基于离散选择实验的育龄期女性孕前保健服务模式选择偏好  

Preference of preconception health care service models for women of childbearing age based on discrete choice experiment

作　　者：杨希 李响 吕婧 麻如欢 邬斌强 徐婷婷 Yang Xi;Li Xiang;LüJing;Ma Ruhuan;Wu Binqiang;Xu Tingting(Department of Health Management and Policy,School of Public Health,Capital Medical University,Beijing 100069,China)

机构地区：[1]首都医科大学公共卫生学院卫生管理与政策学系,北京100069

出　　处：《首都医科大学学报》2024年第4期686-692,共7页Journal of Capital Medical University

基　　金：国家自然科学基金项目(72204172)。

摘　　要：目的探究育龄期女性孕前保健服务模式的选择偏好,为优化生育保障体系、提高育龄期女性孕前保健服务利用率提供研究依据。方法基于离散选择实验设计,采用文献综述和半结构化访谈,确立育龄期女性关注的5个孕前保健服务模式影响因素,即提供孕前检查医院等级、检查内容、提供形式、整合形式和检查地点距离。采用代表性抽样法,运用混合Logistics模型分析北京市育龄期女性孕前保健服务模式偏好及其异质性。结果本研究共纳入有效样本329例。其中84.8%的受访者年龄在35岁以下,74.8%为城市居民。偏好分析结果显示,育龄期女性更倾向于接受检查地点距离近(β=-0.636,P<0.01)、检查内容为19项基本检查+饮食运动心理指导(β=0.611,P<0.01)、可以提供上门指导(β=0.410,P<0.01)、能与婚前检查相结合(β=0.225,P<0.01)的孕前保健服务模式。异质性分析结果显示,农村女性相比于城市女性更加倾向于选择可以提供上门指导和检查距离近的孕前保健服务;有过妊娠经历的女性更偏向选择检查内容包含基因检查的孕前保健服务。结论北京市育龄期女性在选择孕前保健服务模式时最关注检查地点距离和检查内容。不同人口特征的育龄期女性对于孕前保健服务也存在不同的选择偏好。孕前检查应适应人群特征,缩短检查地点距离并推广饮食、运动和心理教育指导。Objective To analyze the preferences of women of childbearing age for preconception health care services and provide insights for optimizing the reproductive health system and enhancing their willingness to have children.Methods A discrete choice experiment questionnaire was developed based on a literature review and semi-structured interviews.It identified five key factors influencing preconception health care preferences:hospital level,examination content,offer form,integrated service form,and distance to the examination location.Using convenient sampling,women of childbearing age in Beijing were surveyed.The sample's measurement information was analyzed using mean(standard deviation)and count information with frequency(composition ratio).Preferences and their interaction with demographic information were analyzed using a mixed logistic model.Results Out of 356 questionnaires,329 were valid(92.4%effective rate).The survey showed 84.8%of respondents were under 35,and 74.8%lived in the city.Women preferred services close to their location(β=-0.636,P<0.01),including 19 basic examinations with education on diet,exercise,and psychology(β=0.611,P<0.01),home guidance(β=0.410,P<0.01),combined with premarital examinations(β=0.225,P<0.01),and offered by level-three hospitals(β=0.104,P=0.089).Women in rural areas preferred home guidance and proximity,while those with previous pregnancies preferred genetic testing.Conclusions Women of childbearing age in Beijing prioritize the distance to the examination location and the examination content when choosing preconception health care services.Preferences vary with demographic characteristics.Recommendations include increasing publicity,strengthening policy guidance,planning services tailored to contemporary women,reducing the distance to examination sites,and promoting guidance on diet,exercise,and psychology during pregnancy.

关 键 词：孕前保健 服务模式 离散选择实验 偏好 

分 类 号：R173[医药卫生—妇幼卫生保健]