| BACKGROUD AND AIMSIn recently, with the improvement of living standards as the result of the development of social and economic, and the acceleration of the aging process of the population, disease spectrum and cause of death spectrum in China have been changing. Chronic non-communicable disease (CND) problems have become increasing serious and the corresponding prevalence rate has increased rapidly. Chronic non-communicable diseases have been the main cause of death in China, the serious socio-economic burden, and one important factor of becoming poor or returning to poverty caused by diseases for family and the community involved.Compared with urban, the increase of prevalence of CND in rural was more rapid in recent years. According to the data of Nutrition and Health Survey of Chinese residents in 2002, the prevalence rate of CND was 19.3% in urban and 18.6% in rural respectively, the difference between them has been becoming increasingly small. Owing to the low level of health consciousness, bad health knowledge, insufficiency of medical services and insurance, the rural residents' rates of awareness, treatment and control about CND are much lower than that of urban counterparts. Consequently, CND brings more bad influence for rural residents. In addition, relatively lower income and insurance coverage among rural population have resulted in more heavy financing burden of chronic diseases, and more family's economic crisis caused by chronic illness. Therefore, it is very imperious and necessary to strengthen chronic disease prevention and control in the rural areas. Community and population intervention measures have been recognized as the most effective and economic strategy in the prevention and control of chronic disease by the World Health Organization and many countries. As the basis for community intervention, promoting health has an irreplaceable role in the community general prevention and treatment of chronic diseases.The aims of this study are to comprchensively and systemically analyze relevant chronic disease knowledge and the level of behavioral risk factors of rural residents in Shandong Province, to elucidate the factors influencing the level of risk factors on the aspect of life and behavior, to discover the key population for health promotion and corresponding intervention direction and measures, to bring forward to the corresponding health promotion strategies of strengthening chronic disease prevention and control for rural residents, and finally to improve rural residents health knowledge and cultivate good health behavior, reducing the morbidity of chronic diseases, to increase the control rate of chronic diseases, and to improve the overall health level of rural residents.METHODSThis study mainly used quantitative data analysis methods. Eight sample counties (cities, districts) were selected from the western and central Shandong Province according to the level of socio-economic development and geographical location by the multi-stage stratified random sampling method. Two sample townships were selected from each sample county (city and district) by the principle of random sampling, two villages were selected randomly from each sample township, each household was sampled by a systematic sampling method according to the roster of head of the household at each village, and all the resident population aged 25 and over were interviewed at the selected families. Total 20,087 people from 10,287 families at 40 villages were interviewed. Questionnaires were used to investigate the socio-economic indicators and the status of prevalence of chronic diseases; related health knowledge and access to health education in the field of chronic diseases; the level of behavioral risk factors of chronic patients; and the state of diseases, the level of relevant knowledge and health seeking behavior. The data used in this study mainly come from existing literature and the above household survey. Data collecting of household survey were completed by postgraduates from the Center for Health Management and Policy of Shandong University under the supervision of their teachers. The SPSS13.0 was used to analyze the data. The descriptive statistical analysis, single factor analysis and multiple logistic regression analysis were the main analysis methods.RESULTSThe level of chronic disease knowledge of rural residents was very low. As for the score of chronic disease knowledge, 48.8% of respondents got 0 score. Rural residents had low willingness of learning health-related knowledge because there were only 49.4% of respondents who want to know relevant chronic disease knowledge. The proportion of learning initiatively health knowledge was also low because there were only 33.0% of respondents who often initiatively acquire health knowledge. Socio-economic factors had statistically significant influence on the level of health knowledge, willingness of learning and behavioral risk factors of rural chronic patients. Women, low level of income, low level of education, the elderly, and the self-evaluation low social status had relatively bad status in mastering and acquirement to the health knowledge.The biggest hope for rural residents on the acquiring the health knowledge type of chronic diseases was disease prevention knowledge. The main approaches that rural residents acquire health knowledge include TV and doctors. Relative to total survey populations, female, low income, the elderly, illiterate and semi-illiterate populations seldom got health knowledge through TV, doctors, especially newspapers and periodicals, but mainly through their family. The first two approaches according to priority ranking made by interviewees on the approaches that they like best to obtain health knowledge were the same among every population group, i.e. doctors and TV. Relative to general population, female, low income, the elderly, illiterate and