Study on the current situation and influencing factors of the knowledge, attitude and practice of cervical cancer prevention and treatment among women in Shanxi Province
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摘要:
目的 了解山西省女性宫颈癌防治知信行现状及其影响因素，为促进女性参与宫颈癌筛查并重视农村女性的健康教育工作提供依据。 方法 采用线上线下相结合的方式对山西省3 460名女性进行问卷调查，运用$\chi^2$检验和二元logistic回归分析模型探讨山西省女性宫颈癌防治知信行的影响因素。 结果 山西省女性宫颈癌知识知晓率为51.3%;防治态度积极率为75.9%;宫颈癌筛查率42.6%;今后愿意接受宫颈癌筛查人数占比92.4%。年龄(OR=0.737, 95% CI: 0.681~0.799, P < 0.001)、文化程度(OR=1.321, 95% CI: 1.219~1.431, P < 0.001)、职业[以公职人员为对照，其他组OR分别为1.166(95% CI: 0.953~1.429, P=0.136)、2.690(95% CI: 2.143~3.377, P < 0.001)、3.114(95% CI: 2.323~4.174, P < 0.001)、1.444(95% CI: 1.051~1.984, P=0.023)]、家庭人均年收入(OR=1.103, 95% CI: 1.051~1.158, P < 0.001)是女性宫颈癌防治知识的影响因素; 年龄(OR=0.719, 95% CI: 0.660~0.785, P < 0.001)、文化程度(OR=1.206, 95% CI: 1.108~1.313, P < 0.001)、职业[以公职人员为对照，其他组OR分别为1.202(95% CI: 0.956~1.512, P=0.116)、1.621(95% CI: 1.241~2.118, P < 0.001)、1.389(95% CI: 0.984~1.962, P=0.062)、1.327(95% CI: 0.958~1.840, P=0.089)]、家庭人均年收入(OR=1.085, 95% CI: 1.029~1.145, P=0.003)、吸烟(OR=0.666, 95% CI: 0.490~0.907, P=0.010)是女性宫颈癌防治态度的影响因素; 年龄(OR=1.161, 95% CI: 1.051~1.284, P=0.003)、户籍(OR=1.474, 95% CI: 1.230~1.767, P < 0.001)、职业[以公职人员为对照，其他组OR分别为1.019(95% CI: 0.832~1.248, P=0.854)、1.840(95% CI: 1.427~2.372, P < 0.001)、0.758(95% CI: 0.477~1.206, P=0.243)、0.626(95% CI: 0.463~0.845, P=0.002)]、婚姻状态[以未婚为对照，其他组OR分别为8.306(95% CI: 6.164~11.194, P < 0.001)、10.480(95% CI: 6.031~18.212, P < 0.001)]、家庭人均年收入(OR=1.114, 95% CI: 1.058~1.174, P < 0.001)、女性疾病患病情况(OR=1.322, 95% CI: 1.142~1.530, P < 0.001)、早餐(OR=1.423, 95% CI: 1.178~1.720, P < 0.001)、体育锻炼(OR=1.192, 95% CI: 1.061~1.340, P=0.003)、人工流产情况(OR=1.237, 95% CI: 1.119~1.367, P < 0.001)是宫颈癌筛查行为的影响因素; 年龄(OR=0.760, 95% CI: 0.683~0.845, P < 0.001)、家庭人均年收入(OR=1.133, 95% CI: 1.050~1.223, P=0.001)、早餐(OR=1.390, 95% CI: 1.074~1.800, P=0.012)、吸烟(OR=0.441, 95% CI: 0.309~0.630, P < 0.001)是宫颈癌筛查意愿的影响因素。 结论 山西省女性对宫颈癌防治知识知晓率和筛查行为表现较差，防治态度有待提高，筛查意愿较高，宫颈癌筛查率城乡差距较大，相关部门需通过多种途径促进女性参与宫颈癌筛查并重视农村女性的健康教育工作。 Abstract:Objective To understand the current status and the influencing factors of knowledge, attitude, and behavior about cervical cancer prevention and treatment among women in Shanxi Province. And we aims to provide a basis for promoting women's participation in cervical cancer screening and emphasizing health education efforts among rural women. Methods A self-designed questionnaire was used. The data of 3 460 women was conducted with $\chi^2$ test and binary logistic regression to explore the influencing factors of cervical cancer knowledge, attitude, and behavior. Results The knowledge awareness rate of cervical cancer among women in Shanxi Province was 51.3%. The positive attitude toward prevention and treatment was 75.9%. The screening rate of cervical cancer was 42.6% and 92.4% women were willing to be screened for cervical cancer in the future. Age(OR=0.737, 95% CI: 0.681-0.799, P < 0.001), education(OR=1.321, 95% CI: 1.219-1.431, P < 0.001), occupation [compared to the group with civil servant, the OR for other groups were 1.166(95% CI: 0.953-1.429, P=0.136), 2.690(95% CI: 2.143-3.377, P < 0.001), 3.114(95% CI: 2.323-4.174, P < 0.001), amd 1.444(95% CI: 1.051-1.984, P=0.023), respectively], and annual per capita household income(OR=1.103, 95% CI: 1.051-1.158, P < 0.001) were the influencing factors for women's knowledge of cervical cancer prevention and treatment. Age(OR=0.719, 95% CI: 0.660-0.785, P < 0.001), education(OR=1.206, 95% CI: 1.108-1.313, P < 0.001), occupation [compared to the group with civil servant, the OR for other groups were 1.202(95% CI: 0.956-1.512, P=0.116), 1.621(95% CI: 1.241-2.118, P < 0.001), 1.389(95% CI: 0.984-1.962, P=0.062), 1.327(95% CI: 0.958-1.840, P=0.089), respectively], annual per capita household income(OR=1.085, 95% CI: 1.029-1.145, P=0.003), and smoking(OR=0.666, 95% CI: 0.490-0.907, P=0.010) were the influencing factors for women's attitude toward cervical cancer prevention and treatment. Age(OR=1.161, 95% CI: 1.051-1.284, P=0.003), household registration(OR=1.474, 95% CI: 1.230-1.767, P < 0.001), occupation [compared to the group with civil servant, the OR for other groups were 1.019(95% CI: 0.832-1.248, P=0.854), 1.840(95% CI: 1.427-2.372, P < 0.001), 0.758(95% CI: 0.477-1.206, P=0.243), 0.626(95% CI: 0.463-0.845, P=0.002), respectively], marital status [compared to the group with not married, the OR for other groups were 8.306(95% CI: 6.164-11.194, P < 0.001), 10.480(95% CI: 6.031-18.212, P < 0.001), respectively], annual per capita household income(OR=1.114, 95% CI: 1.058-1.174, P < 0.001), women's disease prevalence(OR=1.322, 95% CI: 1.142-1.530, P < 0.001), breakfast(OR=1.423, 95% CI: 1.178-1.720, P < 0.001), physical exercise(OR=1.192, 95% CI: 1.061-1.340, P=0.003), and abortion(OR=1.237, 95% CI: 1.119-1.367, P < 0.001) were the influencing factors for cervical cancer screening behavior. Age(OR=0.760, 95% CI: 0.683-0.845, P < 0.001), annual per capita household income(OR=1.133, 95% CI: 1.050-1.223, P=0.001), breakfast(OR=1.390, 95% CI: 1.074-1.800, P=0.012), and smoking (OR=0.441, 95% CI: 0.309-0.630, P < 0.001) were the influencing factors for cervical cancer screening willingness. Conclusions Women's knowledge of cervical cancer prevention and screening behaviors were poor, and the attitude toward prevention and treatment need to be improved. Screening willingness was high, and there was a large gap between urban and rural areas in the cervical cancer screening rate. It is still necessary to promote women's participation in cervical cancer screening through a variety of ways and to pay attention to the health education work of rural women. -
Key words:
- Cervical cancer /
- Knowledge, attitude and practice /
- Influencing factors /
- Women /
- Screening behavior
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表 1 宫颈癌防治知信行单因素分析
Table 1. Univariate analysis of knowledge, attitude and behavior of cervical cancer prevention and treatment
