| Objectives(1)To develop a scale of knowledge,attitude,and practice towards premarital examination and evaluate its validity.(2)To investigate the current situation of knowledge,attitude and practice towards premarital examination among unmarried adults in Haikou and its influence factors.(3)To analysis the trend of premarital examination and the status quo of diseases detected by premarital examination in Haikou in recent ten years.(4)To explore the relationship between premarital examination and knowledge,attitude and practice of residents in Haikou.Methods(1)Based on the conceptual framework of knowledge,attitude and practice,literature review,face-to-face interview and focus group discussion were used to develop the preliminary items of the scale of knowledge,attitude and practice towards premarital examination.Two rounds of consultation on the scale dimensions and items were conducted using Delphi methods by email.Item differentiation analysis and correlation coefficient method were used to analyze the items of the scale.Internal consistency reliability,split half reliability and test-retest reliability were used to test the reliability of the scale,and content validity and structure validity were used to test the validity of the scale.(2)The self-designed questionnaire and scale were used to investigate the existing circumstances and influence factors of knowledge,attitude and practice towards premarital examination among unmarried adults in Haikou.(3)Based on the data of marriage registration and premarital examination in Haikou from January 1,2007 to December 31,2017,the current situation of premarital examination and the diseases detected by premarital examination in Haikou in recent ten years were analyzed by using Joinpoint regression trend analysis.(4)Using the method of multi-stage stratified random sampling,eligible residents marriage registration from 2010 to 2016 were selected from four communities/villages in 2 districts of Haikou as the research objects.A retrospective survey was conducted by using the self-designed basic information questionnaire,Perceived Benefits Scale,Perceived Barriers Scale,the Chinese version of Cardiff Fertility Knowledge Scale and the Premarital examination knowledge,attitude and practice scale developed in this study.The logistic regression analysis was Using to explore the relationship between premarital examination knowledge,behavior and premarital examination.Results1.Preparation the scale of the knowledge,attitude and practice towards premarital examination(1)The knowledge,attitude and practice scale towards premarital examination developed in this study includes knowledge scale,attitude scale and practice propensity scale,with a total of 30 items.(2)The overall Cronbach’sαcoefficient of knowledge,attitude and practice scale towards premarital examination was 0.763,while that of each subscale ranged from 0.712 to 0.827.The split half reliability coefficient of the total scale was 0.741,while that of each subscale ranged from 0.739 to 0.789.The test-retest reliability coefficient of the total scale was 0.838,while that of each subscale ranged from 0.811 to 0.832.The validity of the contents of the total scale was 0.822.2.Current situation and influence factors of knowledge,attitude and practice towards premarital examination among unmarried adults in Haikou(1)According to the survey of knowledge,attitude and practice towards premarital examination from 1,022 unmarried adults,the average score of unmarried adults’premarital examination knowledge was 8.08±1.85(the total score was 16).The average score of premarital examination attitude was 3.59±1.55(the total score was 8).The average score of premarital examination practice propensity was 2.41±1.19(total score was 6).(2)Multiple linear regression analysis showed that age(b=0.628,P<0.001)and level of education(b=1.276,P=0.003)were the primary factors affecting the score of premarital examination knowledge.The score of premarital examination knowledge was lower among young people and people with low education level.Gender(b=0.244,P=0.011),age(b=0.314,P=0.027),level of educational(b=1.500,P<0.001),and premarital examination knowledge score(b=0.084,P=0.033)were the main factors influencing the score of premarital examination attitude.Men,young people,low education level and low scores of premarital examination knowledge have relatively negative attitudes towards premarital examination.The main factors influencing the practice propensity score of premarital examination included gender(b=0.168,P=0.020),age(b=0.223,P=0.039),level of educational(b=0.722,P=0.008),convenience for traveling(b=-0.652,P<0.001),score of premarital examination knowledge(b=0.420,P=0.001),and score of premarital examination attitude(b=0.326,P=0.001),etc.Men,young people,low education level,inconvenient transportation,premarital examination knowledge and attitude score have a weak propensity to premarital examination behavior.3.The trend of premarital examination in Haikou in recent ten years(1)From 2007 to 2017,a total of 304,756 people registered for marriage in Haikou,among whom 129,220 underwent premarital examination,with an average premarital examination rate of 42.4%.The premarital examination rate did not increased significantly from 2007 to2014(APC=8.8%,95%CI:-9.2%～30.5%),after 2014,the premarital examination rate was relatively stable,the decrease was not significant(APC=-11.2%,95%CI:-32.4%～16.6%).