Intervention Study On Voluntary Of Chinese Premarital Medical Examination

BackgroudPremarital medical examination (PME), as the primary prevention measures, used to protect maternal and child health, to reduce birth defects and improve the quality of birth. China introduced the new regulations on marriage registration in2003, and put a start to the voluntary PME. Since then the number of couples undergoing PME had dropped drastically nationwide, but the disease detection rate was still in slow rising, so this grim phenomenon had became the thorny issue of marriage and childbearing care. In order to save the shrap decline rate of PME, the policy of free of charge was carry out in some provinces and had achieved a certain effect. But the situation of PME remained far worse than the mandatory period, and a lot of couples did not appreciate free PME. Plus, local governments were blind pursuit increasing the rate of PME after the free charge policy, but the actual implementation results of PME were not satisfactory. Couples were not truly realize the importance of PME, they didn't care about their examine results at all. So the PME rate was more important than results, and these phenomenon were contrary to the purpose of primary prevention measure of birth defects. Therefore, the marriage and childbearing care urgent was needed to explore useful comprehensive interventions to let more couples attend PME voluntary, took serious on their examine results and improved the actual effect of PME.AimThis study chose Zhejiang Province as a sample. Based on the prior survey and qualitative data, this study was designed the interventions of PME voluntary behaviors under the guidance of health behavior theory. With implemented these interventions, we hoped to improve the actual effects of PME, evaluated the intervention effects, analysed the path between intervention and voluntary behaviors, and provided related suggestions.MethodsThis study used qualitative and quantitative methods to collect data. Firstly, we interviewed20couples who did not participate in PME,20couples who had participated in PME, and5managers and doctors of PME. Then was designed the comprehensive intervention plan for voluntary behaviors of PME. Secondly, this study selected the Marriage Registry of G as the site of intervention, and the whole intervention was carry out during June to October in2011. Couples were intercepted at the site, which were preparing for marriage registration but had not yet participated in PME. This study investigated a total of458couples, and228couples in intervention group and230couples in control group. Intervention group and control group populations by factors such as age, education, occupation, monthly income to match. Intervention group was carried out a series intervention, while the control group was only carried out routine work. Chi-square analysis was used to compare the differences on each dimension of voluntary behaviors of PME, Poisson regression was used to analysis the influence factors of PME, structural equation modeling was used to explain the path between interventions and voluntary behaviors, and cost-effectiveness analysis was used to assess the intervention programs.Intervention planBased on the site observations and qualitative data analysis, this study designed the specific interventions mainly from attitudes (benefits and barriers), perceived threat (perceived susceptibity, perceived seriousness), subjective norm. The whole intervention plan was designed by the guidance of Intervention Mapping and health behavior theory. This study used the form of face to face to intervene couple's behavior intentions, try to change the voluntary behaviors and improve the effects of PME.ResultsFrom the qualitative analysis of results, the study was found current problems in PME. Firstly, the department of civil affairs and premarital emphasised on PME rate, and ignored PEM results; Secondly, deliberately simplified the PME project and consulting guidance; Thirdly, PME results were not sharing information, and also lack of follow up; Fourthly, the education ways of doctors were not professional; Fifthly, the attention and consciousness degree of couples needed to be improved. The cognitive attitudes of couples were as follows. Firstly, couples had a comprehensive understanding on PME benefits; Secondly, there exist two barriers,"busy work" and "complex examine items", in couple's mind to participate in PME. And couples had a barrier with "busy work and no time to get results" on getting PEM report; Thirdly, couples agreed to participate in PME on the subjective attitude, but still needed further help to establish a more positive behavior attitude, and corrected errors that they confuse the PME and physical examination; Fourthly, couples with lack of knowledge about diseases, could make them not take serious on the possible consequences; Fifthly, the way that doctors educate couples in site was generally accepted.From the quantitative analysis of results, this study found out as follows. Firstly, the intervention group had a higher average score on benefits, barriers sense, behavior attitude, perceived susceptibility, and perceived severity than control group. The two groups had a statistically significant difference. There was no significant difference between men and women in composition of each variable. Secondly, the results of Poisson regression on PME voluntary behavior intentions showed that, couples with lower barriers and more positive behavior attitudes could have more strongly behavior intention. Thirdly, the results of Poisson regression on PME voluntary behavior showed that, couples with more positive behavior attitudes and perceived threat were more likely to take practical action. Fourthly, factors, like gender, age, education, occupation and income, had no correlation with PME voluntary behavior intention and behavior. Fifthly, the results of structural equation modeling analysis showed that interventions can increase benefits, perceived susceptibility and perceived severity, and reduce barriers. The interventions could promote couples concerned about their PME results and take the result report timely. Sixthly, interventions, behavior attitudes and perceived threat played a direct impact on couple's behavior intentions. Interventions, behavior intentions played a direct impact on couple's behavior. Seventhly, couple's behavior in control groups was mainly determined by benefits, and in intervention groups was by behavior intentions. Behavior attitudes and perceived threat could play a direct impact on behavior intentions. Eighthly, interventions played a direct impact on behaviors, barriers, perceived susceptibility and perceived severity in both males and females. And the impacts on female's benefits, barriers and perceived susceptibility were slightly larger than males, but the impacts on male's perceived severity were slightly larger than females. Ninthly, this intervetion program had a good economic effect.ConclusionAfter implementing interventions of voluntary behaviors on PME, the cognitive level of couples could be improved, and the positive behavioral intention chould be established. Plus, these interventions were increasing the rate of PME and the behavior of getting results, and also improved the actual effects of PME. These effect interventions could provide a reference for the current marriage and childbearing health care.