变量 Variable 人数(占比/%) Number of people (proportion/%) 防治知识 Prevention and treatment knowledge 防治态度 Preventive and treatment attitude 筛查行为 Screening behavior 筛查意愿 Screening willingness 不了解
Unknow了解
Know不积极
Inactive积极
Active否
No是
Yes否
No是
Yes年龄/岁 Age/years ＜25 745(21.5) 96 649 94 651 692 53 45 700 25~＜35 1 067(30.8) 260 807 205 862 679 388 70 997 35~＜45 875(25.3) 274 601 243 632 325 550 60 815 45~＜55 566(16.4) 235 331 200 366 189 377 52 514 ≥55 207(6.0) 113 94 92 115 102 105 35 172 $\chi^2$值 value 218.694 159.963 686.586 32.586 P值 value ＜0.001 ＜0.001 ＜0.001 ＜0.001 户籍 Household registration 农村 Rural areas 1 339(38.7) 367 972 294 1 045 976 363 109 1 230 城市 Urban areas 2 121(61.3) 611 1 510 540 1 581 1 011 1 110 153 1 968 $\chi^2$值 value 0.792 5.506 213.612 1.007 P值 value 0.374 0.019 ＜0.001 0.316 文化程度 Education level 小学及以下 Elementary school and below 37(1.1) 20 17 19 18 25 12 3 34 初中 Secondary school 297(8.6) 162 135 133 164 152 145 40 257 高中或中专 High school or technical secondary school 379(10.9) 170 209 127 252 169 210 38 341 大专 Junior college 755(21.8) 193 562 168 587 422 333 60 695 本科 Undergraduate 1 500(43.4) 331 1 169 291 1 209 929 571 96 1 404 硕士研究生及以上 Master′s degree or above 492(14.2) 102 390 96 396 290 202 25 467 $\chi^2$值 value 209.657 127.983 45.488 25.486 P值 value ＜0.001 ＜0.001 ＜0.001 ＜0.001 职业 Occupation 公职人员 Civil servant 855(24.7) 270 585 220 635 410 445 62 793 企业人员 Enterprise employee 1 088(31.4) 385 703 303 785 542 546 77 1 011 医疗卫生人员 Medical staff 678(19.6) 117 561 120 558 376 302 40 638 学生 Student 511(14.8) 59 452 70 441 478 33 35 476 无工作人员 No staff 328(9.5) 147 181 121 207 181 147 48 280 $\chi^2$值 value 187.127 84.339 331.532 26.970 P值 value ＜0.001 ＜0.001 ＜0.001 ＜0.001 婚姻状态 Marital status 未婚 Not married 1 158(33.5) 199 959 197 961 1 059 99 84 1074 已婚 Married 2 217(64.0) 746 1 471 607 1 610 898 1 319 168 2 049 其他(离异、分居、丧偶等) Other(divorce, separation, widowhood, etc) 85(2.5) 33 52 30 55 30 55 10 75 $\chi^2$值 value 106.485 50.655 825.004 2.302 P值 value ＜0.001 ＜0.001 ＜0.001 0.316 家庭人均年收入/万元 Annual per capita household income/10 000 yuan ＜1 695(20.1) 241 454 194 501 479 216 63 632 1~＜2 454(13.1) 118 336 107 347 332 122 45 409 2~＜3 553(16.0) 151 402 141 412 351 202 35 518 3~＜5 616(17.8) 165 451 153 463 322 294 55 561 5~＜10 780(22.5) 226 554 163 617 347 433 48 732 ≥10 362(10.5) 77 285 76 286 156 206 16 346 $\chi^2$值 value 25.090 12.650 182.130 15.985 P值 value ＜0.001 0.027 ＜0.001 0.007 女性疾病患病情况 Prevalence of women′s diseases 否 No 3 196(92.4) 881 2 315 768 2 428 1 905 1 291 240 2 956 是 Yes 264(7.6) 97 167 66 198 82 182 22 242 $\chi^2$值 value 10.128 0.125 81.274 0.237 P值 value 0.001 0.723 ＜0.001 0.627 早餐 Have breakfast 从不 Never 54(1.6) 15 39 12 42 42 13 9 45 偶尔 Occasionally 773(22.3) 214 559 174 599 563 210 65 708 每天 Everyday 2 633(76.1) 749 1 884 648 1 985 1 383 1 250 188 2 445 $\chi^2$值 value 0.178 1.548 108.475 7.857 P值 value 0.915 0.461 ＜0.001 0.020 吸烟 Smoking 从来不吸 Never 3 345(96.7) 937 2 408 790 2 555 