欠发达地区农村居民健康行为改变的影响因素——基于计划行为理论的模型建构

doi:10.13438/j.cnki.jdzk.2022.01.010

摘要/Abstract

摘要：通过问卷调查和深度访谈相结合的方法对欠发达的湘西地区农村居民进行数据采集，在数据分析的基础上，分析后脱贫时代农民健康行为改变的内在机理.与以往研究不一样，本研究尝试把媒介使用、健康知识纳入计划行为理论模型，通过结构方程模型探讨媒介使用对农民健康行为的影响.研究结果显示，媒介使用对农村居民健康行为有显著正影响，还通过自我效能、行为态度、主观规范中介变量对健康行为产生间接影响；社交媒体是影响农村居民健康行为改变的有效渠道；农村居民不良健康行为主要集中在抽烟、喝酒、吃腊制品，并对这些行为持肯定态度，文化习俗、权力诉求是不良健康行为难以改变的因素；健康知识作用不显著，健康知识到健康行为可能存在中介变量、伪健康信息泛滥等难以实现健康知识的采纳进而无法促成不良健康行为的改变.

关键词： 媒介使用, 健康行为, 自我效能, 行为态度, 主观规范

Abstract: We collected the data of rural residents in underdeveloped western Hunan through a questionnaire survey and in-depth interviews.Based on the data analysis,this paper analyzed the internal mechanism of farmers' health behavior change in the post-poverty alleviation era.Different from previous studies,this study attempts to integrate media use and health knowledge into the theoretical model of planned behavior and explores the influence of media use on farmers' health behavior through a structural equation model.The results show that:The use of media has a significant positive impact on rural residents' health behavior,and also has an indirect impact on health behavior through self-efficacy,behavioral attitude and subjective norms;Social media is an effective channel for the change of rural residents' health behavior;The unhealthy behaviors of rural residents mainly focus on smoking,drinking and eating preserved food by a positive attitude towards these behaviors.Cultural customs and power demands are the factors that are difficult to change unhealthy behaviors;The role of health knowledge is not significant,and there may be mediating variables from health knowledge to health behavior,and the proliferation of pseudo-health information that makes it difficult to achieve health knowledge adoption and thus does not lead to changes in poor health behavior.

Key words: media use, health behavior, self-efficacy, behavior attitude, subjective norm

龚芳敏, 龚逐流. 欠发达地区农村居民健康行为改变的影响因素——基于计划行为理论的模型建构[J]. 吉首大学学报（自然科学版）, 2022, 43(1): 64-76.

GONG Fangmin, GONG Zhuliu. On Influencing Factors of Health Behavior Change of Rural Residents in Underdeveloped Areas：Model Construction Based on Theory of Planned Behavior[J]. Journal of Jishou University(Natural Sciences Edition), 2022, 43(1): 64-76.

