研究目的

       基于健康信念模型（Health Belief Model，HBM），调查鄂尔多斯市适龄女 性参加宫颈癌筛查的现状，并分析其影响因素；同时制定健康教育方案并在适龄 女性群体开展干预项目，评估干预在知识、信念和行为层面的有效性。

研究方法

       1. 鄂尔多斯市适龄女性宫颈癌筛查的现况调查及影响因素分析：2023 年 5 月至 8 月，本研究采用方便抽样的横断面调查方法，调查了鄂尔多斯市适龄女性 参加宫颈癌筛查的认知与行为现状，采用 Logisitc 回归分析女性对宫颈癌筛查的 知识水平与行为的影响因素。同时，本研究使用 HBM 量表调查了鄂尔多斯市女 性的健康信念情况，使用非参数检验比较不同人群的健康信念程度。此外，本研 究调查了适龄妇女参与宫颈癌筛查的途径和获取相关信息的途径，并使用χ 2检验 进行不同组别的比较。

       2. 鄂尔多斯市适龄女性宫颈癌筛查的干预及效果评价：2023 年 7 月，本研 究从鄂尔多斯市以方便抽样法招募研究对象进行基于HBM 理论模型的健康教育 干预。采用干预前后自身对比的研究设计，通过比较干预前与干预后研究对象的 宫颈癌筛查知识水平、健康信念程度以及参与情况来评估干预效果。其中，人口 学基本信息、知识水平、健康信念通过干预前和干预后立即进行问卷调查获得。 宫颈癌筛查的参与情况通过干预后第 6 个月电话随访获得。通过χ 2检验和 Logistic 回归比较干预前与干预后各指标的差异是否具有显著性。

研究结果

       1. 鄂尔多斯市适龄女性宫颈癌筛查的现况调查及影响因素分析：（1）本研 究共收集 6 174 份有效问卷，3 436 名女性曾参与过宫颈癌筛查，筛查参与率为 55.7%。在 35—64 岁女性中，筛查参与率为 65.7%；多因素 Logistic 回归分析结 果显示居住地、教育水平、职业、家庭月收入均与该年龄范围女性是否参与宫颈 癌筛查有关（p<0.05）。在 21—34 岁女性中，筛查参与率为 22.5%；居住地和 婚姻状况是影响该年龄段女性参加宫颈癌筛查的因素（p<0.05）（2）对 3 436 名参与过宫颈癌筛查的女性进行调查，结果表明政府提供的免费宫颈癌筛查是当 地女性参与宫颈癌筛查的最主要途径，其次为自费检查。（3）正确率较低的知 识条目有“宫颈癌早期可能不会有任何症状”（34.7%）、“男性不会感染人乳 头瘤病毒”（38.8%）、“没有症状的女性也要筛查”（46.4%）、“大部分女 性都可能会发生 HPV 感染”（47.9%）。Logistic 回归分析结果表明，居住地、教育水平、职业和家庭月收入是影响女性对宫颈癌筛查知识水平的相关因素 （p<0.05）。（4）大约 26%的调查对象曾通过传统媒体（如广播、电视、报纸 等）获取宫颈癌筛查相关信息，是最常见的信息渠道；其次为亲朋好友告知 （22.6%）。线性趋势χ 2检验结果表明，各信息渠道使用率均随着年龄增加而呈 现下降趋势（p<0.005）。（5）在所有研究对象中，健康信念各维度得分均优于 理论均值 3 分。秩和检验分析结果表明，感知易感性、感知益处、感知阻碍、自 我效能均与宫颈癌筛查行为（p＜0.05）及宫颈癌筛查的知识水平有关（p＜0.001）。

       2. 鄂尔多斯市适龄女性宫颈癌筛查的干预及效果评价：（1）共纳入 326 名 女性，基线时有 196 名（60.1%）女性在 5 年内未筛查。（2）对 326 名女性的知 识水平进行分析，干预后知识水平明显提升（p＜0.05）。χ 2检验结果显示，城市 女性的知识总分高于农村（p=0.020），汉族女性的知识总分高于少数民族 （p=0.037）。（3）干预后，各健康信念维度得分均显著改善（p<0.001），自 我效能得分的提升最少，仅提高 0.39±0.98 分，感知阻碍得分的降低幅度最大， 降低 0.72±1.47 分，其余维度得分提升均超过 0.60 分。（4）对 196 名基线未筛 查的女性进行分析，干预 6 个月后，有 107 名（54.6%）女性参加了宫颈癌筛查。 χ 2检验结果显示，不同年龄、居住地、婚姻状况、教育水平和职业的女性筛查参 与率有显著差异（p＜0.05）。（5）对 196 名基线未筛查的女性进行分层 Logistic 回归分析，结果表明在控制一般人口学因素后，感知易感性（p=0.033）、感知 严重性（p=0.033）、感知益处（p=0.031）、感知阻碍（p=0.020）是影响筛查行为的因素。

研究结论

       1. 鄂尔多斯市女性对宫颈癌筛查的认知水平和既往筛查情况较好，但仍有提升空间。农村及少数民族女性的知识水平和筛查参与率较低，应成为今后科普宣教和筛查动员的重点对象。

       2. 传统媒体和亲朋好友告知是鄂尔多斯市女性获取健康信息最重要的途径，在关注新媒体平台对健康信息应用的同时，鄂尔多斯仍应充分发挥传统媒体的作用。

       3. 以 HBM 为理论框架的干预方案可以显著提升女性宫颈癌筛查的知识水 平和实际行动，但仍需进一步的研究证实筛查率的提升有多少可以归因于健康教育干预。

Objectives

Based on the Health Belief Model (HBM), this study aims to investigate the status of cervical cancer screening knowledge and practice among eligible women in Ordos City and analyze the influencing factors. Simultaneously, this study will also develop health education programs and implement interventions to eligible women, then evaluate the effectiveness of interventions on knowledge, belief, and practice of cervical cancer screening.