1 924 1 421 239 3 106 一般 Usually 89(2.6) 32 57 35 54 51 38 16 73 经常 Often 26(0.7) 9 17 9 17 12 14 7 19 $\chi^2$值 value 3.218 13.276 1.364 28.551 P值 value 0.200 0.001 0.506 ＜0.001 体育锻炼 Physical exercise 很少 Rarely 1 863(53.8) 521 1 342 427 1 436 1 112 751 134 1 729 一般 Usually 1 150(33.2) 304 846 290 860 666 484 94 1 056 经常 Often 447(13.0) 153 294 117 330 209 238 34 413 $\chi^2$值 value 9.821 3.254 24.828 0.979 P值 value 0.007 0.196 ＜0.001 0.613 人工流产情况/次 Abortions conditions/times 0 2 354(68.0) 576 1 778 550 1 804 1 602 752 168 2 186 1 568(16.5) 213 355 141 427 195 373 53 515 2 447(12.9) 155 292 117 330 156 291 29 418 ≥3 91(2.6) 34 57 26 65 34 57 12 79 $\chi^2$值 value 53.394 2.905 340.447 7.998 P值 value ＜0.001 0.407 ＜0.001 0.046 
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表 2 二元logistic回归分析模型变量赋值
Table 2. Variable assignments of binary logistic regression analysis
自变量 Independent variable 赋值 Assignment 年龄/岁 Age/years ＜25=1; 25~＜35=2; 35~＜45=3; 45~＜55=4; ≥55=5 户籍 Household registration 农村=1; 城市=2 Rural areas=1; Urban areas=2 文化程度 Education level 小学及以下=1; 初中=2; 高中或中专=3; 大专=4; 本科=5; 硕士研究生及以上=6
Elementary school and below=1; Secondary school=2; High school or technical secondary school=3; Junior college=4; Undergraduate=5; Master′s degree or above=6职业 Occupation 公职人员=1; 企业人员=2; 医疗卫生人员=3; 学生=4; 无工作人员=5
Civil servant=1; Enterprise employee=2; Medical staff=3; Student=4; No staff=5婚姻 Marital status 未婚=1; 已婚=2; 其他(离异、分居、丧偶等)=3 Not married=1; Married=2; Other (divorce, separation, widowhood, etc)=3 家庭人均年收入/万元 Annual per capita household income/10 000 yuan ＜1=1; 1~＜2=2; 2~＜3=3; 3~＜5=4; 5~＜10=5; ≥10=6 女性疾病患病情况 Prevalence of women′s diseases 否=0; 是=1 No=0; Yes=1 早餐 Have breakfast 从不=1; 偶尔=2; 每天=3 Never=1; Occasionally=2; Everyday=3 吸烟 Smoking 从来不=1; 一般=2; 经常=3 Never=1; Usually=2; Often=3 体育锻炼 Physical exercise 很少=1; 一般=2; 经常=3 Rarely = 1; Usually = 2; Often = 3 人工流产情况 Abortions conditions 0=1; 1=2; 2=3; ≥3=4
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表 3 宫颈癌防治知信行多因素分析
Table 3. Multivariate analysis of knowledge, attitude and behavior of cervical cancer prevention and treatment
因变量 Dependent variable 自变量 Independent variable β值 value sx Wald $\chi^2$值 value OR值 value (95% CI) P值 value 防治知识 Prevention and treatment knowledge 年龄/岁 Age/years -0.305 0.041 55.933 0.737(0.681~0.799) ＜0.001 文化程度 Education level 0.278 0.041 46.215 1.321(1.219~1.431) ＜0.001 职业 Occupation 公职人员 Civil servant 1.000 企业人员 Enterprise employees 0.154 0.103 2.218 1.166(0.953~1.429) 0.136 医疗卫生人员 Medical staff 0.990 0.116 72.706 2.690(2.143~3.377) ＜0.001 学生 Students 1.136 0.149 57.739 3.114(2.323~4.174) ＜0.001 无工作人员 No staff 0.367 0.162 5.132 1.444(1.051~1.984) 0.023 家庭人均年收入/万元 Annual per capita household income/10 000 yuan 0.098 0.025 15.832 1.103(1.051~1.158) ＜0.001 常数 Constant -1.171 0.262 19.996 0.310 ＜0.001 防治态度 Preventive and treatment attitude 年龄/岁 Age/years -0.329 0.044 55.264 0.719(0.660~0.785) ＜0.001 文化程度 Education level 0.187 0.043 18.676 1.206(1.108~1.313) ＜0.001 