(2)The Joinpoint regression results of premarital examination rate for different characteristic groups found that the premarital examination rate of women increased significantly from 2007 to 2015(APC=4.9%,95%CI:4.1%～5.8%),the increase of the premarital examination rate from2015 to 2017 was not significant(APC=1.2%,95%CI:-3.9%～6.5%).The premarital examination rate of men increased significantly from 2007 to2014(APC=6.8%,95%CI:2.1%～11.7%),there was no significant change in the premarital examination rate after 2014(APC=-13.0%,95%CI:-38.9%～23.9%).The premarital examination rate of all age groups showed an inflection point in 2014,from 2004 to 2014,there was no significant increase in the 20-25-year-old group,the 26-30-year-old group and the group over 40 years old(APC=7.7%,95%CI:-1.2%～17.5%,APC=9.0%,95%CI:-1.4%～20.5%,APC=4.6%,95%CI:-2.6%～12.4%),from 2014 to 2017,the premarital examination rate of the three groups decreased significantly(APC=-15.4%,95%CI:-27.5%～-1.4%,APC=-20.1%,95%CI:-35.2%～-1.5%,APC=-26.1%,95%CI:-37.6%～-12.5%).The 31-40 year old group increased significantly from2007 to 2014(APC=9.9%,95%CI:0.1%～20.6%),the premarital examination rate decreased significantly from 2014 to 2017(APC=-15.9%,95%CI:-27.1%～-3.0%).The premarital examination rate in Longhua District increased significantly from 2007 to 2014(APC=13.1%,95%CI:7.2%～19.4%),and decreased significantly from2014 to 2017(APC=-10.9%,95%CI:-17.1%～-4.4%).The premarital examination rate in Meilan District increased significantly from 2007 to2013(APC=15.8%,95%CI:1.5%～32.1%),and there was no significant change from 2013 to 2017(APC=-15.5%,95%CI:-30.6%～2.9%).There was no significant change in the premarital examination rate in Qiongshan district from 2007 to 2017(APC=0.5%,95%CI:-7.0%～8.6%).The premarital examination rate in Xiuying District did not increase significantly from 2007 to 2013(APC=1.7%,95%CI:-21.6%～32.0%),but decreased significantly from 2013 to 2017(APC=-9.6%,95%CI:-23.0%～-6.0%).The premarital examination rate of primary school group and junior middle school group did not change significantly from2007 to 2013(APC=2%,95%CI:-29.5%～47.7%,APC=17.3%,95%CI:-21.8%～76.2%),and decreased not significantly from 2013 to 2017(APC=-3.4%,95%CI:-17.9%～13.6%,APC=-4.1%,95%CI:-15.8%～9.1%).The average annual increase of the premarital examination rate in senior high school group was not significant(AAPC=-6.8%,95%CI:-89.4%～715.5%).The premarital examination rate of junior college and above group increased significantly from 2007 to 2014(APC=14.2%,95%CI:1.1%～31.7%),and decreased significantly from 2014 to 2017(APC=-19.0%,95%CI:-33.7%～-1.0%).(3)The average annual increase in the detection rate of premarital diseases was not significant(AAPC=5.3%,95%CI:-21.5%～41.3%).The detection rate of restricted registered diseases decreased slightly from2007 to 2009,but the decline was not significant(APC=-32.4%,95%CI:-97.6%～1813.4%).The growth from 2009 to 2017 was not significant(APC=19.7%,95%CI:-2.5%～46.4%).(4)In the regional distribution of diseases affecting marriage registration,there was no significant difference among the regions with severe mental illness(χ~2=2.29,P>0.05).The age distribution is that the number of detected cases of various diseases in the age group over 40years old is more than that in other age groups.There was no significant difference in gender distribution except for the incidence rate of severe psychosis(χ~2=1.02,P>0.05).The incidence rate of other diseases affecting marriage registration in men was higher than that in women,which was statistically significant(P<0.05).4.Relationship between knowledge,attitude and practice of premarital examination and the examination of residents in Haikou(1)The influence factors of premarital examination was studied in1,031 registered people.Premarital examination rate of the sample was57.6%.The scores of residents who participated in premarital examination in premarital examination knowledge,premarital examination attitude,premarital examination behavior tendency and so on were higher than those who did not participate in premarital examination,and the difference was statistically significant(P value was less than 0.001).(2)The results of multivariate unconditional logistic regression showed that female(OR=1.549,95%CI:1.126～2.131),over 40 years old(OR=2.114,95%CI:1.322～3.411),graduate degree(OR=4.488,95%CI:1.715～11.842),suffering from chronic diseases(OR=8.142,95%CI:4.044～16.602),self-rated health status is general(OR=21.302,95%CI:1.608～281.025),and the sense of benefit score is 24～26 points(OR=3.121,95%CI:1.181～6.325),the sense of benefit score of more than 26 points(OR=5.751,95%CI:3.89～8.654),reproductive knowledge score of more than 11 points(OR=1.592,95%CI:1.204～3.124),premarital medical examination knowledge score of more than 13 points(OR=1.210,95%CI:1.137～1.464),and premarital medical examination behavior tendency score of more than 4.5 points(OR=2.132,95%CI:1.668～2.725)are the positive influencing factors of premarital medical examination.Obstacle score above 20(OR=0.831,95%CI:0.716～0.964)is the risk factor of premarital medical examination.Conclusions(1)The premarital examination knowledge,attitude and practice propensity scale developed in this study demonstrate the convincing reliability and validity,which can be used to assess the status of premarital examination knowledge,attitude and practice of residents.(2)A relatively low score of knowledge,attitude and practice towards premarital examination among unmarried adults in Haikou,proving the intervention to improve is expected.The score of premarital examination knowledge is related to the age and educational level of unmarried adults.The score of premarital examination knowledge was lower among young people and people with low education level.The score of premarital examination attitude is related to the score of unmarried adults’gender,educational level and premarital examination knowledge.Men,young people,low education level and low scores of premarital examination knowledge have relatively negative attitudes towards premarital examination.The score of premarital examination practice propensity is related to the unmarried adults’gender,age,education level,convenient transportation,the score of premarital examination knowledge and the score of premarital examination attitude.Men,young people,lowe ducation level,inconvenient transportation,premarital examination knowledge and attitude score have a weak propensity to premarital examination behavior.(3)From 2007 to 2017,the premarital examination rate in Haikou showed not increase over time,there is discrepancy in the growth of premarital examination in different populations and time periods in Haikou.Among the marriage restriction diseases,hepatitis B,tuberculosis,HIV and other legal infectious diseases ranked first,accounting for92.1%.(4)The premarital examination rate of married residents in Haikou is related to premarital examination knowledge and their practice propensity.Male,younger,low education experience(junior high school and below),no chronic diseases,high self-rated health scores,low benefit scores,high obstacle scores,and low fertility knowledge scores are the main factors influencing the premarital examination.20 figures,49 tables and 127 references... |
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