主动健康导向的上海市社区居民健康管理认知和就医行为现状调查及影响因素分析  

Survey on the current status and analysis of influencing factors of health management cognition and medical care behaviors of active health-oriented community residents in Shanghai

作　　者：黎婉钰 张晓岚 金花 徐芬 于德华 Li Wanyu;Zhang Xiaolan;Jin Hua;Xu Fen;Yu Dehua(Community Health Service Center of Xiayang Street,Qingpu District,Shanghai 201799,China;Department of General Practice,Yangpu Hospital,School of Medicine,Tongji University,Shanghai 200090,China;Shanghai General Practice and Community Health Development Research Center,Shanghai 200090,China;Research Center for General Practice,School of Medicine,Tongji University,Shanghai 200090,China;School of Medicine,Tongji University,Shanghai 200090,China)

机构地区：[1]上海市青浦区夏阳街道社区卫生服务中心,上海201799 [2]同济大学附属杨浦医院全科医学科,上海200090 [3]上海市全科医学与社区卫生发展研究中心,上海200090 [4]同济大学医学院全科医学研究中心,上海200090 [5]同济大学医学院,上海200090

出　　处：《中华全科医师杂志》2025年第3期270-278,共9页Chinese Journal of General Practitioners

基　　金：上海市领军人才(YDH-20170627);国家自然科学基金(72104183);上海市杨浦区中心医院学科带头人攀登计划(Ye2202103);上海市青浦区卫生健康系统第五轮学科建设和人才培养(YY2023-46);上海市“医苑新星”青年医学人才培养资助计划项目(SHWSRS 2024_70)。

摘　　要：目的了解上海市社区居民的健康管理认知与就医行为现状,分析其相关影响因素,以推动主动健康导向的健康管理策略优化。方法该研究为横断面调查,2023年2—5月通过分层随机抽样,在上海市各行政区以随机数表法分别抽取1~4个街镇的社区卫生服务中心,最终选取28个社区卫生服务中心作为调研点。研究团队在每个选定的中心以方便抽样法从就诊居民中选取至少50名作为调研对象。共纳入1436名社区居民,以现场填写问卷星的形式调研,研究内容涵盖居民的健康管理认知水平、慢性病管理情况、就医意向、体检行为及异常结果处理情况。采用多元回归分析法评估健康管理认知与就医行为的相关性及其影响因素。结果健康管理认知水平调查结果显示,827名(57.6%)居民认知水平较高。在755名(52.6%)患有慢性病的居民中,高认知组自评控制稳定者占比[318名(76.0%)]明显高于低认知组[223名(66.2%)],差异有统计学意义(χ^(2)=9.01,P=0.003)。多元回归分析显示,女性(OR=1.293,95%CI:1.028~1.627)、≤44岁及45~59岁(OR=2.328,95%CI:1.648~2.328;OR=1.351,95%CI:1.035~1.763)、本科及以上学历(OR=1.784,95%CI:1.256~2.534)、居住辖区为郊区(OR=1.577,95%CI:1.235~2.014)、使用职工医保和居民医保(OR=2.294,95%CI:1.629~3.232;OR=1.628,95%CI:1.149~2.306)、患1种慢性病(OR=3.110,95%CI:1.918~5.042)及签约家庭医生(OR=1.870,95%CI:1.431~2.442)均为健康管理认知的正向关联因素(均P<0.05)。在就医行为方面,908名(63.2%)居民表现出较高的主动就医意向,906名(63.1%)和796名(55.4%)居民分别表现为积极参与体检和及时处理体检异常结果。高认知组居民在就医意向(χ^(2)=33.26)、体检方式(χ^(2)=110.71)体检频次(χ^(2)=45.37)及体检后异常结果处理方式(χ^(2)=93.14)等方面显著优于低认知组,差异具有统计学意义(均P<0.05)。社区居民就医行为影响因素的线性回归分析结果显示,年龄Objective To understand the current status of health management cognition and healthcare behaviors of community residents in Shanghai,and to analyze their related influencing factors,in order to promote the optimization of proactive health-oriented health management strategies.Methods This study was a cross-sectional survey.From February to May 2023,1-4 community health service centers were randomly selected from each administrative district in Shanghai by stratified random sampling using the random number table method.Ultimately,28 community health service centers were selected as research sites.The research team then used convenience sampling method to select at least 50 patients as research subjects from those visiting each selected center.A total of 1436 community residents were included in this study in the form of on-site completion of questionnaire stars,and the study covered the residents′level of health management cognition,chronic disease management,intention to seek medical care,physical examination behavior,and handling of abnormal values.Multiple regression analysis was used to assess the correlation between health management cognition and medical consultation behavior and their influencing factors.Results The results of the health management awareness survey showed that 827 residents(57.6%)had a relatively high level of awareness.Among the 755 residents(52.6%)with chronic diseases,the proportion of self-assessed stable control was significantly higher in the high-cognition group(318(76.0%))than that in the low-cognition group(223(66.2%)),and the difference was statistically significant(χ^(2)=9.01,P=0.003).Multiple regression analysis showed that females(OR=1.293,95%CI:1.028-1.627),≤44 years old and 45-59 years old(OR=2.328,95%CI:1.648-2.328;OR=1.351,95%CI:1.035-1.763),bachelor′s degree or above(OR=1.784,95%CI:1.256-2.534),living in suburban area(OR=1.577,95%CI:1.235-2.014),use of employee health insurance and resident health insurance(OR=2.294,95%CI:1.629-3.232;OR=1.628,95%CI:1.149-2.306),suf

关 键 词：健康管理 就医行为 主动健康 社区居民 认知度 

分 类 号：R47[医药卫生—护理学]