve the research. The awareness level of the informed choice of contraception and contraception has promoted the change of the attitude of the research subjects' informed choice, changed the composition of the contraceptive measures for women of childbearing age, improved the satisfaction of the use of contraception methods, promoted the women of childbearing age to seek counseling service actively, improved the satisfaction of the consultation, and enhanced the flow of women of childbearing age. The ability to choose the method of contraception should be carried out. We should actively carry out the quality of family planning service in the floating population - the informed choice of contraception and contraception, improve the level of family planning service and the ability to choose the informed choice of female contraception and birth control, in order to further promote the women's sexual and reproductive health service.
【學位授予單位】：復旦大學
【學位級別】：博士
【學位授予年份】：2014
【分類號】：R169.4

【參考文獻】

相關期刊論文 前10條

1 黃健初;張力;彭晚蓮;羅燕笑;廖衛(wèi)陽;江仁彬;劉肖華;;廣東省流動人口生殖健康知識狀況及影響因素分析[J];廣東醫(yī)學;2012年09期

2 王相理;四種宮內(nèi)節(jié)育器的臨床效果比較[J];廣東醫(yī)學院學報;1999年01期

3 李玉艷;武俊青;張玉鳳;黃萍;劉偉信;鄭曉瑛;詹紹康;楊廷忠;;干預項目對流動人口避孕節(jié)育需求的影響[J];國際生殖健康/計劃生育雜志;2010年06期

4 武俊青;張玉鳳;趙瑞;李玉艷;王瑞平;詹紹康;程建萍;;上海市閔行區(qū)流動人口避孕情況及影響因素分析[J];國際生殖健康/計劃生育雜志;2012年03期

5 周穎;李玉艷;趙洪鑫;趙瑞;武俊青;;中國三城市已婚流動人口避孕方法使用構(gòu)成分析[J];國際生殖健康/計劃生育雜志;2012年03期

6 鄭立新,朱嘉銘,田佩玲,陳勇,宋玉潔,陳詠詩;廣州外來未婚年輕女工性行為狀況及影響因素[J];中國計劃生育學雜志;2000年04期

7 方可娟,周維謹,程介山,周幸,白世澤,王有華,劉鴻,黃秀君,劉鋒,譚寶麗,陳卉,張仲焰,劉善民,李國紅,李紅,Peter Fajans,Mary Broderick,Ruth Simmons;中國重慶市避孕技術引入需求的戰(zhàn)略評估[J];中國計劃生育學雜志;2002年01期

8 馬瑞蘭,尚裕良;自主與指導相結(jié)合 推進西部避孕節(jié)育知情選擇[J];中國計劃生育學雜志;2003年06期

9 李秀芬,柏廷蘭,施鴻武,李燕華;少數(shù)民族貧困地區(qū)開展知情選擇的影響因素及對策[J];中國計劃生育學雜志;2004年02期

10 崔念,李民享,田愛平,謝黎,羅世媛,陳曉勤;成都市未婚流動人群性和生殖健康狀況與需求調(diào)查[J];中國計劃生育學雜志;2004年03期

，

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