發(fā)布時(shí)間：2018-05-12 22:27

  本文選題：社會資本 + 惡性腫瘤��； 參考：《安徽醫(yī)科大學(xué)》2015年碩士論文

【摘要】：背景:隨著惡性腫瘤治療手段和防治技術(shù)的不斷進(jìn)步,患者的生存期得到了顯著的延長,社區(qū)成為患者康復(fù)或生活的主要場所,而生活質(zhì)量指標(biāo)也隨之成為惡性腫瘤領(lǐng)域的研究熱點(diǎn)。由于惡性腫瘤疾病的特殊性以及當(dāng)前針對社區(qū)惡性腫瘤的研究較少等原因,開展對社區(qū)惡性腫瘤患者生活質(zhì)量的研究具有重要的學(xué)術(shù)意義和社會意義。此外,現(xiàn)在越來越多的研究發(fā)現(xiàn)社會因素與生活質(zhì)量相關(guān),而社會資本作為探索社會因素作用于健康機(jī)制的新視角,已在衛(wèi)生領(lǐng)域中得到一定程度的重視與應(yīng)用。社會資本有助于發(fā)掘并有效利用潛在的無形資源,為探索改善惡性腫瘤患者的生活質(zhì)量提供了新的方向。目的:本研究旨在從微觀社會資本視角,探索城鄉(xiāng)社區(qū)惡性腫瘤患者的社會資本現(xiàn)狀,探討社會資本對惡性腫瘤患者生活質(zhì)量的影響。一方面在理論層面彌補(bǔ)現(xiàn)有研究的不足,另一方面從現(xiàn)實(shí)層面利用社會資本這一無形資源,促進(jìn)社區(qū)惡性腫瘤患者控制病情、緩解癥狀,改善生活質(zhì)量。方法:本研究采用多階段抽樣方法,首先通過綜合考慮安徽省各市的地理位置和經(jīng)濟(jì)水平,確定銅陵市(銅官山區(qū)、銅陵縣)、合肥市(包河區(qū)、肥西縣)、阜陽市(潁州區(qū)、潁上縣)為研究現(xiàn)場,然后在樣本區(qū)縣中再簡單隨機(jī)抽取1-2個(gè)居民區(qū)(行政村),最后根據(jù)選取的樣本居民區(qū)(行政村)所提供的慢性病患者資料,在2014年9-11月使用自制問卷對轄區(qū)內(nèi)符合納入標(biāo)準(zhǔn)的惡性腫瘤患者進(jìn)行集中或入戶調(diào)查。數(shù)據(jù)分析階段使用SPSS18.0進(jìn)行描述性統(tǒng)計(jì)分析、因子分析、單因素相關(guān)分析和多重線性回歸分析。結(jié)果:(1)惡性腫瘤患者基本特征:男性較多(64.3%),且以老年患者為主(60歲以上的占78%),文化程度偏低(文盲者最多占38.3%),職業(yè)以農(nóng)民/打工者為主(57.1%),個(gè)人月收入和家庭人均月收入均較低(500元以下者最多);胃癌最多(23.3%),其次為食管癌(16.7%);確診時(shí)間較長,1-3年的所占比例最高(28.7%),出現(xiàn)轉(zhuǎn)移、復(fù)發(fā)和并發(fā)癥的比例較低(分別為9.5%、11.2%、11.2%),疼痛的發(fā)生率為69.5%,其中輕度疼痛所占比例最高(35.4%)。城鄉(xiāng)社區(qū)惡性腫瘤患者在文化程度、月收入、家庭成員數(shù)、職業(yè)、患病類型、合并疾病種類、疼痛和治療情況上存在差異。(2)社會資本問卷信效度:結(jié)構(gòu)效度方面,主成分分析提取出6個(gè)公因子,共解釋79.190%的總變異,問卷的整體Cronbach’sα系數(shù)為0.926,6個(gè)維度Cronbach’sα系數(shù)除社會參與為0.640,其余5個(gè)維度均大于0.8。(3)社會資本現(xiàn)狀:①社會參與:57.6%的調(diào)查對象沒有參加過任何組織,77.8%的調(diào)查對象近一年沒有參加過任何圈子活動,城市社區(qū)調(diào)查對象的社會參與程度高于農(nóng)村社區(qū)(組織參與:46.7%VS.39%;圈子參與:26.3%VS.19%)。②信任:調(diào)查對象的信任程度普遍較高,除對家人或親戚完全信任的比例最高(49.9%),對其他對象(陌生人、朋友、鄰居、綜合醫(yī)院醫(yī)生、社區(qū)醫(yī)生、居委會/村委會工作人員)均是部分信任的比例最高,城鄉(xiāng)社區(qū)調(diào)查對象的信任水平不存在統(tǒng)計(jì)學(xué)差異。③社會支持:個(gè)人支持方面,遇到困難時(shí),53.6%的調(diào)查對象多數(shù)能獲得精神支持51.9%多數(shù)能獲得物質(zhì)支持;組織支持方面,遇到困難時(shí)調(diào)查對象完全不會獲得組織精神支持(27.7%)和物質(zhì)支持(28.0%)的比例均最高。城市社區(qū)患者完全不會獲得組織精神支持和物質(zhì)支持的比例均要低于農(nóng)村社區(qū)(18.4%VS.34.9%;19.7%VS.34.4%)。④互惠:當(dāng)親戚、鄰居、朋友遇到困難時(shí),分別有51.0%、57.3%和55.9%的調(diào)查對象選擇多數(shù)會幫忙,并且城市社區(qū)患者選擇完全會幫助的比例均高于農(nóng)村社區(qū)(親戚:36.2%VS.17.9%;鄰居:21.1%VS.13.8%;朋友:23.0%VS.15.4%)。⑤凝聚力與歸屬感:46.7%的調(diào)查對象認(rèn)為本社區(qū)/村人與人之間的關(guān)系較為融洽,本人(39.5%)和他人(36.3%)對居住社區(qū)/村關(guān)心程度所占比例最高的均為一般關(guān)心,69.4%的調(diào)查對象認(rèn)為搬離現(xiàn)在的社區(qū)/村會舍不得,以上問題城鄉(xiāng)社區(qū)之間均存在統(tǒng)計(jì)學(xué)差異。(4)惡性腫瘤患者生活質(zhì)量現(xiàn)狀:生理狀況平均得分為19.994分,社交/家庭狀況平均得分為19.867分,情緒狀況平均得分為16.896分,功能狀況平均得分為15.127分,整體生活質(zhì)量平均得分為71.884分,城市社區(qū)患者生活質(zhì)量總分及各維度得分均高于農(nóng)村社區(qū);單因素分析顯示,影響惡性腫瘤患者生活質(zhì)量的因素有城鄉(xiāng)、性別、婚姻狀況、文化程度、職業(yè)和月收入、惡性腫瘤確診時(shí)間、疼痛、有無轉(zhuǎn)移、復(fù)發(fā)和并發(fā)癥、治療費(fèi)用來源;多重線性回歸分析顯示,影響因素包括年齡、家庭人均月收入、疼痛和確診時(shí)間。(5)社會資本與生活質(zhì)量關(guān)系:社會資本與生活質(zhì)量的相關(guān)分析和多重線性回歸結(jié)果一致。結(jié)果顯示社會資本越高生活質(zhì)量越好(beta=0.241,p0.01),凝聚力與歸屬感(beta=0.209,p0.01)、互惠(beta=0.247,p0.01)和社會參與(beta=0.096,p0.05)3個(gè)維度與生活質(zhì)量總分呈顯著正相關(guān);信任因子對惡性腫瘤患者生活質(zhì)量各維度均無影響;凝聚力與歸屬感因子與生理和功能狀況成正相關(guān);互惠因子對所有生活質(zhì)量維度均有影響;組織支持因子與生理狀況呈正相關(guān);個(gè)人支持因子與社交/家庭狀況呈正相關(guān);社會參與因子與情緒狀況成正相關(guān);社會資本因子總分對所有的生活質(zhì)量維度均有影響。