社区结直肠癌筛查促进与障碍因素的混合研究及护理启示  

A mixed-method study on facilitators and barriers to community colorectal cancer screening

作　　者：施冰梓 孙玉静 张雅思 张静[2] SHI Bingzi;SUN Yujing;ZHANG Yasi;ZHANG Jing

机构地区：[1]哈尔滨医科大学护理学院,哈尔滨市150081 [2]哈尔滨医科大学附属第四医院护理部

出　　处：《中华护理杂志》2025年第7期856-863,共8页Chinese Journal of Nursing

摘　　要：目的探讨在社区中实施结直肠癌筛查的促进与障碍因素,为社区护理实践提供参考。方法基于实施研究综合框架,于2024年2月—7月,在哈尔滨市8所社区卫生服务中心分别采用目的抽样和便利抽样法对108名社区护士和550名社区居民进行问卷调查,采用二元Logistic回归分析探究社区护士结直肠癌筛查知识与居民结直肠癌筛查行为的影响因素;通过目的抽样选取21名社区护士及23名居民进行半结构化访谈,运用归纳演绎法分析整理访谈资料。结果①创新领域:明确的结直肠癌筛查目标和免费筛查促进结直肠癌筛查,流程复杂和资源不足阻碍结直肠癌筛查。②外部环境:政策支持、资金资助和协作机制促进结直肠癌筛查,资金不足和沟通不完善阻碍结直肠癌筛查。③内部环境:组织文化和领导支持是促进结直肠癌筛查的因素,护士培训和团队协作不足为结直肠癌筛查的障碍因素。④个体特征领域:混合研究结果表明,社区护士与居民在动机、能力、机会和需要4个方面对筛查的实施产生影响。⑤实施过程:定期反馈和团队合作促进结直肠癌筛查,但操作复杂性和沟通不足阻碍筛查。结论该研究从社区护士与居民2个层面分析了影响结直肠癌筛查实施的促进与障碍因素,建议简化筛查流程,优化筛查工具和政策支持,强化护士培训与健康教育,完善沟通反馈机制,从而提高居民的结直肠癌筛查参与率。Objective To identify facilitators and barriers to colorectal cancer screening in community healthcare and propose effective implementation strategies.Methods From February to July 2024,a survey based on the consolidated framework for implementation research(CFIR)was conducted in 8 community health centers in Harbin,using purposive and convenience sampling to select 108 nurses and 550 residents.Binary logistic regression was used to analyze factors affecting nurses’screening knowledge and residents’behaviors.Semi-structured interviews with 21 nurses and 23 residents were analyzed using inductive-deductive methods.Results In the innovation domain,clear goals and free screening facilitated the implementation,while complex processes and resource shortages were barriers.Externally,policy support,funding,and collaboration promoted the screening,but funding gaps and poor communication hindered it.Internally,organizational culture and leadership were positive,while nurse training and teamwork were insufficient.Mixed-method results showed that motivation,ability,opportunity,and needs of nurses and residents significantly impacted screening.Regular feedback and teamwork aided the implementation,but complexity and communication gaps remained obstacles.Conclusion This study analyzed the facilitators and barriers to the screening implementation from the perspectives of community nurses and participants.Recommendations include simplifying processes,optimizing tools and policies,strengthening nurse training and health education,improving communication feedback,and improve outcomes,thereby increasing the participation rate of residents in colorectal cancer screening.

关 键 词：结直肠癌 筛查 促进因素 障碍因素 实施研究综合框架 混合方法 社区护理 

分 类 号：R473.2[医药卫生—护理学]