| Backgrounds:In recent years,traditional Chinese medicine(TCM) has been constantly challenged,and it seems that the existence and development of TCM appear crisis.The main reasons includes:①The current evaluation of TCM effect only covers the therapeutic function of Chinese medicine or acupuncture, without considering the entire effect of TCM;②The evaluation of TCM effect applied the laboratory examination standards that western medicine often used in treatment,various kinds of physiological and biological indexes;③TCM effect was just evaluated under the biological medical model.The holistic concept of TCM emphasizes the harmony between man and universe,which believes that human being is an organic whole,man and the nature are unified.The holistic concept not only remarks on using medicine to deat with diseases, but also places emphasis on applying prevention,health cultivation, rehabilitation,exercise,dietary care and psychological adjustment to protect the health of people.Therefore,the evaluation of TCM effect should not stopped at the estimation of treatment,while synthetic evaluation should be performed on the effect of the overall measures of TCM.This kind of synthetic evaluation is the integrated measurement of human body' s health, which should consist of the aspects of psychology,physiology and social accommodation.For this reason,we take quality of life as the synthetic evaluation system.Nowadays,the specific apptication that could indicate the hotistic concept of TCM is the community health work with TCM characteristics, and the evaluation of the effect of TCM community is able to reflect the overall function of TCM.Community health work with TCM characteristics includes the dissemination of TCM knowledge,TCM prevention,health care measures and spread of appropriate techniques,as well as TCM related diet and health cultivation intervention,and all of these are in accordance with the dissemination of health knowledge by modern health education,cultivation of the faith of performing health behaviors,and the formation of a certain health behavior in the end.It is virtually the health education of TCM.With the theory of knowledge,attitude and practice(KAP) in modern health education, we studied the citizen condition of the knowledge,attitude and practice about TCM(TCM KAP) after the work of the community with TCM characteristics carries out,and SF-36 questionnaire of the quality of life was taken as the synthetic evaluation indexes for the health condition of community citizens,so as to estimate the effect of the holistic concept of TCM.The overall effect of TCM was discussed by analyzing the differences of quality of life among different crowds,on the aspects of various TCM knowledge,different TCM faith,whether use TCM health care and cultivation in daily life.Objective:1.An investigation questionnaire of TCM KAP was developed to measure community citizen the grasping extent in TCM knowledge,the faith and attitude to TCM, the frequency and habit of using TCM prevention,health care,rehabilitation, health cultivation,dietary care and body building method in daily life.2.The investigation questionnaire of TCM KAP was applied to investigate elder citizen' s situation of knowledge,attitude and practice about TCM in a certain national TCM model community of Liwan district and some ordinary community.3.The situation of the quality of life about the elder citizens in these two communities was investigated by SF-36 simple quality of life scale.4.The relation between TCM KAP and quality of life was analyzed,and suggestions were proposed for the sanitary institutions to further carry out TCM community work.Methods:1.The development of the investigation questionnaire of TCM KAP uses Delphi expert consultant method.After two series of expert consultation,on the basis of synthetically considering the expert' s positive coefficient,authority coefficient,concentration extent and coordination coefficient,the items of the investigation questionnaire of TCM KAP was screened and determined, reliability and validity evaluation of the definite questionnaire was performed,and the investigation questionnaire of TCM KAP was finally determined.2.The investigation applied the methods of typical survey and cluster random sampling survey.About 400 elder citizens in Hualin street community-National Model Community with TCM Characteristics in Liwan district,and an ordinary community-Jinhua street community were selected to participate the investigation.They were investigated by the investigation questionnaire of TCM KAP and SF-36 simple quality of life scale.3.The data of these two communities were statistically analyzed.With the comparison of the total scores of the investigation questionnaire of TCM KAP and the scores of knowledge,attitude and practice respectively between the two communities,the relation between TCM KAP and each influencing factor was discussed.The relation between quality of life and each influencing factor was explored by comparing the score conditions of SF-36 simple quality of life scale in the two communities.The relation between the score of the investigation questionnaire of TCM KAP and that of SF-36 simple quality of life scale was analyzed to discuss the further direction of TCM community work.Results:1.After two series of consultation with 30 experts,about 29 items were screened and determined as the final items of the investigation questionnaire of TCM KAP.After reliability and validity test,retest of reliability of the questionnaire,the Spearman correlation coefficient of the results of the two investigation were both bigger than 0.5,and the value of P is smaller than 0.01.The total Cronbach' s a coefficients of the questionnaire are 0.921, 0.955,0.901 and 0.963 respectively,and the mean is over 0.90.The split-half reliabilities are 0.864,0.853,0.787 and 0.872 respectively,and the mean is over 0.75.On the aspect of validity,the evaluation opinions of experts on the questionnaire were concentrated,which got the uniform agreement from the experts,so it has better content validity.Structure validity used the method of factor analysis,3 common factors were produced by factor analysis, all of which could explain 65.4%of the population variance,and all the factor loading values belonged to the middle and high extent(≥0.4),and it indicates the structure validity is good.Both the reliability and validity of the questionnaire reach the requirement.2.The results of the investigation questionnaire of TCM KAP indicated that the correct rate of grasping TCM knowledge,faith and confidence on TCM,number of people using TCM health care methods and treatments in daily life of the elder citizens in TCM community were higher than those in the ordinary community.The three aspects of knowledge,attitude and practice of TCM are mutually affected,and all of them have the relation of linear correlation. The influences of various factors on the TCM KAP were further discussed,after Logistic