Structural equation model analysis of category Ⅱ vaccine behavior based on knowledge-attitude-practice theory
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摘要:
目的 调查贵州省学龄儿童家长的二类疫苗接种知识、态度和行为，探索其影响因素，为促进二类疫苗接种提供建议。 方法 采用分层抽样的方法，在贵州省铜仁市选择1个区和1个县的若干小学作为抽样地点，使用结构化问卷对纳入的儿童家长进行面对面调查，利用结构方程模型探究儿童家长对二类疫苗的知识、态度和接种行为的关系。 结果 共计收到有效问卷517份，接种组家长对于二类疫苗效果知识问题回答正确率高于未接种组，接种组家长更认同二类疫苗的作用和功效，未接种组家长更担心二类疫苗的风险问题。家长受教育程度越高(γ=0.266)越赞同疫苗的效果(β=0.469)、越反对疫苗的风险(β=0.398)，会促进二类疫苗的接种行为；家长的受教育程度负向影响家长对于疫苗效果的态度(γ=-0.725)。 结论 应当关注受教育程度低的家长，帮助他们正确理解二类疫苗相关知识；对于文化程度较高的家长，应侧重二类疫苗安全性和有效性的宣讲，打消家长过分对疫苗效果和安全性的质疑，促进二类疫苗接种。 Abstract:Objective To provide suggestions for promoting the practice of category Ⅱ vaccine, the knowledge, attitude, practice (KAP) as well as impact factors of category Ⅱ vaccine among parents of school-aged children in Tongren City, Guizhou Province were assessed. Methods Stratified sampling was used to select several primary schools in one district and one country of Tongren City, Guizhou Province. A structured questionnaire was used to investigate the parents′ KAP of category Ⅱ vaccine and the structural equation model was used to explore the association of parents′ KAP. Results A total of 517 valid questionnaires were received in this study. Parents in the vaccinated group had a higher rate of correct answers to questions about the effectiveness of category Ⅱ vaccine than those in the unvaccinated group. Parents in the vaccinated group were more likely to agree on the effectiveness of category Ⅱ vaccine, while parents in the unvaccinated group were more concerned about the risk of category Ⅱ vaccine. Higher parental educational level (γ=0.266), higher agreement on the effectiveness of the vaccine (β=0.469), and opposition to the risks of the vaccine promoted vaccination behavior for the category Ⅱ vaccine (β=0.398); parental education negatively affected parental attitudes toward the effects of the vaccine (γ=-0.725). Conclusions Attention should be paid to poorly educated parents to help them properly understand knowledge about category Ⅱ vaccine. For parents with higher education level, emphases should be placed on the explanation of the safety and effectiveness of category Ⅱ vaccine, in order to dispel parents′ doubts and promote practice of category Ⅱ vaccines. -
图 1 家长对疫苗知识的判断/疫苗相关态度与儿童二类疫苗接种情况分布图
A: 疫苗知识；B：疫苗态度；V：接种过；U：未接种。
a: P < 0.05; b: P < 0.01; c: P < 0.001。Figure 1. Parents′ judgment of vaccine knowledge/vaccine-related attitudes and distribution chart of category Ⅱ vaccination for their children
A: vaccine knowledge; B: vaccine attitude; V: vaccinated; U: unvaccinated.
a: P < 0.05; b: P < 0.01; c: P < 0.001.
图 2 疫苗接种KAP结构方程模型
ζ1：获取知识的能力；η1：疫苗效果知识；η2：疫苗风险知识；η3：疫苗效果态度；η4：疫苗风险态度；η5：二类疫苗接种行为; x1-x2：ζ1的观察标识；y1-y4：η1的观察标识；y5-y7：η2的观察标识；y8-y14：η3的观察标识；y15-y16：η4的观察标识；y17-y19：η5的观察标识。
Figure 2. KAP structural equation model of vaccination
ζ1:The ability to acquire knowledge; η1:Vaccine effectiveness knowledge; η2:Vaccine risk knowledge; η3:Vaccine effectiveness attitude; η4:Vaccine risk attitude; η5:Category Ⅱ vaccine behavior; x1-x2:The observation mark of ζ1;y1-y4:The observation mark of η1;y5-y7:The observation mark of η2;y8-y14:The observation mark of η3;y15-y16:The observation mark of η4;y17-y19:The observation mark of η5.
表 1 家长和儿童基本情况分析
Table 1. Basic characteristics analysis of parents and children
特征 Characteristics 儿童接种二类疫苗[人数(占比/%)]
Children receive the category Ⅱ vaccine [Number of people (proportion/%)]Z/χ2值
valueP值
value接种 Vaccinated 未接种 Unvaccinated 儿童户口 Child′s region 0.293 0.588 城镇户口 Urban 17(73.9) 6(26.1) 农村户口 Rural 399(80.8) 95(19.2) 儿童性别 Child′s gender 0.326 0.568 男 Male 215(81.4) 49(19.6) 女 Female 201(79.4) 52(20.6) 母亲受教育程度 Mother′s education level -2.065 0.039 小学及以下 Primary and below 66(67.3) 32(32.7) 初中 Junior 267(84.8) 48(15.2) 高中/职高/中专 Senior 55(82.1) 12(17.9) 大专/大学 College 28(75.7) 9(24.3) 父亲受教育程度 Father′s education level -1.397 0.163 小学及以下 Primary and below 60(71.4) 24(28.6) 初中 Junior 255(82.5) 54(17.5) 高中/职高/中专 Senior 70(83.3) 14(16.7) 大专/大学 College 31(77.5) 9(22.5) 疫苗知识总得分 Total vaccine knowledge score -3.458 < 0.001 0~3 134(72.8) 50(27.2) 4~6 206(83.1) 42(16.9) 7~9 76(89.4) 9(10.6) 
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表 2 疫苗接种KAP结构方程模型计算结果
Table 2. Calculation results of KAP structural equation model for vaccination
路径 Path 系数
coefficientsx P值
value疫苗效果知识←理解知识的能力(γ11) Vaccine effectiveness knowledge←The ability to acquire knowledge(γ11) 0.580 0.114 < 0.001 疫苗风险知识←理解知识的能力(γ21) Vaccine risk knowledge←The ability to acquire knowledge(γ21) 0.672 0.118 < 0.001 疫苗效果态度←疫苗效果知识(β31) Vaccine effectiveness attitude←Vaccine effectiveness knowledge(β31) 0.865 0.145 < 0.001 疫苗效果态度理解知识的能力(γ31) Vaccine effectiveness attitude←The ability to acquire knowledge(γ31) -0.725 0.260 0.005 疫苗风险态度←疫苗效果知识(β41) Vaccine risk attitude←Vaccine effectiveness knowledge(β41) -0.533 0.170 0.002 疫苗风险态度理解知识的能力(γ41) Vaccine risk attitude←The ability to acquire knowledge(γ41) 0.710 0.235 0.002 二类疫苗接种行为←疫苗效果态度(β53) Category Ⅱ vaccine behavior←Vaccine effectiveness attitude(β53) 0.469 0.114 < 0.001 二类疫苗接种行为←疫苗风险态度(β54) Category Ⅱ vaccine behavior←Vaccine risk attitude(β54) 0.398 0.138 0.004 二类疫苗接种行为←理解知识的能力(γ51) Category Ⅱ vaccine behavior←The ability to acquire knowledge(γ51) 0.266 0.117 0.023 注：系数表示标准化路径系数的估计值；sx表示路径系数的sx。
Note: Estimate represents an estimate of the standardized path coefficient; sx represents the sx term of the path coefficient.
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