結(jié)論:(1)本研究研制的城鄉(xiāng)社區(qū)惡性腫瘤患者社會資本問卷具有良好的信效度;(2)城鄉(xiāng)惡性腫瘤患者社會參與水平較低,較少能獲得組織支持,但信任水平高,互惠意識強(qiáng),且認(rèn)為居住社區(qū)凝聚力較好,對社區(qū)有較強(qiáng)歸屬感。城市社區(qū)惡性腫瘤患者的社會資本各維度和整體因子得分均高于農(nóng)村患者;(3)社會資本的提升有助于提高城鄉(xiāng)社區(qū)惡性腫瘤患者的生活質(zhì)量,除信任外,其余社會資本各因子對其生活質(zhì)量都有不同程度的影響,特別是互惠因子在其中起著重要作用。建議:(1)通過健全城鄉(xiāng)社會組織、完善惡性腫瘤患者組織支持體系建設(shè)、提高惡性腫瘤患者互惠意識、增強(qiáng)城鄉(xiāng)社區(qū)惡性腫瘤患者的凝聚力與歸屬感等措施,提升惡性腫瘤患者社會資本,從而改善其生活質(zhì)量;(2)采取因地制宜的措施,縮小城鄉(xiāng)惡性腫瘤患者的差距。
[Abstract]:Background: with the continuous progress of the treatment and prevention technology of malignant tumor, the survival period of the patients has been greatly extended, and the community has become the main place for the patients to recover or live, and the quality of life has become a hot spot in the field of malignant tumor. There are few reasons for the study of the tumor. It is of great academic and social significance to study the quality of life of the patients with malignant tumor in the community. In addition, more and more studies have found that social factors are related to the quality of life, and social capital has been obtained in the field of health as a new perspective on the role of social factors in the health mechanism. A certain degree of attention and application. Social capital helps to explore and effectively use the potential intangible resources, and provides a new direction for the improvement of the quality of life of patients with malignant tumor. The influence of the quality of life of the patients with sexual tumor. On the one hand, the deficiency of the existing research is made up at the theoretical level. On the other hand, the intangible resource of social capital is used in the practical level to promote the control of the disease, relieve the symptoms and improve the quality of life. The geographical location and economic level of each city in Huizhou Province, Tongling (Tongguan mountain, Tongling county), Hefei city (Baohe District, Feixi county), Fuyang city (Yingzhou District, Yingshang County) as the research site, and then 1-2 residential districts (administrative villages) in the sample district and county, and finally according to the selected sample residential area (administrative village). The patient's data, using a self-made questionnaire in the 9-11 month of 2014, conducted a centralized or household survey on patients who met the standard of malignant tumors within the jurisdiction. The data analysis stage used SPSS18.0 to carry out descriptive statistical analysis, factor analysis, single factor correlation analysis and multiple linear regression analysis. Results: (1) the basic characteristics of malignant tumor patients: Male More (64.3%), and the majority of the elderly (78% over 60 years of age), low cultural level (38.3% of the illiterate majority), the occupation of farmers / migrant workers (57.1%), individual monthly income and family per capita income is lower (500 yuan is the most); the most gastric cancer (23.3%), followed by esophageal cancer (16.7%), the diagnosis time is longer, 1-3 years accounted for the