参考文献

[1] 国家卫生健康委员会.2018年11月12日例行新闻发布会文字实录[EB/OL].[2021-01-18].http:∥www.nhc.gov.cn/wjw/xwdt/201811/1a8e1048d621436fa8aa5933663acd4b.shtml.
[2] 任刚美,覃清蓉,郝儒杰.贫困地区有效开展健康扶贫研究：以叙永县为例[J].中共四川省委党校学报,2018(4):70-74.
[3] 李静.中国健康扶贫的成效与挑战[J].求索,2019(5):95-103.
[4] 张得平,马俊杰,戚宏云,等.甘肃省某深度贫困县居民健康素养调查[J].疾病预防控制通报,2019(6):8-9.
[5] PHILLIP L RICE.健康心理学[M].胡佩诚,译.北京:中国轻工业出版社，2000:7.
[6] KALJEE L M.Alcohol Use and Hiv Risk Behaviors Among Rural Adolescents in Khanh hoa Province Viet Nam[J].Health Educ. Res.,2005，20(1):71-80.
[7] 林丹华,方晓义,李晓铭.健康行为改变理论述评[J].心理发展与教育,2005(4):122-127.
[8] 寿文华.媒体对农村健康生活方式的影响[J].北京体育大学学报,2008(3):313-314.
[9] 侯煜,杜仕勇,刘迅.乡村治理视角下欠发达乡村村民媒介素养研究[J].四川理工学院学报（社会科学版）,2019(6):39-51.
[10] 邓胜利,付少雄,陈晓宇.信息传播媒介对用户健康信息搜寻的影响研究：基于健康素养和信息检索能力的双重视角[J].情报科学,2017(4):129-135.
[11] AJZEN I.The Theory of Planned Behavior[J].Organizational Behavior and Human Decision Processes,1991，50(2):179-211.
[12] 徐斌,陆芳芳,孙杨青，等.基于计划行为理论的托幼儿童家长EV71疫苗接种意愿影响因素分析[J].现代预防医学,2020(19):3518-3521.
[13] NOAR S M,ZIMMERMAN R S.Health Behavior Theory and Cumulative Knowledge Regarding Health Behaviors:Are We Moving in the Right Direction?[J].Health Education Research,2005(3)：275-290.
[14] 闫岩.计划行为理论的产生、发展和评述[J].国际新闻界,2014(7):113-129.
[15] 林素真(Sue-Jen Lin).高雄市新移民女性的媒体使用与健康资讯需求[J].广播与电视,2012(34):55-92.
[16] AJZEN I.The Theory of Planned Behavior Organizational Behavior and Human Decision Processes[J].Health Education Research,1991,50(2):179-211.
[17] FREBERG KAREN.Using the Theory of Planned Behavior to Predict intention to Comply with a Food Recall Message[J].Health Communication,2013,28(4):359-365.
[18] ANDERSON C N,NOAR S M,ROGERS B D.The Persuasive Power of Oral Health Promotion Messages:A Theory of Planned Behavior Approach to Dental Checkups Among Young Adults[J].Health Communication,2013,28(3):304-313.
[19] AHN J,KAHLOR L A.No Regrets When It Comes to Your Health:Anticipated Regret,Subjective Norms,Information Insufficiency and Intent to Seek Health Information From Multiple Sources[J].Health Communication,2020,35(10):1295-1302.
[20] AJZEN I.Attitudes personality,and behavior[M].Maidenhead:Open University Press,1988:35.
[21] AJZEN I.The Theory of Planned Behavior Organizational Behavior and Human Decision Processes[J].Health Education Research,1991,50(2):179-211.
[22] 黄顺铭.虚拟社区里的知识分享:基于两个竞争性计划行为理论模型的分析[J].新闻与传播研究,2018(6):52-76.
[23] FISHBEIN M,CAPPELLA J N.The Role of Theory in Developing Effective Health Communications[J].Journal of Communication,2006,56(S1):S1-S17.
[24] FISHBEIN M,YZER M C.Using Theory to Design Effectivehealth Behavior Interventions[J].Communication Theory,2003,13:164-183.
[25] 胡晶晶,张伟宏,罗婉丽,等.行为改变理论应用于慢性病病人护理干预的研究进展[J],循证护理,2019(9):804-806.
[26] 刘宇伟,吕淑荣.个人健康行为改变主要理论及其整合应用[J].中国健康教育,2018(3):284-287.
