| ObjectiveThis study mainly evaluates the effect of the safe delivery service model of "one main two auxiliary" pilot project in Yunnan Tibetan area to improve the utilization of maternity care service in the project area,summarizes the experience and problems in the implementation of the project,and to provide scientific basis for the promotion and implementation in more similar areas.MethodThe study based on the ecological model of health promotion using qualitative and quantitative methods to carry out the investigation.A quasi experimental study design was used to measure the project impact over a period of four years(2011 to 2015)between the intervention and comparison group among the four townships of Weixi.Among them,two townships(Baijixun,Kangpu)were considered as intervention groups who received the Safe Delivery Project intervention and one was designed comparison township(Zhonglu,Pantiange)who did not received the Safe Delivery Project intervention.Stratified cluster sampling was used to select the representative respondents from the four districts,and this study used difference-in-difference method to assess the effect of the intervention.Results(1)In the intervention group,the knowledge of maternal health care was generally better than that of the control group after intervention,which considered the need for more than 5 prenatal care intervention group from 60%before the intervention rose to 87.2%.And the results of difference-in-difference method evaluating the maternal health knowledge of the subjects also showed that the intervention had obvious effect on improving the knowledge level of the number of prenatal examinations and the hospital delivery benefits knowledge,the interactive coefficient of interventions and time were respectively 1.338,1.222 OR = 3.811,3.395,P<0.05.(2)In the maternal health attitude,the intervention group and the control group in the intervention of seven dangerous situations need to seek medical treatment attitude was significantly improved,the intervention group choose home delivery from 9.1%before decreased to 2.1%after the intervention,while the control group choose a slight increase.And the results of the regression showed that the intervention had a significant effect on improving the attitude of maternal health care,??1.565,1.239,P<0.01.(3)The intervention group had significantly improved in maternal health care behavior after intervention,while the control group was far less than the intervention group.The detection rate of early pregnancy in the intervention group increased by nearly 14 percentage points after intervention,the rate of more than 5 prenatal care of intervention group increased from 69.0%to 71.4%after intervention,the hospital delivery rate in the intervention group also improved.The results of difference-in-difference method also show that the intervention has a significant effect on improving maternal health behavior.? =1.243,0.761,2.117;OR=3.466,2.139,8.305;P<0.05.ConclusionThe intervention measures of "one main two auxiliary" safe delivery model can play a positive role in maternal health knowledge,attitude and behavior,including the detection rate of early pregnancy,the rate of more than 5 prenatal care,the hospital delivery rate and other important indicators are obvious improved,and the results of difference-in-difference method showed that the intervention was meaningful.The above shows that the safe delivery service model of "one main and two auxiliary" is effective and effective in the Tibetan area of Yunnan,and can play a positive role in the utilization of maternal health service.Suggestions(1)Promoting the participation of stakeholders in the project,especially community forces,is the key to project in the design,implementation and evaluation.(2)Grassroots maternal and child health service providers are also "vulnerable" and need to be fully respected and understood.(3)Grassroots women's organizations,especially the natural village-level women's group leader,can be relied on.(4)Building the labour room in the remote administrative village.(5)Prospecting of maternal health care and mobile health. |
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