ratio. The highest (28.7%) cases (9.5%, 11.2%, 11.2%), the incidence of pain was 69.5%, and the proportion of mild pain was the highest (35.4%). In urban and rural community patients with malignant tumor, the degree of culture, monthly income, family membership, occupation, type of disease, type of disease, pain and treatment (2) the reliability and validity of the social capital questionnaire: the structure validity, the principal component analysis extracted 6 public factors, and explained the total variation of 79.190%. The overall Cronbach 's alpha coefficient of the questionnaire was 0.926,6 Cronbach' s alpha except for the social participation of 0.640, the other 5 dimensions were greater than 0.8. (3) social capital status: (1) social participation: 57.6 % of the respondents did not participate in any organization, 77.8% of the respondents did not participate in any circle of activities in the past year. The social participation of urban community respondents was higher than that of rural communities (organization participation: 46.7%VS.39%; circle participation: 26.3%VS.19%). The proportion of trust is the highest (49.9%). The proportion of other objects (strangers, friends, neighbors, general hospital doctors, community doctors, residents' committee / village committee staff) is the highest proportion of partial trust, and there is no statistical difference in the level of trust between urban and rural communities. Third, social support: in the case of personal support, 53.6% of the investigation is in question. The majority of the majority of the mental support can be supported by the majority of the material support; in the case of organizational support, the proportion of the respondents (27.7%) and material support (28%) is the highest in the case of difficulties. The proportion of urban community patients who do not obtain organizational mental support and material support is lower than that of the rural community (18.). 4%VS.34.9%; 19.7%VS.34.4%). Reciprocity: when relatives, neighbors, and friends encounter difficulties, 51%, 57.3%, and 55.9% of the respondents choose the majority to help, and the proportion of urban community patients to be fully assisted is higher than that in rural communities (relatives: 36.2%VS.17.9%; neighbors: 21.1%VS.13.8%; friends: 23.0%VS.15.4%). Sense: 46.7% of the respondents believed that the relationship between the community and the people was more harmonious, and I (39.5%) and others (36.3%) were the most concerned about the proportion of the community / village, and 69.4% of the respondents believed that the community / village would be reluctant to move away from the present, and there was a statistical difference between the urban and rural communities. (4) the quality of life of the patients with malignant tumor: the average score of the physiological status was 19.994, the average score of social / family status was 19.867, the average score of the emotional state was 16.896, the average score of the functional status was 15.127, the average score of the whole life quality was 71.884, the total score of the quality of life of