غربالگری سرطان دهانه رحم: مداخله‌ای آموزشی، مبتنی بر مدلهای تغییر رفتار فرانظری و اعتقاد بهداشتی در زنان شهر گناباد

نوع مقاله: اصیل پژوهشی

نویسندگان

1 کارشناس ارشد آموزش بهداشت و ارتقاء سلامت، مرکز تحقیقات عوامل اجتماعی مؤثر بر سلامت، دانشگاه علوم پزشکی گناباد، گناباد، ایران.

2 دانشیار گروه بهداشت عمومی و ارتقاء سلامت، مرکز تحقیقات عوامل اجتماعی مؤثر بر سلامت، دانشکده بهداشت، دانشگاه علوم پزشکی گناباد، گناباد، ایران.

3 استادیار، گروه پزشکی اجتماعی، دانشکده پزشکی، دانشگاه علوم پزشکی گناباد، گناباد، ایران.

4 دانشیار گروه بهداشت عمومی و ارتقای سلامت، مرکز تحقیقات عوامل اجتماعی مؤثر بر سلامت، دانشکده بهداشت، دانشگاه علوم پزشکی بیرجند، بیرجند، ایران.

چکیده

مقدمه: غربالگری بیماری‌های مزمن همچون سرطان دهانه رحم، در تشخیص زودرس و پیشگیری از ایجاد این بیماری در زنان از اهمیت بسزایی برخوردار است. از آنجایی که در ایران، سرطان دهانه رحم، دومین علت مرگ ناشی از سرطان‌های وابسته به جنس را به خود اختصاص داده است، لذا مطالعه حاضر با هدف ارتقاء رفتار غربالگری پاپ اسمیر انجام گرفت.
روش‌کار: این مطالعه نیمه‌تجربی در سال 1393 بر روی 80 نفر از زنان 65-20 ساله ساکن شهر گناباد که دارای پرونده فعال بهداشتی بودند، انجام شد. افراد در دو گروه 40 نفره آزمون و شاهد قرار گرفتند. واحدهای پژوهش شامل زنانی بودند که در مراحل پیش تفکر، تفکر، آمادگی و برگشت از مدل مراحل تغییر قرار داشتند (رفتار غربالگری را انجام نمی‌دادند). گروه آزمون بر اساس سازه‌های مدل اعتقاد بهداشتی در جهت ارتقاء رفتار غربالگری پاپ اسمیر آموزش دیدند و گروه شاهد آموزش‌های معمولی که توسط کارکنان بهداشتی در مورد رفتار غربالگری پاپ اسمیر در مراکز بهداشتی- درمانی ارائه می‌شود را دریافت کردند. برای گردآوری داده­ها از پرسشنامه محقق ساخته استفاده شد که این پرسشنامه قبل و 3 ماه بعد از مداخله آموزشی توسط آزمودنی­ها تکمیل گردید. برای تجزیه و تحلیل داده­ها از نرم‌افزار آماری SPSS (نسخه 20) و آزمون­های تی مستقل، تی زوجی، کای اسکوئر و آزمون دقیق فیشر استفاده شد. میزان p‌ کمتر از 05/0 معنی‌دار در نظر گرفته شد.
یافته‌ها: قبل از انجام مداخله آموزشی بین دو گروه در مراحل تغییر رفتار تفاوت معنی‌داری مشاهده نشد (05/0<p)، اما 3 ماه بعد از مداخله آموزشی این تفاوت در مراحل تغییر رفتار غربالگری پاپ‌اسمیر بین گروه­های آزمون و شاهد معنی‌دار بود (001/0p<). همچنین بر اساس نتایج آزمون تی زوجی، میانگین نمرات آگاهی، انگیزه برای سلامتی، شدت، منافع، موانع و خودکارآمدی درک شده بین گروه آزمون قبل و بعد از مداخله معنی‌دار بود (05/0>p). بعد از مداخله، عملکرد رفتار غربالگری پاپ‌اسمیر در گروه آزمون به‌طور معنی‌داری بیشتر از گروه شاهد بود (001/0p<).
نتیجه‌گیری: آموزش رفتار غربالگری پاپ‌اسمیر مبتنی بر مدل­های اعتقاد بهداشتی و مراحل تغییر می­تواند بر ارتقاء رفتار غربالگری پاپ اسمیر در زنان مؤثر باشد.

کلیدواژه‌ها


عنوان مقاله [English]

Screening for Cervical Cancer: An Educational Intervention Based on Transtheoretical Models and Health Belief in Women of Gonabad, Iran

نویسندگان [English]

  • Maryam Ghahramani 1
  • Ali Alami 2
  • Hossein Mohammad zade moghaddam 3
  • Mitra Moodi 4
1 M.Sc. in Health Education and Health Promotion, Social Determinants of Health Research Center, Gonabad University of Medical Sciences, Gonabad, Iran.
2 Associate Professor, Department of Public Health and Health Promotion, Social Determinants of Health Research Center, School of Public Health, Gonabad University of Medical Sciences, Gonabad, Iran.
3 Assistant Professor, Department of Social Medicine, School of Medicine, Gonabad University of Medical Sciences, Gonabad, Iran.
4 Associate Professor, Department of Public Health and Health Promotion, Social Determinants of Health Research Center, School of Public Health, Birjand University of Medical Sciences, Birjand, Iran.
چکیده [English]

Introduction: Screening for chronic diseases, such as cervical cancer is important in early diagnosis and prevention of the disease in women. Cervical cancer in Iran is the second leading cause of death due to sex-linked cancers. With this background in mind, this study conducted to improve the behavior of Pap smear screening.
Methods: This quasi-experimental study was performed in 2014 on 80 women aged 20-65 years old in Gonabad, Iran with active health records. The subjects were divided into the two groups of experiment and control, each containing 40 participants. The research units were the women at the stages of pre-contemplation, contemplation, preparation, and relapse of the transtheoretical model and did not have screening behavior. The test group received constructions based on health belief model toward improving the behavior of Pap smear screening. However, the control group received the regular trainings provided by the personnel in health centers about the behavior of Pap smear screening. A researcher-made questionnaire used to collect the data was completed pre- and three months post-intervention by the subjects. All the data were analyzed by independent t-test, paired t-test, Chi-square, and Fisher's exact test using SPSS version 20. P-value < 0.05 was considered as significant for all tests.
Results: Before the educational intervention in the stages of behavior change, there was no significant difference between the two groups (P > 0.05). However, three months post-intervention, the difference between the experiment and control groups was significant in the stages of change in the Pap smear behavior screening (P < 0.001). Moreover, According to the results of paired t-test, the mean scores of knowledge, motivation for health, severity, benefits, barriers, and perceived self-efficacy in the test group were significantly different pre- and post-intervention (P < 0.05). After the intervention, the performance of Pap smear screening behavior was significantly higher in the experiment group, compared to the control group (P < 0.001).
Conclusion: Findings of this study demonstrated that training the pap smear screening behavior based on the models of health belief and change stages can affect the promotion of Pap smear screening behavior in women.

کلیدواژه‌ها [English]

  • Cervical Cancer
  • Change stages model
  • Gonabad
  • Health belief model
  • Pap smear screening behavior
  • Women
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