城市社区妇女参加宫颈癌筛查行为意向结构方程模型分析

目的建构具有态度、主观行为准则等概念的"城市社区妇女接受宫颈癌筛查行为意向整合模型",探讨影响城市社区妇女接受宫颈癌筛查(宫颈涂片检查)行为的因素。方法用结构式问卷调查1591名上海某社区妇女参加宫颈癌筛查相关知识、态度和行为意向。验证性因子分析建立测量模型,再构建结构方程模型。最大似然法(ML)估计参数,通过评价修正来确定最佳结构模型。结果社区妇女既往参加过宫颈癌筛查的占42.1%,其中三年内参加过宫颈癌筛查的占56.7%。结构方程模型拟合较好,正向影响参加筛查行为意向的因素包括对象个体主观行为准则、对家庭社会责任的感知、对筛查促进因素的感知、参与筛查的自我效能和对宫颈涂片的态度。宫颈癌相关知识对行为意向无影响。对象对行为改变障碍的感知对参与筛查行为意向的作用是负向的。结论要提高社区妇女宫颈癌筛查项目的覆盖率,不能仅提供免费筛查服务和健康知识的培训,还需要构建筛查环境,包括家属的动员,社区妇女较易接受的女性筛查医师的配备、医师检查技能的提高等,同时筛查对象本身信念层面对筛查必要性的感知和改变也是重要的。

A Study on Woman's Behavior Intention Model of Cervical Cancer Screening under the Structural Equation Model

Objective To build a model of the Pap smear behavior intention for urban women in China.Methods A cross sectional study was carried out in two urban communities in Shanghai,China.A total of 1 591 women at the ages of 30 to 65 years participated in this study.Their general information and cervical cancer screening related health knowledge,altitude and behavior intention were collected.Measurement models were built by confirmatory factor analysis and parameters were estimated by Maximum Likelihood(ML) method.The final structural equation model(SEM) was determined by comprehensive evaluation and necessary modification.Results 42.1% of the participants were screened and 56.7% of them had been screened in last 3 years.The goodness of fit for the structural equation model was satisfactory that most of the indices met corresponding requirements.The model indicates that the Pap smear behavior intention for women is prominently influenced by their attitudes,subjective norms,perceive on family responsibility,perceive on enabling factors and self efficacy.Conclusion Cervical cancer screening programs should not only be limited to health education but environment factors as well,including mobilizing family members,providing female doctors and well-trained doctors.The belief change of participants is also important to improve the cervical cancer screening rate.