Liabsuetrakul Tippawan, Chongsuvivatwong Virasakdi, Lumbiganon Pisake, Lindmark Gunilla
Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, 90110 Songkhla, Thailand.
Soc Sci Med. 2003 Nov;57(9):1665-74. doi: 10.1016/s0277-9536(02)00550-6.
Over 10% of current births in all countries of the world are delivered by caesarean section. Single-dose ampicillin or cefazolin administered after cord clamping has been proven to be effective for the prevention of post-caesarean infections as indicated in many randomised trials and reviews in the Cochrane Library. This study aimed to determine three determinants of behavioural intention using the theory of planned behaviour: attitudes, subjective norms, and perceived controls. Intentions were examined for five aspects of the use of antibiotic prophylaxis, namely whether or not antibiotics were used, used in all caesarean sections, after rather than before cord clamping, whether ampicillin/cefazolin or broader-spectrum antibiotics were used, and whether single or multiple doses were given. Fifty obstetricians selected from university, regional, and general hospitals in southern Thailand, were surveyed using a questionnaire and in-depth interview. Their intentions to use a single dose and to use in all cases were low, and this was related to negative attitudes and reference groups who did not approve of the single dose. The negative attitude was based on scepticism concerning the applicability of well-equipped trials from the developed world and fear of consequences of post-caesarean infections. Norms carried over from residency training had more long-term influence in their practice than newer information from books or journals. Perceived external controls on their practice were less predictive of intentions. Intentions were only partly predictive of behaviour. Changing attitudes, introducing evidence-based information into residency training and strengthening control systems in the hospital are essential to improve intentions.
世界上所有国家超过10%的新生儿是通过剖宫产分娩的。如Cochrane图书馆的许多随机试验和综述所示，脐带结扎后给予单剂量氨苄西林或头孢唑林已被证明对预防剖宫产术后感染有效。本研究旨在运用计划行为理论确定行为意向的三个决定因素：态度、主观规范和感知控制。对预防性使用抗生素的五个方面的意向进行了研究，即是否使用抗生素、在所有剖宫产中使用、在脐带结扎后而非之前使用、使用氨苄西林/头孢唑林还是广谱抗生素，以及给予单剂量还是多剂量。从泰国南部的大学医院、地区医院和综合医院选取了50名产科医生，通过问卷调查和深入访谈进行了调查。他们使用单剂量以及在所有病例中使用的意向较低，这与消极态度以及不赞成单剂量的参照群体有关。消极态度基于对来自发达国家的设备完善试验适用性的怀疑以及对剖宫产术后感染后果的恐惧。住院医师培训中传承下来的规范在他们的实践中比来自书籍或期刊的新信息具有更长期的影响。他们实践中感知到的外部控制对意向的预测性较小。意向仅部分预测行为。改变态度、将循证信息引入住院医师培训以及加强医院控制系统对于改善意向至关重要。
