Xu Qiaohua, Chen Biyun, Jin Donghui, Yin Li, Huang Yuelong
Department of Chronic Diseases Control and Prevention, Hunan Provincial Center for Diseases Control and Prevention, Changsha, Hunan, China.
PeerJ. 2019 Mar 7;7:e6579. doi: 10.7717/peerj.6579. eCollection 2019.
Cost-effective strategies of chronic disease control, integrated health education and health promotion play important roles in the programs of chronic disease demonstration districts in China. The performance of these districts can be directly assessed by their health education and promotion work. However, there have been only a few performance assessments done on these programs, most of which made without the inclusion of proper quality indicators. This study was designed to establish a framework of indicators for outcome evaluation of health education and promotion efforts in Chinese districts, and explore the factors involved in promoting these efforts.
A modified two-round Delphi survey was first used to construct quality indicators on a nine-point Likert scale. With those indicators, the rank sum ratio (RSR) method was then conducted through rank conversion and parametric statistics, to assess and classify the performance of ten districts or counties randomly chosen both from demonstration and non-demonstration districts in the Hunan province.
The Delphi process produced seven themes and 25 sub-themes as quality indicators. The seven themes included organizational management, financial support, professional personnel, health education and promotion, residents' health awareness and behaviors, residents' satisfaction, and residents' health literacy. The districts were classified into four levels by RSR as follows: One demonstration district at the first-ranked level, five other demonstration districts at the second-ranked level, all non-demonstration districts at the third-ranked level. None were at the fourth-qualified level.
Chronic disease demonstration districts performed better on the work of health education and health promotion than the non-demonstration districts. The work should be focused on the following measures of chronic diseases: organizational management, financial support, media-related broadcasting, technical support, community-based promotion and supportive environment, and people's enhanced awareness and health literacy.
具有成本效益的慢性病控制策略、综合健康教育和健康促进在中国慢性病示范区项目中发挥着重要作用。这些示范区的成效可通过其健康教育和促进工作直接评估。然而，对这些项目的绩效评估较少，且大多数评估未纳入适当的质量指标。本研究旨在建立中国地区健康教育和促进工作成果评估指标框架，并探讨促进这些工作的相关因素。
首先采用改良的两轮德尔菲调查法构建九点李克特量表上的质量指标。然后使用这些指标，通过秩转换和参数统计进行秩和比（RSR）法，对从湖南省示范区和非示范区随机选取的十个区县的绩效进行评估和分类。
德尔菲过程产生了七个主题和25个子主题作为质量指标。这七个主题包括组织管理、财政支持、专业人员、健康教育和促进、居民健康意识和行为、居民满意度以及居民健康素养。根据RSR将各区县分为四个等级，如下：一个示范区处于一级，其他五个示范区处于二级，所有非示范区处于三级。没有处于四级合格水平的。
慢性病示范区在健康教育和健康促进工作方面比非示范区表现更好。这项工作应聚焦于以下慢性病防控措施：组织管理、财政支持、媒体相关宣传、技术支持、社区层面的推广和支持性环境，以及提高人们的意识和健康素养。