职业 Occupation 公职人员 Civil servant 1.000 企业人员 Enterprise employees 0.184 0.117 2.474 1.202(0.956~1.512) 0.116 医疗卫生人员 Medical staff 0.483 0.136 12.532 1.621(1.241~2.118) ＜0.001 学生 Students 0.329 0.176 3.484 1.389(0.984~1.962) 0.062 无工作人员 No staff 0.283 0.167 2.889 1.327(0.958~1.840) 0.089 家庭人均年收入/万元 Annual per capita household income/10 000 yuan 0.082 0.027 9.006 1.085(1.029~1.145) 0.003 吸烟 Smoking -0.406 0.157 6.664 0.666(0.490~0.907) 0.010 常数 Constant 1.158 0.336 11.880 3.185 ＜0.001 筛查行为 Screening behavior 年龄/岁Age/years 0.150 0.051 8.578 1.161(1.051~1.284) 0.003 户籍 Household registration 0.388 0.092 17.611 1.474(1.230~1.767) ＜0.001 职业 Occupation 公职人员 Civil servant 1.000 企业人员 Enterprise employees 0.019 0.103 0.034 1.019(0.832~1.248) 0.854 医疗卫生人员 Medical staff 0.610 0.130 22.106 1.840(1.427~2.372) ＜0.001 学生 Students -0.277 0.237 1.365 0.758(0.477~1.206) 0.243 无工作人员 No staff -0.469 0.153 9.349 0.626(0.463~0.845) 0.002 婚姻状态 Marital status 未婚 Not married 1.000 已婚 Married 2.117 0.152 193.396 8.306(6.164~11.194) ＜0.001 其他(离异、分居、丧偶等) Other(divorce, separation, widowhood, etc) 2.349 0.282 69.444 10.480(6.031~18.212) ＜0.001 家庭人均年收入/万元 Annual per capita household income/10 000 yuan 0.108 0.027 16.541 1.114(1.058~1.174) ＜0.001 女性疾病患病情况 Prevalence of women′s diseases 0.279 0.075 13.973 1.322(1.142~1.530) ＜0.001 早餐 Have breakfast 0.353 0.097 13.333 1.423(1.178~1.720) ＜0.001 体育锻炼 Physical exercise 0.176 0.060 8.686 1.192(1.061~1.340) 0.003 人工流产情况/次 Abortions conditions/times 0.212 0.051 17.232 1.237(1.119~1.367) ＜0.001 常数 Constant -5.058 0.348 210.893 0.006 ＜0.001 筛查意愿 Screening willingness 年龄/岁 Age/years -0.275 0.054 25.657 0.760(0.683~0.845) ＜0.001 家庭人均年收入/万元 Annual per capita household income/10 000 yuan 0.125 0.039 10.364 1.133(1.050~1.223) 0.001 早餐 Have breakfast 0.330 0.132 6.273 1.390(1.074~1.800) 0.012 吸烟 Smoking -0.818 0.182 20.268 0.441(0.309~0.630) ＜0.001 常数 Constant 2.806 0.434 41.819 16.541 ＜0.001
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表 4 宫颈癌防治知信行的共同影响分析
Table 4. Common impact analysis of knowledge, attitude and behavior of cervical cancer prevention and treatment
因变量 Dependent variable 自变量 Independent variable 否 No① 是 Yes ① OR值 value (95% CI) P值 value 筛查行为 Screening behavior 防治知识 Prevention and treatment knowledge 不了解 Unknow 577(59.0) 401(41.0) 0.956(0.815~1.122) 0.583 了解 Know 1 410(56.8) 1 072(43.2) 防治态度 Preventive and treatment attitude 不积极 Inactive 520(62.4) 314(37.6) 1.231(1.040~1.457) 0.016 积极 Active 1 467(55.9) 1 159(44.1) 筛查意愿 Screening willingness 否 No 193(73.7) 69(26.3) 2.095(1.567~2.800) ＜0.001 是 Yes 1 794(56.1) 1 404(43.9) 筛查意愿 Screening willingness 防治知识 Prevention and treatment knowledge 不了解 Unknow 155(15.8) 823(84.2) 3.170(2.414~4.163) ＜0.001 了解 Know 107(4.3) 2 375(95.7) 防治态度 Preventive and treatment attitude 不积极 Inactive 134(16.1) 700(83.9) 2.642(2.015~3.465) ＜0.001 积极 Active 128(4.9) 2 498(95.1) 注：①以人数(占比/%)表示。
Note: ① Number of people(proportion/%).
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