the urban community patients and the scores of all the dimensions were all A single factor analysis showed that the factors affecting the quality of life of patients with malignant tumors were urban and rural, sex, marital status, educational level, occupational and monthly income, time of diagnosis, pain, metastasis, recurrence and complications, and the source of cost of treatment. Multiple linear regression analysis showed that the factors included age, family per capita. Monthly income, pain and time of diagnosis. (5) the relationship between social capital and quality of life: the correlation analysis of social capital and quality of life and the results of multiple linear regression. The results show that the higher the social capital is, the better the quality of life (beta=0.241, P0.01), the cohesion and belonging (beta=0.209, P0.01), beta=0.247, P0.01 and social participation (beta=0.) 096, P0.05) there was a significant positive correlation between the 3 dimensions and the total quality of life; the confidence factor had no influence on the quality of life of the cancer patients; the cohesion and the sense of belonging were positively related to the physiological and functional status; the reciprocal factor had an influence on all the quality of life; the organizational support factor was positively related to the physiological status; There is a positive correlation between holding factor and social / family status; social participation factor is positively related to emotional state; social capital factor total score has an impact on all the quality of life. Conclusion: (1) the social capital questionnaire of patients with malignant tumor in urban and rural communities has good reliability and validity; (2) the social participation of patients with malignant tumor in urban and rural areas Low level, less organization support, but high level of trust, strong sense of reciprocity, good community cohesion and strong sense of belonging to the community. The scores of social capital and overall factor in urban community malignant tumor patients are higher than those of rural patients; (3) the promotion of social capital is helpful to improve the malignant swelling in urban and rural communities. The quality of life of the tumor patients, in addition to trust, the other social capital factors have different influence on the quality of life, especially the reciprocal factor plays an important role. (1) through the improvement of urban and rural social organizations, the construction of the organization support of the malignant tumor patients is perfected, the reciprocal consciousness of the malignant tumor patients is improved and the urban and rural areas are enhanced. The cohesiveness and sense of belonging of the patients with malignant tumor in the community can improve the social capital of the patients with malignant tumor and improve their quality of life. (2) take measures to reduce the gap between the patients with malignant tumor in urban and rural areas.

【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R73-31

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