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不同干预方法对孕产妇孕产期保健服务认知和行为改变研究:一项随机对照试验

Impact of different interventions on cognitive and behavioral change toward maternal health:a randomized controlled trial

  • 摘要: 目的 评价不同干预方法对孕产妇孕产期保健服务认知和行为改变的效果。方法 2019年12月9日至2020年1月12日在3家妇儿专科医院选取研究对象1 400名, 采用区组随机化方式均衡分配到1个对照组(常规孕产期保健服务)和3个干预组中(微信干预组、专人团队服务干预组、微信与专人团队服务结合干预组)。干预前后分别完成自制问卷调查, 评价干预措施在提高孕产妇对孕产期保健服务认知和改善行为方面的有效性。结果 微信干预组、专人团队服务干预组和两者相结合的干预方式均改善了孕产妇对孕产期保健服务的认知和行为。相较于对照组, 微信和专人服务相结合的方式对认知的5个方面均有改善, 即:早孕建卡(71.80%与97.13%, χ2=84.87, P<0.001), 产前检查(90.41%与96.26%, χ2=9.564, P<=0.002), 至少5次产检(90.70%与95.40%, χ2=5.932, P<=0.015), 首选顺产(90.70%与96.84%, χ2=11.196, P<=0.001)以及产后42天复查(68.31%与94.54%, χ2=78.927, P<0.001);专人团队服务组在除“产前检查必要性”以外的4个认知方面都有所提高;微信干预组则只在早孕建卡和产后42天复查两个方面高于对照组。此外, 微信与专人服务结合组的早孕建卡率和产后复查率最高(97.70%和100.00%), 专人团队服务次之(94.83%和98.85%)。虽然微信干预组的早孕建卡率与对照组相比, 差异无统计学意义(90.20%与87.21%, χ2=1.545, P<>0.05), 但其产后复查率明显高于对照组(95.10%与91.28%, χ2=3.980, P<0.05)。结论 采用微信和专人团队服务, 尤其两者相结合的方式, 可有效提高孕产妇对孕产期保健服务认知以及促进行为改变的干预方式是有效的。

     

    Abstract: Objective To evaluate the impact of different interventions on cognitive and behavioral changes toward maternal health services.Methods Block randomization was used to allocate 1 400 participants selected from 3 hospitals into one control group(routine service) and three intervention groups(WeChat group, Specialist team group and We Chat + Specialist team group) from December 9th 2019 and January 12th 2020. Self-developed questionnaires were used to evaluate the impact of the different interventions on cognitive and behavioral changes toward maternal health services pre-and post-intervention.Results The 3 intervention groups all reported higher rate of cognitive and behavioral change toward maternal and child health care. Compared with control group, We Chat +Specialist team group improved awareness of maternal health services in terms of examination in early pregnancy(71. 80%vs.97. 13%, χ2= 84. 87, P>0. 001), antenatal examination(90. 41%vs.96. 26%, χ2= 9. 564, P= 0. 002), minimum five check-ups(90. 70%vs.95. 40%, χ2= 5. 932, P= 0. 015), preference of vaginal delivery(90. 70%vs.96. 84%, χ2= 11. 196, P= 0. 001)and 42 th days examination postpartum(68. 31%vs.94. 54%, χ2= 78. 927, P<0. 001). Specialist team intervention group improved awareness in all five aspects except for antenatal examination. We Chat intervention group only had higher awareness rate than that of control group in terms of examination in early pregnancy and 42 th days examination postpartum. In addition, the rates of establishing cards in early pregnancy and postnatal checkup among We Chat + Specialist team group was the highest(97. 7% &100. 00%), followed by the Specialist team group(94. 83% & 98. 85%). There were no significant differences between the We Chat intervention group and control group in the rate of establishing cards in early pregnancy(90. 20%vs.87. 21%, χ2= 1. 545, P>0. 05), however, the former had a significantly higher rate of postnatal checkup(95. 10%vs.91. 28%, χ2= 3. 980, P<0. 05).Conclusion We Chat and Specialist team intervention, particular the combination of both services will effectively improve pregnant women's cognition and behaviors toward maternal health services.

     

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