应用健康信念模型探索上海市某镇居民肠镜检查意愿影响因素
Factors associated with intention to receive colonoscopy among community residents in a town of Shanghai: Based on health belief model
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摘要:
目的 运用健康信念模型（HBM），探寻影响居民参加肠镜检查的因素。
方法 2015年5月，采用方便抽样的方法，从上海市某镇选取大肠癌初筛阳性后接受和拒绝肠镜检查（接受组和拒绝组）各200人进行健康信念问卷调查，应用t检验比较两组在HBM易感性认知、严重性认知、益处认知、障碍认知和行为线索5个维度上的差异，并运用logistic回归模型评估各维度得分对肠镜检查意愿的影响。
结果 最终获得有效问卷395份，接受组199份，拒绝组196份。两组HBM问卷得分分别为（0.66±0.12）分和（0.55±0.14）分，接受组得分高于拒绝组（P < 0.001）。接受组在HMB 5个维度上的认知程度均高于拒绝组（均P < 0.05）。在大肠癌发病率随年龄增长而增加的易感性知识，以及大肠癌筛查在降低发病及死亡率，提高治疗效果及掌握自身健康状况的益处认知方面，接受组认知程度高于拒绝组（均P < 0.001）。在获得医生建议和家人朋友支持比例上，接受组相对于拒绝组的OR值分别为4.25（95% CI：2.05~8.84）和9.08（95% CI：4.19~19.68）；而拒绝组则更加认可大肠癌治愈可能性低及缺乏肠镜检查时间。logistic回归中益处认知得分对模型影响最大，其OR值为44.37（95% CI：8.83~222.96）；其次为行为线索和障碍认知得分，OR（95% CI）分别为9.36（3.36~26.05）、7.00（2.45~20.03）。
结论 未接受肠镜检查者对大肠癌易感性认知和肠镜检查益处认知不足，社会支持缺乏；对大肠癌治疗和预后的消极态度及缺乏肠镜检查时间也是阻碍人群进行肠镜检查的重要因素。
Abstract:Objective To identify the factors associated with residents' acceptance of colonoscopy based on health belief model (HBM).
Methods The study was conducted in community residents in a town of Shanghai in May 2015. We selected 200 participants who accepted colonoscopy (colonoscopy group) and 200 participants who rejected (non-colonoscopy group) after being informed of positive primary screening result of colorectal cancer by convenience sampling, and asked them to complete a questionnaire survey on health belief. The two groups were measured for the differences by t test in variables pertinent to HBM, including perceived susceptibility, severity, benefits, barriers, and cues to action.
Results A total of 395 residents completed the questionnaire, among whom 199 accepted colonoscopy and 196 rejected. The total scores of HBM were 0.66±0.12 for the colonoscopy group and 0.55±0.14 for the non-colonoscopy group, respectively (P < 0.001). The scores of the five dimensions of HMB in the colonoscopy group were also higher than those in the non-colonoscopy group (Ps < 0.05). Individuals in the colonoscopy group had higher perception levels than those in the non-colonoscopy group in the susceptibility dimension that increased colorectal cancer incidence was associated with higher age and in the benefit dimension that colorectal cancer screening reduced incidence and mortality, improved treatment, and understand self health condition (Ps < 0.001). Suggestions from physicians and supports from family and friends were also important cues to action for residents' acceptance of colonoscopy, with OR (95% CI) of 4.25 (2.05-8.84) and 9.08 (4.19-19.68), respectively, for the colonoscopy group versus the noncolonoscopy group. While for the non-colonoscopy group, they believed less possibility of curing colorectal cancer and had little time for colonoscopy. In the logistic regression analysis, the dimension of benefits had the greatest contribution to the modelOR(95% CI), 44.37 (8.83-222.96), followed by cues to action9.36 (3.36-26.05) and barriers7.00 (2.45-20.03).
Conclusion The non-colonoscopy group shows insufficient perceived susceptibility, perceived benefits, and social support. Negative attitude towards treatment and prognosis of colorectal cancer and the lack of time for colonoscopy are important barriers to accept colonoscopy.
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