综合干预对杭州市社区医务人员提供戒烟咨询的效果及影响因素分析  

Assessment on the impact of smoking cessation counseling service and related influencing factors under comprehensive community-based intervention programs about the community medical staff in Hangzhou city

作　　者：王胜锋[1] 刘清[1] 刘庆敏[2] 任艳军[2] 吕筠[1] 李立明[1] 

机构地区：[1]北京大学公共卫生学院流行病与卫生统计学系,100191 [2]杭州市疾病预防控制中心

出　　处：《中华流行病学杂志》2014年第9期1002-1006,共5页Chinese Journal of Epidemiology

基　　金：社区健康干预（CIH）项目（牛津健康联盟·中国·杭州）.

摘　　要：目的 评价综合干预对社区医务人员提供戒烟咨询的短期效果及影响因素.方法 以杭州市下城区和拱墅区作干预区,开展为期2年的综合吸烟干预,西湖区为对照区,干预前后采用问卷调查戒烟资源、准备情况及实际行动,评价干预效果.采用logistic回归分析戒烟干预的影响因素.结果 干预区299人,对照区141人,吸烟率均约5％.（1）戒烟资源：干预前后,干预区获取种类分别为2、3种,利用种类分别为1、3种,干预前后差异有统计学意义（均P＜0.001）,对照区获取及利用种类均呈下降趋势.（2）准备情况：干预区准备好戒烟咨询的比例在干预前后分别为35.5％、52.0％,干预前后差异有统计学意义（P＜0.001）,对照区前后分别为28.1％、39.3％,干预前后无统计学意义（P=0.162）.（3）实际行动,干预区能对≥90％的患者提供戒烟咨询的医务人员比例呈小幅上升趋势,而对照区呈下降趋势,差异均无统计学意义.准备情况的改善有助于提高医务人员询问患者吸烟状况的比例（调整OR=1.43,P=0.007）.结论 综合干预可一定程度增加社区医务人员戒烟培训及戒烟资源的获取机会和利用水平,改善其提供咨询的准备心态,但并不能显著改善其提供戒烟咨询服务的行为,需考虑建立配套机制,切实促进行为改善.Objective To evaluate the short-term impact of comprehensive community-based intervention programs on smoking cessation counseling services provided by community medical staff and related influencing factors in three districts of Hangzhou city.Methods Within the framework of Community Interventions for Health （CIH） Program,a community trial was conducted in two districts （Xiacheng and Gongshu） and a district （Xihu） as control,by a parallel comparison and random grouping based quasi-experimental design.Two independent questionnaire-based surveys of cross-sectional samples in the intervention and comparison areas were used to assess the impact of intervention.Results There were 299 and 141 medical staff in the areas of intervention and ‘ control＇,respectively.For the intervention area,the quantity of available resources increased from 2to 3 and the quantity of used resources increased from 1 to 3 （both P〈0.001）,while the area of control had a downward trend for both quantities.For the ratios of well-readiness for smoking counseling,in the intervention area were 35.5%,52.0% before and after intervention （P〈0.001）,while the ‘controlled＇ area they were 28.1%,39.3%,respectively （P=0.162）.A slight increase was seen in the intervention area for the proportion of the medical staff who had been provided smoking cessation counseling,as ≥90% patients （including asking smoking status,announcing risks related to the risks of smoking and advising smoking cessation programs etc.）,while the proportion decreased in the area of ‘control＇.The improvement of preparedness would promote medical staff to ask their patients about smoking status （OR=1.43,P=0.007）,while all factors as a whole would not influence the medical staff to inform patients about the danger of smoking and advice patients to quit smoking.Conclusion Comprehensive community-based interventions could increase the opportunities for medical staff to acquire and utilize smoking cessation resources to some extent,as well as

关 键 词：戒烟咨询 干预效果 影响因素 社区医务人员 

分 类 号：R163[医药卫生—公共卫生与预防医学]