[27] LIN C A,LAGOE C.Effects of News Media and Interpersonal Interactions on H1N1 Risk Perception and Vaccination Intent[J].Communication Research Reports,2013,30(2)：127-136.
[28] LI L,BAUTISTA J R.Incorporating Communication Factors in the Theory of Planned Behavior to Predict Chinese University Students' Intention to Consume Genetically Modified Foods[J].International Journal of Communication,2020，14:2338-2359.
[29] DUTTA-BERGMAN,MOHAN J.Primary Sources of Health Information:Comparisons in the Domain of Health Attitudes,Health Cognitions,and Health Behaviors[J].Health Communication,2004,16(3):273-288.
[30] PORTNOY D B,SCOTT-SHELDON L,JOHNSON B T,et al.Computer-Delivered Interventions for Health Promotion and Behavioral Risk Reduction:A Meta-Analysis of 75 Randomized Controlled Trials,1988-2007[J].Preventive Medicine,2008,47(1)：3-16.
[31] ZHANG J,BRACKBILL D,YANG S,et al. Efficacy and Causal Mechanism of An Online Social Media Intervention to Increase Physical Activity:Results of A Randomized Controlled Trial[J].Preventive Medicine Reports,2015,2(4)：651-657.
[32] YI M,LIN C A.Communicating Food Safety Via the Social Media:the Role of Knowledge and Emotions on Risk Perception and Prevention[J].Science Communication,2014,36(5)：593-616.
[33] KESSLER K M.Primary Prevention of Coronary Heart Disease in Women Through Diet and Lifestyle[J].New England Journal of Medicine,2001,343(24)：1814-1818.
[34] 陈致中,黄荟云,陈嘉瑜.健康传播信息对受众健康行为影响之实证研究：基于饮食行为倾向的实验[J].现代传播(中国传媒大学学报),2016(7):52-57.
[35] HO S S,LIAO Y,ROSENTHAL S.Applying the Theory of Planned Behavior and Media Dependency Theory:Predictors of Public Pro-Environmental Behavioral Intentions in Singapore[J].Environmental Communication,2015,9(1)：77-99.
[36] 格兰茨.健康行为与健康教育理论、研究和实践[M].北京:中国社会科学出版社,2014:38.
[37] FISHBEIN M.The Role of Theory in Hiv Prevention[J].Aids Care,2000,12(3):273-278.
[38] KANG N,NAH S,RECORD R A,et al.Communication,Reasoning,and Planned Behaviors:Unveiling the Effect of Interactive Communication in an Anti-Smoking Social Media Campaign[J].Health Communication,2017,32(1):41-50.
[39] YANG Q,WU S.How Social Media Exposure to Health Information Influences Chinese People's Health Protective Behavior During Air Pollution:A Theory of Planned Behavior Perspective[J].Health Communication,2021,36(3):324-333.
[40] 聂静虹,金恒江.病患就医意愿和健康意向的影响因素研究：基于计划行为理论(TPB)模型的构建[J].新闻大学,2017(5):86-94.
[41] JEMMOTT L S,JEMMOTT J B.Sexual Knowledge,Attitudes,and Risky Sexual Behavior Among Inner-City Black Male Adolescents[J].Journal of Adolescent Research,1990,5(3)：346-369.
[42] 翟倩倩,周世丹,王杰贞,等.安阳市居民健康生活方式与行为素养影响因素分析[J].河南预防医学杂志,2019(11):814-818.
[43] 李淑霞,张凌.老年高血压患者疾病防治知识和健康行为的相关性研究[J].护理学报,2012(5):1-4.
[44] 孔梅枝.“知信行”健康教育模式对冠心病病人疾病知识的认知程度和遵医行为的影响[J].现代临床护理,2011(1):43-44.
[45] 刘兰,汪俊华,黄文湧,等.贵州省少数民族地区乙肝防治知识、态度、行为现况调查[J].中华疾病控制杂志,2015(11):1092-1095.
