西部地区农村居民两周患病未就诊影响因素研究  

Influencing Factors of Non-treatment-seeking Behaviors for Perceived Morbidity within Two Weeks among Rural Residents in Western China

作　　者：贺嘉慧 李培雯 马喜民 乔慧 HE Jiahui;LI Peiwen;MA Ximin;QIAO Hui(School of Public Health and Management,Ningxia Medical University,Yinchuan 750004,China;Ningxia Key Laboratory of Environmental Factors and Chronic Disease Control,Yinchuan 750004,China)

机构地区：[1]宁夏医科大学公共卫生与管理学院,宁夏回族自治区银川市750004 [2]宁夏环境因素与慢性病控制重点实验室,宁夏回族自治区银川市750004

出　　处：《中国全科医学》2023年第16期1946-1952,共7页Chinese General Practice

基　　金：国家自然科学基金资助项目(71864030)——宁夏医改试点县农村居民卫生服务利用、费用负担及公平性的动态变化与医保补偿政策的关系研究;国家自然科学基金资助项目(72164033)——宁夏南部山区农村家庭健康贫困及其脆弱性的动态变化、影响因素与多维治理研究。

摘　　要：背景 近年来,卫生服务研究成为我国卫生事业的重要研究领域。既往研究多针对居民两周患病、两周就诊情况及其相关影响因素进行分析,而作为负向指标的两周患病未就诊研究较为少见。目的 了解农村居民两周患病未就诊现状,对其影响因素进行探讨并分析原因,从而提出针对性建议。方法 于2019年12月,采取多阶段分层整群随机抽样方法,抽取宁夏回族自治区农村地区4县27 196例居民,采用自制调查问卷展开两周患病情况的问卷调查。问卷内容包括居民的人口学特征、居民的健康特征及医疗卫生服务可得性和可及性,根据调查结果构建两周患病未就诊情况的结构方程模型,分析其影响因素并进行检验。结果 本研究共收集问卷27 196份,有效问卷21 451份,有效回收率为78.88%。宁夏农村地区居民两周患病率为14.97%(3 212/21 451),两周就诊率为4.57%(981/21 451),两周患病未就诊率为69.46%(2 231/3 212)。不同性别、年龄、受教育程度、职业、自评健康状况、患有慢性病情况、两周患病卧床天数及到二级及以上医疗机构时间的居民两周患病未就诊情况比较,差异均有统计学意义(P<0.05)。结构方程模型拟合结果显示,人口学特征对居民两周患病未就诊情况影响的总效应为-0.101(β=0.110),其中直接效应为0.107,间接效应为-0.208;健康特征对居民两周患病未就诊情况的影响为直接效应,总效应为-0.210(β=-0.313)。结论 宁夏回族自治区农村地区居民两周患病未就诊率较高且居民健康特征对两周患病未就诊影响较大,说明该地区居民的主动健康意识较差,应针对其影响因素,采取相应措施、制定相关政策,从而优化医疗卫生资源配置,提高该地区卫生服务利用水平。Background Health service research has become an important research field in health industry of China recently.Existing studies mainly focus on the prevalence of perceived morbidity within two weeks and associated treatmentseeking behaviors as well as influencing factors in residents,but rarely involve in their non-treatment-seeking behaviors.Objective To understand the prevalence of non-treatment-seeking behaviors in rural residents with perceived morbidity within two weeks,and to explore and analyze the influencing factors,so as to put forward targeted suggestions.Methods In December 2019,by use of a multistage stratified cluster random sampling approach,27196 residents from four rural counties of Ningxia Hui Autonomous Region were selected to attend an interviewer-administered,face-to-face survey using a selfdeveloped Two-week Morbidity Questionnaire for understanding their demographics,health characteristics,and the availability and accessibility of medical and health services.A structural equation model built based on the survey results was used to analyze and test the influencing factors of non-treatment-seeking behaviors for two-week morbidity.Results Of the residents,21451(78.88%)who effectively responded to the survey were included for analysis.The two-week morbidity in the respondents was 14.97%(3212/21451),and the prevalence of non-treatment-seeking behaviors was 69.46%(2231/3212).The prevalence of non-treatment-seeking behaviors for two-week morbidity varied by gender,age,education level,occupation,self-assessed health status,prevalence of chronic diseases,the number of days of bed rest for an illness,and the time to go to secondary or higher medical institutions(P<0.05).The fitting outcome of the structural equation model showed that the total effect of demographics on non-treatment-seeking behaviors was-0.101(β=0.110),of which the direct effect was 0.107,and the indirect effect was-0.208.Health characteristics had a direct effect on non-treatment-seeking behaviors with a total effect of-0.210(β=-0

关 键 词：卫生服务 患病率 两周患病未就诊 影响因素分析 结构方程模型 宁夏回族自治区 

分 类 号：R195[医药卫生—卫生统计学] R197[医药卫生—卫生事业管理]