semi-illiterate populations had lower demands for some approaches, such as TV, newspapers, periodicals, books and brochures in order to get health knowledge. However, these populations had higher demands for other approaches, such as broadcast, relatives and friends, and family in order to get health knowledge. Broadcast was ranked 3rd among the approaches that these populations like best. Relative to existing approaches, rural residents hoped to more utilize some approaches that have high authority and reliability, such as doctors, newspapers, periodicals and books, broadcast and brochures. On the contrary, they hoped to reduce the utilization on other approaches that are informal and unreliable, such as TV, colleagues and friends, and family in order to get health knowledge. The gap between supply and demand for getting health knowledge through doctors was the biggest.The levels of behavior risk factors related to chronic diseases among rural residents in Shandong province are relatively high. The smoking rate was 32.3% (male, 65.6%; female, 4.5%); the proportion lack of sleep was 12.4%, and the proportion with hypersomnia was 29.1%; the proportion with over four-hour static activities every day reached 25.3%; the proportion with regular physical exercises was only 2.9%; the consumptions of vegetable, fruit, fish and prawn, livestock and poultry, milk and legume weren't enough, while the consumptions of grease, grain and salt were too excessive, and the proportion with excessive fat consumption was 27.4%; the proportion lack of vegetables was 72%, and the salt consumption among 91.5% of the survey population exceeded the standard recommended by WHO (6g/day); the proportion with high-risk drink behaviors reached 9.3% (male, 18.9%; female, 1.9%).There were statistical differences for the effects of demographic and social-economic factors, health knowledge levels and health status on different behavior risk factors. The life and behavior styles of women, old people, low-income people and low education-level people are usually bad for their health status. For example, passive smoking, lack of vegetables, excessive or lack of sleep, lack of physical exercises, etc., often appear in these populations. However, some common behavior risk factors (for example, high-fat diet and high-risk drinking) also appear in those people with high knowledge level, high income and high social class. Mastering health knowledge has positive effects on the formation of health behaviors, while mastering health knowledge doesn't mean the necessary formation of health behaviors. Usually, if rural residents know that they have suffered chronic diseases or perceive bad health status, they will change such unhealthy life and behavior styles as smoking, high-risk drinking, etc., but such problems as high-fat diet and excessive static activities will also easily appear.The levels of rural self-reported chronic patients' knowledge about their disease conditions were very low; they were lack of related prevention and disease control knowledge; and they did badly in following the doctors' directions to change life and behavior styles and regularly take medicine. The education level, complications, the course of diseases, the grade of scores of hypertension related knowledge, and the willingness and behaviors to gain health knowledge were significant factors that influenced self-reported hypertension patients' knowledge about their disease conditions. Those people with higher education-level, complications, longer course of diseases and higher-score of hypertension related knowledge knew better about their own diseases. The income level, sex, education level, self-perceived health status, complications, the course of diseases, and the willingness and behaviors to gain health knowledge were significant factors that influenced self-reported hypertension patients' mastering hypertension related knowledge. The male, higher education-level, younger, higher income-level, or longer course-of-diseases self-reported patients had higher-level hypertension related knowledge.The male, older, or higher education-level self-reported patients did better in following the doctors' directions to change life and behavior styles; the main reasons that self-reported patients didn't follow the doctors' directions to change life styles included " can't change long-term customs" and "perceive only mild symptoms, so unnecessary". The age group, self-perceived social class, self-perceived health status, score of knowledging about one's own disease, and with or without complications are significant factors that influenced self-reported hypertension patients' following doctors' directions to regularly take medicine. Those people, who were older, had higher self-perceived social class, knew more about their own diseases, had complications and had worse self-perceived health status, were of greater possibility to follow doctors' directions to take medicine regularly. The main reasons that the patients didn't follow doctors' directions to take medicine included "perceive only mild symptoms, so unnecessary'' and "financial difficulties".Policy implications1)Strengthen the organization and construction of rural communities, and carry out health promotion activities based on the whole population; 2)strengthen the health promotion activities aiming at the women, low-income and low-education-level people, and old people; 3)subdivide the objects of health promotion activities, and improve the pertinence of health promotion activities; 4)reform and improve the assessment and compensation mechanisms for primary medical institutions and their staff, and improve their enthusiasm of supplying health promotion services; 5) at first implement "small-scope and high-intensity" pilots and explorations, and improve and extend after achieving good experiences.
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