【作者】 赵燕利；

【导师】 刘纯艳；

【作者基本信息】 天津医科大学 ， 护理学， 2005， 硕士

【摘要】 乳腺癌是世界范围内严重威胁妇女健康的恶性肿瘤,大力开展乳腺癌的早期发现、早期诊断、早期治疗,已经证明是改善疾病预后、提高生活质量、降低乳腺癌死亡率最有效的方法。许多关于乳腺癌早期发现方法(乳腺自我检查、乳腺临床检查、乳腺x线检查)的研究均表明:人群对这些健康促进项目的利用率并不尽人意。因此,针对中国具体国情,有必要探讨影响中国妇女实施乳腺自检的因素,以便制定有效的乳腺癌早期发现健康教育计划。 【目的】制定、实施并评价乳腺癌早期发现健康教育项目对中国妇女的乳腺癌及乳腺自检知识、态度和自检行为的影响。应用知信行模式(Knowledge,Attitude,Belief,Practice,KABP)和健康信念模式(Health Belief Model,HBM),分析影响研究人群采取乳腺自检行为(Breast Self-examination,BSE)的因素,为今后制定有效的健康教育策略提供依据。 【方法】2004年7至10月份,天津医科大学279名护理本科生在接受有关乳腺癌及其早期发现的知识和自检技巧的系统培训后,作为健康教育者,针对1395名妇女,展开了多种形式的乳腺癌早期发现及乳腺自检健康教育。并采用问卷调查的形式,就乳腺癌及乳腺自检的相关知识、态度和行为进行调查,随访三个月后,对健康教育项目的效果进行评价并分析影响调查人群乳腺自检行为的因素。 【结果】接受培训后,研究人群的知识、态度和自检行为均有不同程度的提高。使用KAP模式对影响自检行为的因素进行分析发现,相关知识的掌握并不对行为产生促进作用,乳腺自检行为主要与既往乳腺疾病史(干预前:OR=2.069,95%CI:1.340～3.193;干预后:OR=1.920,95%CI:1.119～3.295)和乳腺自检态度(干预前:OR=7.652,95%CI:5.426～10.790;干预后:OR=4.275,95%CI:3.206～5.701)有关。对健康信念模式的四个参数分别与乳腺自检行为进行单因素Logistic回归分析,结果发现:干预前,“知觉到更多还原

【Abstract】 Breast cancer is one of the leading causes of death throughout the world. Early detection、 early diagnosis and timely treatment have currently proved the most powerful weapon in the fight against breast cancer. It has significant value in ameliorating the prognosis of the disease、 improving the quality of life and reducing the mortality rate from breast cancer. Nevertheless, many studies concerning the implementing of breast cancer screening methods demonstrate that these health-promoting programs are regrettably underutilized. Given the concrete condition of China, It is therefore necessary to explore factors that influence the performance of breast self-examination (BSE) among Chinese women in order to promote the early detection of breast caner with the only available screening tool, i.e. BSE, in the future cancer prevention and control program. Objectives:To improve the breast cancer early detection awareness and breast self-examination performance among Chinese women through promoting knowledge concerning breast caner and propagandizing the techniques of breast self-examination, evaluation was then made to assess the effectiveness of the health educational program. KABP Model(nowledge, Attitude, Belief, Practice) and Health Belief Model (HBM) were introduced to explore and identify the potential factors that influence the practice of BSE and to provide reference for developing productive health education strategies in future health-promoting activities. Methods:In 2004, An intervention study was conducted among a convenient sample of 1395 women recruited to receive an intensive health educational program withregard to the early detection of breast cancer, mainly focusing on the BSE practice, data were collected through a self-administered questionnaire both at baseline and three month follow-up. Results:Significant improvement was observed concerning the knowledge, BSE attitude and practice after the health education program. Utilizing the KABP model to analyze the factors related to BSE practice, Findings showed that mastery of relevant knowledge was not indicative of the practice of BSE, which was, instead, statistically associated with personal history of breast disease (Pre-intervention: OR=2.069, 95%CI: 1.340 — 3.193; Post-intervention: OR=1.920, 95%CI: 1.119—3.295) and BSE attitude ( Pre-intervention: OR=7.652, 95%CI: 5.426—10.790; Post-intervention: OR=4.275, 95%CI: 3.206—5.701) . Results from univariate analysis between the four parameters of HBM and the BSE behavior demonstrated that perceived susceptibility> perceived benefits^ perceived barriers were statistically associated with BSE performance at baseline (with OR: 1.231 > 1.401 > 1.367, respectively) and perceived susceptibility, perceived severity n perceived benefits^ perceived barriers at follow-up (with OR 1.267 ^ 1.074 > 1.478 > 1.302, respectively). Adjusted with such demographic characteristics as ageN educational background > vocation marital status > personal history of breast disease > experience with breast caner of relatives or friends, the relation remained significant both at baseline and follow-up, which indicates that belief in and attitude toward BSE determines whether one would adopt this health-promoting behavior and some socioeconomic factors might exert slight influence on the BSE practice. The results of further Multi-Logistic regression revealed that perceived barriers were statistically associated with BSE performance at baseline (with OR: 1.345, 95%CI: 1.287—1.405) and perceived更多还原