regression analysis,it was found out that,on the aspect of the total score of TCM KAP,the OR value that higher than the mean in TCM community was 15.27 times of that of the ordinary community,female was 3.31 times of male, and the total score of the TCM KAP among citizens with 2 to 5 thousand income is higher.The Logistic regression analysis of all the influencing factors and knowledge,attitude and practice of TCM indicated that the people in TCM community with middle to low income(below 1 thousand yuan,1-2 thousand yuan, 2-5 thousand yuan),more than 10 years of habitation in Liwan district,and age from 60 to 70,the score of knowledge was higher.The elder citizens in TCM community are better than the ordinary community on the aspects of faith and attitude to TCM,TCM related behaviors in daily life(The OR value of the attitude part that is over the mean in TCM community is 20.77 times of that of the ordinary community,and the OR value of the practice part that is over the mean in TCM community is 3.29 times of that of the ordinary community.)3.The results of SF-36 simple quality of life scale showed that the quality of life score of the elder citizens in TCM community was higher than that of the ordinary community on the aspects of physiological functional authority, overall health,energy,feeling function and body pain,the total score of the quality of life was also higher than that of the ordinary community.The Logistic regression analysis indicated that the score of people in TCM community,elder females,with undergraduate degree,is higher.TCM is also the influencing factor to the score of physiological functional authority, feeling function and body pain,whose OR values are higher than those in the ordinary community.Maybe it is due to the reason that the elders in TCM community accepted more effects from TCM cultures,grasped some methods of TCM to adjust their psychology,as well as practice body buildings more frequently in daily life,such as Tai Ji Quan,Tai Ji Jian,Qi Gong,etc,their feeling problems were relatively less,and the effect of pain to the body was little,comparing with the ordinary community.4.The statistical analysis of the relation between the score of the investigation questionnaire of knowledge,attitude and practice about TCM and each score of SF-36 quality of life scale indicated that,among the eight dimensions in quality of life,the scores of physiological functional authority,overall health,energy,social function,emotional health and body pain have linear correlation with the total score of knowledge,attitude and practice.The total score of quality of life and each part of knowledge, attitude and practice in the investigation questionnaire of TCM RAP were performed the relative analysis of Pearson respectively,which showed that the total score of quality of life has positive correlations with knowledge, attitude and practice about TCM respectively.The typical correlation analysis manifested that the higher score of attitude and practice,the higher score of each item in quality of life.Further analysis indicated that the people with higher score of attitude about TCM,the higher score of physiological functional authority,social function,emotional health and body pain in quality of life,which could be drew to the conclusion that the person that was more willing to accept TCM treatment,their score of body pain would be higher(counting the score conversely,the extent of body pain is lighter). Therefore,their quality of life is better.On the aspect of behavior,the people that used more health behavior and health care methods of TCM have higher scores on physiological function,energy,social function,emotional health and body pain in quality of life.Conclusion:1.The items of the investigation questionnaire of TCM KAP was screened and determined by Delphi expert consultation method,and it met the requirements after reliability and validity evaluation,which could be taken as the tools to measure the TCM knowledge,faith and behavior investigation for community citizens,as well as the spread in the future work.2.The grasping extent of the eider citizens in the community with TCM characteristics-the community work adopted the holistic concept of TCM was better than that of the ordinary community,and they are more confident in TCM,and more willing to accept the measurements and methods of TCM treatment, health care,rehabilitation,health cultivation,dietary care and body building.In daily life,comparing with the elder citizens of ordinary community,those in TCM community use health care and dietary care methods of TCM more frequently,they accepted more therapeutic methods of TCM, furthermore,they often practice the body building arts of TCM,and use the psychological adjustment ways of TCM.It also reflects the work of TCM spreading in the community with TCM characteristics,the influence on the citizens in TCM knowledge,faith and attitude exceeds that of the ordinary community,which indicated the effort and effect of work.3.As to the elder citizens in the TCM community,the total score of SF-36 simple quality of life scale,as well as the score of physiological functional authority,overall health,energy,feeling function and body pain respectively, was higher than that of the ordinary community,and it indicated that the health condition of the elder citizens in TCM community was better than those in the ordinary community if quality of life was taken as the final evaluation index. It also reflects that the application of the holistic concept of TCM makes the elder citizen' s quality of life better than those in the ordinary community to some extent,which proves the effect of the application of TCM holistic concept is affirmative,and its influence on quality of life is positive.4.The statistical analysis of the relation between the score of the investigation questionnaire of TCM KAP,and that of SF-36 simple quality of life scale indicated that TCM community has positive influences on the total score of quality of life,the score of physiological function,physiological functional authority,feeling function and body pain respectively,which means it can enhance the overall quality oflife,improve the physiological function, physiological functional authority,feeling function and body pain.5.The shortcoming and insufficiency of cross-sectional study is that its demonstration power of the inference of causal relationship is relatively poor, therefore,the results in the comparison of quality of life between TCM community and Not-TCM community would be more persuasive,if random control or prospective cohort study could be used in the further researches,indexes of TCM work with more standard and quantification were applied for the intervention design,and the intervention factors were controlled.Finally, the qualities of the citizens in TCM community and Not-TCM community were compared,and the results would be more persuasive.
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