[46] 蒋燕,崔颖,苏潇歌,等.中国中西部贫困地区农村居民健康相关行为现状调查[J].中华流行病学杂志,2013(3):231-235.
[47] 国家卫生健康委员会财务司.关于实施健康扶贫工程的指导意见[EB/OL].[2021-04-18].http:∥www.nhc.gov.cn/caiwusi/zcxxi/201606/d16de85e75644074843142dbc207f65d.shtml.
[48] 王培安.全面实施健康扶贫工程[J].行政管理改革,2016(4):36-41.
[49] 汪三贵,刘明月.健康扶贫的作用机制、实施困境与政策选择[J].新疆师范大学学报(哲学社会科学版),2019(3):82-91.
[50] 热孜万古丽·买买提,姚华,刘冠军,等.“健康中国”背景下新疆地区健康文化促进探讨[J].现代医院管理,2019(1):89-91.
[51] 胡浩,孙修福,高琦,等.信息、动机、行为技巧模型与艾滋病行为干预[J].中国公共卫生,2007,23(9):1071.
[52] COHEN A.Statistical Power Analysis for the Behavioral Sciences[M].New Jersey:Lawrence Erlbaum Associates,1999:20-25.
[53] XIE Bo. Older Adults' Health Information Wants in the Internet Age:Implications for Patient-Provider Relationships[J].Journal of Health Communication,2009,14(6)：510-524.
[54] 侯煜,杜仕勇,刘迅.乡村治理视角下欠发达乡村村民媒介素养研究[J].四川理工学院学报(社会科学版),2019(6):39-51.
[55] 周全,汤书昆.媒介使用、信息认知能力与公众的环境科学知识获取：基于全国代表性数据的实证研究[J].科学学研究,2017(4):481-490.
[56] 曹昂.健康意义、另类视角与本土情境：“文化中心路径”对健康传播学的批判与重构[J].新闻与传播研究,2020(7):57-76.
[57] DUTTA-BERGMAN M J.Theory and Practice in Health Communication Campaigns:A Critical Interrogation[J].Health Communication,2005,18(2):103-122.
[58] 熊迅,刘琛.中缅边境傈僳族的健康传播实践[J].南京医科大学学报,2012(2):86.
[59] 吴世文,王一迪,郑夏.可信度的博弈:伪健康信息与纠正性信息的信源及其叙事[J].全球传媒学刊,2019(3):73-91.
[60] LARSON H J,COOPER L Z,ESKOLA J,et al.Addressing the Vaccine Confidence Gap[J].Lancet,2011,378(9790):526-535.
[61] DANIEL J,DOUGLAS K M,RALPH T.The Effects of Anti-Vaccine Conspiracy Theories on Vaccination Intentions[J].PLoS ONE,2014,9(2):e89177.
[62] HUANG C,DANNENBERG A L,HAALAND W,et al.Changes in Self-Efficacy and Outcome Expectations From Child Participation in Bicycle Trains for Commuting to and From School[J].Health Education & Behavior,2018,45(5):748-755.
[63] VAUGHAN C A,GHOSH-DASTIDAR M,DUBOWITZ T.Attitudes and Barriers to Healthy Diet and Physical Activity:A Latent Profile Analysis[J].Health Education & Behavior,2018,45(3):381-393.
[64] 杨梦晴,赵宇翔,宋士杰,等.国外健康行为研究中信息框架理论的源流、应用与发展[J].情报学报,2020(6):662-674.
[65] RIET JONATHAN VAN'T ,RUITER ROBERT A C,WERRIJ MARIEKE Q,et al.Self-Efficacy Moderates Message-Framing Effects:the Case of Skin-Cancer Detection[J].Psychology & Health,2010,25(3):339-349.
[66] 朱梦茜,颜祥林,袁勤俭.自我效能理论及其在国外信息系统领域的应用与展望[J].信息资源管理学报,2019(4):122-131.
[67] 李长风,李芳,刘素,等.健康中国背景下发展家庭医生健康行为干预技能SWOT分析[J].中国社会医学杂志,2019(1):74.
[68] 李洁.从“制度”到“生活”：新中国70年来公共卫生政策演变[J].中国公共卫生,2019(10):1281-1284.
[69] YANG Q.Are Social Networking Sites Making Health Behavior Change Interventions More Effective? A Meta-Analytic Review[J].Journal of Health Communication,2017,22:223-333.
[70] YANG Q,LIU J,LOCHBUEHLER K,et al.Does Seeking E-Cigarette Information Lead to Vaping? Evidence from a National Longitudinal Survey of Youth and Young Adults[J].Health Communication,2019,34:298-305.