Center for Health Policy and Management Studies, Nanjing University, Nanjing, China.
Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, China.
PLoS One. 2018 Mar 22;13(3):e0194061. doi: 10.1371/journal.pone.0194061. eCollection 2018.
Postpartum Family Visits (PFVs) have been advocated as a way to improve health outcomes for puerperal women and their newborns. This study aimed to identify individual factors associated with the utilization of PFVs in rural Jiangsu Province, China.
We employed responses of the household survey in Jiangsu province, part of the National Health Service Survey (NHSS), a nationally representative survey in China. The data analysis framework was designed based on Andersen's behavioral model. The outcome variables included nonuse and deficient use of PFVs, and the explanatory variables were organized into three hierarchical levels: predisposing, enabling and need factors. Univariate analysis and multivariate logistic regression analysis were conducted to examine the impact of the three hierarchical levels on PFVs utilization.
A total of 884 rural women who had a childbearing history in the prior five years answered PFVs questions. About 23.4% of them had never received any PFVs, and 40.4% received <3 visits. In the results of multivariate logistic regression, educational level (OR = 0.43, 95% CI: 0.24-0.77), income (OR = 0.62, 95% CI: 0.43-0.88), the distance from the nearest hospital (OR = 1.49, 95% CI: 1.07-2.07) and parity (OR = 2.17, 95% CI: 1.54-3.05) had significant relationship with nonuse. Factors significantly associated with deficient use of PFVs included employment (OR = 0.62, 95% CI: 0.39-0.98), the distance from the nearest hospital (OR = 1.73, 95% CI: 1.26-2.36), level of delivery institution (OR = 1.57, 95% CI: 1.14-2.17), and parity (OR = 1.45, 95% CI: 1.03-2.05).
The study found lower Social Economic Status (SES), long distance with primary health institutions, and the increased need for services stemming from multi-parity reduced the likelihood of nonuse or deficient use of PFVs in rural areas. Multiparous, low SES women and those living far away from primary health institutions should be paid more attention to assure the coverage of postpartum care.
产后家庭访视（PFVs）已被提倡为改善产妇和新生儿健康结果的一种方法。本研究旨在确定与中国江苏省农村地区 PFVs 利用相关的个体因素。
我们利用了江苏省家庭调查的回应，该调查是中国全国卫生服务调查（NHSS）的一部分。数据分析框架是基于安德森行为模型设计的。因变量包括不使用和未充分使用 PFVs，解释变量分为三个层次：倾向因素、促成因素和需求因素。进行了单变量分析和多变量逻辑回归分析，以检查三个层次对 PFVs 使用的影响。
共有 884 名在过去五年中有生育史的农村妇女回答了 PFVs 问题。其中约 23.4%的人从未接受过任何 PFVs，40.4%的人接受的访视次数<3 次。在多变量逻辑回归的结果中，教育水平（OR=0.43，95%CI：0.24-0.77）、收入（OR=0.62，95%CI：0.43-0.88）、离最近医院的距离（OR=1.49，95%CI：1.07-2.07）和产次（OR=2.17，95%CI：1.54-3.05）与不使用有显著关系。与 PFVs 利用不足显著相关的因素包括就业（OR=0.62，95%CI：0.39-0.98）、离最近医院的距离（OR=1.73，95%CI：1.26-2.36）、分娩机构水平（OR=1.57，95%CI：1.14-2.17）和产次（OR=1.45，95%CI：1.03-2.05）。
本研究发现，较低的社会经济地位（SES）、与初级卫生机构的距离较远，以及由于多胎而增加的服务需求，降低了农村地区不使用或未充分使用 PFVs 的可能性。多胎、低 SES 的妇女和远离初级卫生机构的妇女应得到更多关注，以确保产后护理的覆盖范围。