Methods

1. Cervical cancer screening status and influencing factors among eligible women in Ordos City: This was a cross-sectional study using the convenience sampling from May to August in 2023, to investigate the status of eligible women's knowledge and behavior of cervical cancer screening. Logistic regression was used to analyze the influencing factors of women's knowledge and behavior towards cervical cancer screening. Meanwhile, this study measured the degree of health belief of women using the HBM scale. The comparison of health belief among different groups was conducted by non-parametric tests. In addition, this study investigated the approach to participation in the cervical cancer screening and the sources of related information, which were compared among different groups by Chi-square test.

2. Development and evaluation of a health education intervention for cervical cancer screening: This was a pre-post health education intervention based on HBM, which recruiting participants by convenience sampling in Ordos City in July 2023. To evaluate the effectiveness of the intervention, this study compared the knowledge, health belief, and the participation of cervical cancer screening. Demographic information, knowledge, and health belief were collected through questionnaires before and immediately after the intervention. The participation of cervical cancer screening was obtained by telephone in the 6th month after the intervention. Chi-square test and logistic regression were used to compare the effectiveness of intervention among different groups.

Results

1. Cervical cancer screening status and influencing factors among eligible women in Ordos City: (1) A total of 6,174 valid questionnaires were collected in this study, of which 3,436 had participated in cervical screening, with a screening rate of 55.7%. Among women aged 35-64 years, with a screening rate of 65.7%, the multi-logistic regression showed that that residence, education level, occupation and monthly household income were the relevant factors influencing women's participation in cervical cancer screening (p<0.05). Among women aged 21-34 years, with a screening rate of 22.5%, the multi-logistic regression showed that that residence and marital status were the relevant factors influencing women's participation in cervical cancer screening (p<0.05). (2) The survey of 3,436 women who had participated in cervical cancer screening showed that the free cervical cancer screening provided by government was the major approach of screening of local women, followed by screening at their own expense. (3)The knowledge items with a low correct rate included "Cervical cancer may not have any symptoms in the early stages" (34.7%), "Men can not get infected with HPV" (38.8%), "Women with no symptoms should also get screened" (46.4%), and "Most women may get HPV infection" (47.9%). The results of logistic regression showed that residence, education level, occupation, and monthly household income were influencing factors of women's awareness of practice (p<0.05). (4) The traditional media (radio, television, newspapers, etc.) was the main information resource of cervical cancer screening, with about 26% of the respondents had received health information through it, followed by friends and relatives (22.6%). The results of the linear trend Chi-square test indicated that the usage of each information source shows a decreasing trend with age (p<0.005). (5) Among all the respondents, the scores of health belief in all dimensions were better than the theoretical mean (3 points). The results of the rank sum test analysis indicated that perceived susceptibility, perceived benefits, perceived obstacles, and self-efficacy are related to cervical cancer screening (p<0.05) and knowledge level (p<0.001).

2. Development and evaluation of a health education intervention for cervical cancer screening: (1) A total of 326 women were included in to the study, with 196 (60.1%) women were not screened within 5 years. (2) The knowledge level of the 326 women was significantly improved after the intervention (p<0.05). Chi-square test results showed that the knowledge level of urban women was higher than that of rural (p=0.020), and Han Chinese women was higher than minority women (p=0.037). (3)After intervention, all dimension of HBM got improved significantly (p<0.001), with the least increase in self-efficacy scores by only 0.39±0.98 points, the greatest reduction in perceived obstacle by 0.72±1.47 points, and the rest of the dimension scores got improved by more than 0.60 points. (4) Analysis of 196 women who were not screened at baseline indicated that 107 (54.6%) women participated in cervical cancer screening 6 months after the intervention. Chi-square test showed there are differences in screening rates by age, residence, marital status, education level and occupation (p<0.05). (5) Stratified logistic regression analysis of 196 women who were not screened at baseline showed that perceived susceptibility (p=0.033), perceived severity (p=0.033), perceived benefit (p=0.031), and perceived obstacle (p=0.020) were the influencing factors on screening after controlling the demographic factors.

Conclusions

1. The knowledge level and screening rate of women in Ordos City are at a relatively high level, but still need improvements. With the lower knowledge level and screening rates, rural and ethnic minority women should be the focus of future health education and motivation for the cervical cancer screening.

2. Traditional media is the most important information source for women in Ordos to know about cervical cancer. While developing the social media platforms, Ordos should not ignore the influence of the traditional media.

3. Health education intervention based on the HBM can significantly improve women's knowledge and actual action on cervical cancer screening. But further research is still needed to confirm that the screening rate is still high. The programme can significantly improve women's knowledge and practical action of cervical cancer screening, but further research is still needed to analyze how much of the increase in screening rate could be attributed to the health education intervention.