Mechanism Of Health Behavior Change Of Primary Health Workers In Rural China

[Purpose]Objectives:This thesis aims to establish the mechanism of the health behavior change of the health workers and interpret the regulation of the health behavior change of the basic health workers in rural areas based on the research of health integration factors.The intervention trail was conducted to validate the validity of the mechanism.[Methods]The mechanism of the health behavior change of health workers was constructed by using the Citespace and systematical analysis.The qualitative analysis of the "123 team"workers by using Behavior Investigation in Qianjiang,to clarify the intervention aims and measures.This thesis clarifies the trial's hypotheses and draws the intervention paths under the guidance of the theory of change.This thesis also establishes the assessment indexes of the readiness of change in health integration based on the theory of readiness of change for grouping according to the ranking of readiness of change.The Chi-square test was adopted to analyze the basic conditions and the homogeneity of the control and intervention groups.This thesis makes the scale of planning behavior of health workers by using the theory of planning behavior(TPB).The control and intervention groups were monitored and assessed by adopting the qualitative and quantitative methods.The change of indexes was tested by using T test and the increment of significant changed indexes was analyzed by using group T test or U test to manifest the effectiveness of intervention.Last,the causes and effects among the behavior attitude(BA),the subjective norm(SN),the perceived behavior control(PBC),the behavior intention and the behaviors were verified by adopting the Partial Least Squares(PLS).[Results]In this study,the behavior of individual service,the information utilization and the information exchange between the township hospital workers and village doctors were promoted by using the intervention measures of education,economic encourage and institutionalized.Comparing with the control group,the township health workers of the intervention group provided 16 more times of individual service,enhanced 4.92 scores in information utilization,and enhanced 4.24 scores in information feedback.Comparing with the control group,the village health workers of the intervention group provided 2 more times of individual service,enhanced 3.36 scores in information utilization,and enhanced 4.64 scores in information feedback.The results of behavior intervention,the key influencing factors of the behaviors and the mechanism verification of the health workers indicated that there were good convergent and discrimination validity of the individual service,the information utilization and information exchange model between the township and village health workers.Given the township health workers,the path coefficient between the individual service intervention and the SN was 0.257,between the SN and the behavior intention was 0.287,between the behavior intention and behavior was 0.451.The path coefficient between the individual service intervention and the PBC was 0.436,between the PBC and the behavior was 0.256.The path coefficient between the information utilization and the BA was 0.392,between the BA and the behavior intention was 0.412,between the behavior intention and the behavior was 0.347.The path coefficient between the information exchange and the SN was 0.398,between the SN and the behavior intention was 0.427,between the behavior intention and the behavior was 0.463.There was a significant relationship existing between the information exchange and the PBC of the township health workers,and the path coefficient was 0.186.The relationship existed between the PBC and the behaviors,and the path coefficient was 0.179.Given the village health workers,the path coefficient between the individual service intervention and the SN was 0.235,between the SN and the behavior intention was 0.210,between the behavior intention and the behavior was 0.326.The path coefficient between the individual service intervention and the PBC was 0.351,between the PBC and the behavior was 0.446.The path coefficient between the information utilization and the BA was 0.381,between the BA and the behavior intention was 0.357,between the behavior intention and the behavior was 0.252.The path coefficient between the information utilization training and the SN was 0.189.The path coefficient between the information exchange and the SN was 0.443,between the SN and the behavior intention was 0.412,between the behavior intention and the behavior was 0.473.The path coefficient between the information exchange and the PBC was 0.196.[Conclusions&Suggestions]Conclusions:Health behavior change is the necessary condition of health integration.The cause and effect among the behavior attitude,subjective norm,perceived behavior control,behavior intention and behavior of the basic health workers exist.The health workers' behaviors change can be promoted by the behavior intervention.Different people have different actions and intensity in behavior attitude,subjective norm,perceived control and behavior intention.The feasibility intentionality,pertinence and effectiveness of the health integration can be improved as the guide of health workers' behavior change.Suggestions:It should consider the health worker integration and the health behavior change as the guide of policy in health integration policy making,implementing and evaluation,for designing and intervening the health integration.The behavior change of the health workers should to be the basic target in making policy.A full consideration of the rule of health workers' behavior change should be taken,and using the four intervention measures of health worker integration to make the intervention and support measures of the health worker intervention.The progress of the health workers' behavior change should be monitored during the policy implementation to realize the thought of health workers,adjust the measures,and guarantee the health workers' behavior change.The experiences should be refined during the policy making and promoting to provide reference for the other areas.[Innovation&Limitation]Innovation:Drawing on the TBP not only established and verified the mechanism of health behavior change of the health workers in line with the reality of rural China,but also provided new ideas and measures of health integration practice in rural China.Besides,the theory of change and theory of health change readiness were used to guarantee the scientific results during the intervention trial and provided new ideas of design,implementation and assessment of other similar health intervention trails.Limitation:In this study,the objective was the primary health workers,and the town was the least intervention unit,the health behavior of the health worker integration between the township and villages by using complex intervention measures.Considering the limits of time and cost,a quasi-experiment instead of the group random experiment was used in this study.Besides,due to the shortage of intervention time(9 months),even the second-stage intervention trail will be continued,which will be collected more data and information(the continuous tracking of health workers and the satisfaction of the residents)to develop a deeper research in verifying the mechanism of health behavior change of health workers.