健康信念对儿童安全座椅使用的影响因素分析
Influence factors of health beliefs on car child safety seats use
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摘要:
背景 2017年新修订的《上海市道路交通管理条例》4岁以内儿童乘坐家庭乘用车出行应配备并正确使用儿童安全座椅。但目前该立法未明确处罚对象及罚则，导致执法落地困难，同时存在儿童年龄段设定较低、未基于儿童身高体重等客观指标制定的问题，与国外发达国家间存在一定差距。
目的 调查立法后黄浦区儿童安全座椅使用情况，结合健康信念模式进一步探索其影响因素。
方法 2018年10-12月间对整群随机抽取的上海市黄浦区13家托幼机构中的1 868名有车家庭3~6岁儿童父亲或母亲开展问卷调查，内容包括一般人口学特征、儿童安全座椅使用情况、健康信念量表。量表共20个条目6个维度，采用李克特5点计分法。t/F检验比较不同特征对象健康信念各维度得分均值，多因素logistic回归分析筛选影响因素。
结果 儿童安全座椅配备率为79.4%（1 483/1 868），使用比例为75.3%（1 406/1 868），高频次使用比例为60.6%（1 132/1 868），立法知晓率为38.0%（709/1 868）。调查对象感知严重性均分最高，为（9.6±1.4）分，行动提示均分最低，为（7.7±2.0）分，其余得分包括：感知易感性均分（8.9±1.5）分，感知效益均分（8.9±1.6）分，感知障碍均分（9.2±2.2）分，自我效能均分（8.2±2.0）分。高频次使用组除了感知障碍得分低于低频次使用组及不使用组，其他各个维度得分均高于低频次使用组及不使用组（P=0.000）。上海市户籍儿童家长感知易感性及自我效能得分高于外省市儿童家长（t=3.821，P=0.000；t=2.223，P=0.000）。儿童父亲感知障碍得分高于母亲（t=2.165，P=0.031）。调查对象文化程度越高，感知严重性、易感性、效益、自我效能、行动提示得分越高（P < 0.05）。家庭人均月收入3 000元及以下者感知障碍得分高于3 000元以上者（P < 0.05），除行动提示得分差异无统计学意义外，其余维度得分均低于3 000元以上者（P < 0.05）。非独生子女家庭感知障碍得分高于独生子女家庭（t=-2.289，P=0.022）。儿童年龄4岁以下，儿童上海市户籍，调查对象儿童家长文化程度高，家庭经济条件好，独生子女家庭，家长感知易感性、效益，行动提示，自我效能得分高，知晓立法是促进儿童安全座椅高频次使用的主要因素，感知障碍是不利因素。
结论 立法后黄浦区儿童安全座椅使用率有所提高。运用健康信念探索影响儿童安全座椅使用的相关因素，通过提升儿童家长的使用信念及自我效能，降低感知障碍，加强普法宣传推动立法完善，进一步推广普及儿童安全座椅的使用。
Abstract:Background In the newly revised regulation on road traffic of Shanghai in 2017, children under four years old should be equipped with and use child safety seats properly in cars. At present, the legislation has not defined the violators and the rules of punishment, so it is difficult for the new law to be executed. There are problems that the law targets younger children and is not based on objective indicators such as height and weight of children, which indicate some differences with developed countries.
Objective This study is conducted to investigate the use of car child safety seats in Huangpu District after the legislation revised in Shanghai and to explore the influence factors based on health belief model (HBM).
Methods A questionnaire survey was conducted among 1868 fathers or mothers of 3-6 years old children from 13 kindergartens in Huangpu District of Shanghai from October to December 2018, including demographic characteristics, usage of child safety seats, and health belief scale. The scale had 20 items and 6 dimensions, and was scored by 5-point Likert method. T/F tests were used to analyse the mean scores of health beliefs in different dimensions of characteristics, and multiple logistic regression was used to explore potential influence factors.
Results According to the questionnaires, 79.4% (1 483/1 868) of the respondents owned child safety seats, 75.3% (1 406/1 868) children used child safety seats, the proportion of high frequency child safety seats use was 60.6% (1 132/1868), and the legislative awareness rate was 38.0% (709/1 868). The average scores of perceived severity, action cue, perceived susceptibility, perceived benefit, perceived barrier, and self-efficacy were 9.6±1.4, 7.7±2.0, 8.9±1.5, 8.9±1.6, 9.2±2.2, and 8.2±2.0, respectively. The high frequency group showed higher scores of HBM dimensions except perceived barrier than the low frequency group and the no usage group (P=0.000). The parents of children with Shanghai household registration showed higher scores of perceived susceptibility and self-efficacy than the those with nonShanghai household registration (t=3.821, P=0.000; t=2.223, P=0.000). Fathers showed a higher score of perceived barrier than mothers (t=2.165, P=0.031). The respondents with higher educational level showed higher scores of perceived severity, susceptibility, benefit, selfefficacy, and action cue (P < 0.05). Those with household per capita monthly income ≤ 3 000 yuan showed a higher score of perceived barrier and lower scores of the other HBM dimensions, except action cue, than those with > 3 000 yuan (P < 0.05). The only child families showed a higher score of perceived barrier than the multiple children families (t=-2.289, P=0.022). Younger child, child household registration in Shanghai, high educational level of the respondents, good family economic conditions, only child families, parents, with high scores of perceived susceptibility, benefit, action cue, high self-efficacy, and awareness of legislation were the factors to promote the high frequency usage of child safety seats, while perceived barrier was the adverse factor.
Conclusion After the legislation revised, the usage rate of child safety seats in Huangpu District has been improved. The health belief could be used to carry out targeted health education for parents, and enhancing parents' health belief and self-efficacy, reducing perceived barrier, strengthening legislation publicity, and promoting the improvement of legislation are conductive to further promote the usage of child safety seats.
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