Evaluation Of Reproductive Health Intervention Based On IMB Model Among Female Disabled People

BackgroundDisabled people in our country is growing fast. The disability population size had risen from 51.64 million to 82.96 million, accounting for the population proportion from 4.90%to 6.34% in 2006. While the female disabled people was 40.19 million, accounting for48.45%. Disabled women’ reproductive health has been in a high-risk and marginalization state. Compared with such a large number of disabled people, our research on reproductive health of disabilities has been obviously insufficient.Based on the theory of information-motivation-behavioral skills model(IMB model)we designed a questionnaire. The paper had studied disabled women reproductive health information, motivation, behavior skills and prevention behavior, and drawn a conclusion of the intervention. Finally, we had a comprehensive analysis of the status of reproductive health and the main factors affecting the reproductive health of the disabled women. Such a conclusion would be provided scientific suggestions to improve strategies and measures for disabled women in the future.ObjectsThrough the questionnaire survey, this study aims to understand basic demographic characteristics of disabled women. The validity and reliability of the questionnaire were analyzed, and the feasibility of its application were evaluated. Then we built the prototypeof IMB model and evaluated the efficacy of the intervention to provide scientific basis to improve the reproductive health of the disabled.MethodsThree jurisdictions in a city were selected randomly, and the disabled women of childbearing age as the research object in each area were selected too. On the basis of the IMB model we self-designed questionnaire. The baseline survey was conducted by direct and indirect method of interview. The research objects asked to complete the same scale after two weeks to assess the test-retest reliability. The hypothetical IMB was examined by structural equation model using the AMOS20.0 software. The final line survey was conducted after intervention. Using Epidata3.1 software to build database and using SPSS19.0 software to data process and statistical analysis. The statistical description we usedx±s or rate, and statistical inference used t test, analysis of variance or chi-square test. In analysis of the influence factors we used the binary logistic regression or multivariable linear regression analysis.Result1. Baseline surveyThe mean score of reproductive health knowledge was 12.64(SD=5.26). The overall accuracy rate was 45.14%. One-way ANOVA analysis show that the level of disability,cultural degree, job, and the average monthly income was the influence factors of the reproductive health knowledge. Multivariable linear regression analysis showed the cultural level was the main affecting factor of the reproductive health knowledge. Compared with illiteracy disabled women, the higher cultural degree, the better cognition of reproductive health knowledge.The mean score of motivation was 27.10(SD=5.26). The mean score of attitudes to sex and reproductive health was 12.98(SD=2.21). The mean score of attitudes to condom was14.07(SD=2.52).The mean score of behavior skills was 9.71(SD=3.72). The mean score of behavior skills who do use the condom in the nearest sexual behavior was higher than do not use.91% of the sex experience did not use condom of the first sex. In married people, this accounted for 95.6%. According to the degree of culture, the lower level of education, the higher proportion of did not use the condom of the first sex. 59.3% of the objects used condom in the nearest sexual behavior. 75% of the disabled women failed to understand the important steps to use condom.2. Validity and reliabilityThe internal reliability Cronbach`s α coefficient was 0.613~0.708, which the highest reliability was the attitude of sexually open(Cronbach`s α coefficient=0.708). The spearman correlation coefficient was >0.6. The test-retest correlation coefficient was statistically significant(P<0.05). It means the scale of the retest reliability is good. Factor analysis showed that scale had good structure validity, and the four common factors could explain the content of 78.41%.3. The establishment of IMB modelThe direct effect of information to preventive behavior was 0.14, and the indirect effect was 0.25. The direct effect of motivation to preventive behavior was 0.09, and the indirect effect was 0.29. The overall effect of behavior skills to preventive behavior was0.43. The direct effect of motivation on preventive behavior is not statistically significant,and smaller than indirect effect. It means that motivation is affecting prevention behavior through behavior skills. The overall effect of behavior skills to preventive behavior is greater than the information and motivation. It is show that the behavior skills has important implication for prevention.4. Intervention resultsAfter the intervention, the mean score of reproductive health knowledge in the comprehensive intervention group was significantly higher than before. And the accuracy rate was increased from 43.5% to 60.28%. Except for hearing disabled people, the difference of knowledge score was statistically significant after the comprehensive intervention. The mean score of motivation before and after the comprehensive intervention were 26.96(SD=3.11) and 29.21(SD=2.54) respectively, and the difference was statistically significant. The mean score of the sex communication skill before and after thecomprehensive intervention were 9.69(SD=3.61) and 12.05(SD=2.05) respectively, and the difference was statistically significant. The mean score of motivation and the sex communication skill before and after the basic intervention had no difference.The score of the key steps in the proper use of condoms was increase after the comprehensive intervention. The behavior of checking the condom valid, using the condom before sex and ensuring the condom trap the genital had significantly improved. And the basic intervention had no difference.ConclusionDisabled women have a certain understanding of reproductive health knowledge, but the understanding is not comprehensive. There have some wrong ideas, and their knowledge and behavior does not match. The behavioral skills need to be improved, and the intervention should be strengthened in the future.The government should be enrich the handicapped people’s reproductive health knowledge in many ways. Such as improved their understanding to the gynecological examination, enhanced the ability of self health care and the consciousness of medical treatment. Such a improvement would be make free physical examination to play its due role. In addition, we should improve the disabled women`s self-efficacy, cultivate the condom use and negotiation skills, establish healthy behavior idea, strengthen risk awareness to the unsafe sexual behavior and be wary of sexually transmitted diseases.It shows that the research of the reproductive health questionnaire with IMB is reliable and credible through the comprehensive evaluation of the validity and reliability.The IMB model can effectively predict the high risk behaviors of the disabled women.Through the information, condom use skills, peer education, prevention of behavioral skills training, the disabled women`s reproductive health awareness improved significantly. It is improving the reproductive health knowledge, the right attitude and cultivating correct preventive behavior skills, while reducing the risk behavior motivation.