偏远地区少数民族孕产妇精准管理模式构建及干预策略优化研究—基于社区参与和交叉性理论

Health inequality among ethnic minorities has already caused the widespread attention globally. Low utilisation of maternal health services exists among ethnic minority women in remote areas of western China. Based on the Cohort Study of Natural Population at High Altitude in Southwest China, this study will take community-based participatory research as the main method to identify the main obstacles to seeking and receiving maternal health services in mountainous ethnic areas of Yunnan Province by carrying out in-depth interviews and group discussions with stakeholders in community. The qualitative data will be analysed by using the intersectional approach as the analytical framework. Community participatory approach will be employed to select and optimize intervention strategies, and to build a community-family-individual acceptable precision management for ethnic minority pregnant women in remote areas which cover whole process of pregnancy. It aims to improve the works of maternal health workers at primary level and change the health behaviour of pregnant women. The evaluation index system of ability to provide precision management for ethnic minority pregnant women in primary health institutions will be established by expert consultation. The on-the-spot survey will be carried out to assess the feasibility and sustainability of the precision management for ethnic minority pregnant women in remote areas, and to provide evidence for policy making to reduce the health disparities and promote health equity for ethnic minorities.

少数民族人群的卫生公平问题已经被国际社会普遍关注。本研究针对中国西部偏远地区少数民族孕产妇卫生服务利用低的现状，依托西南区域高海拔世居高原自然人群队列研究，拟在云南省少数民族聚集的山区县，以社区为基础的参与式研究为主要方法，对社区的各利益相关者开展深入访谈、小组讨论等定性研究，以交叉性理论为分析框架，甄别出偏远地区少数民族孕产妇寻求和接受妇幼卫生服务的主要障碍；遴选、优化目前的干预措施，构建得到社区、家庭、妇女共同认可的针对偏远地区少数民族孕产妇的全过程、综合性、个体精准化的管理模式，改善基层妇幼卫生人员的工作方式和孕产妇的健康行为方式；采用专家咨询构建基层卫生机构开展少数民族孕产妇精准管理能力的评估指标体系，开展现场调查对偏远地区少数民族孕产妇精准管理模式的可行性、可持续性进行初步论证。为国内外缩小少数族裔人群健康差距、促进健康公平的政策制定提供依据。

本项目针对中国西部偏远地区少数民族孕产妇卫生服务利用不足的现状，系统回顾了全球20个妇幼健康促进条件现金转移支付项目，全面分析了云南省孕产妇和婴幼儿的死亡趋势、主要死亡原因及死亡地点；在此基础上，选择云南省少数民族聚集的山区县，以社区为基础的参与式研究为主要方法，以交叉性理论为分析框架，甄别出目前仍然阻碍偏远地区少数民族孕产妇卫生服务利用的“医疗信息”“检查设备”“医疗技术”“经济成本”和“时间成本”五方面因素；基于离散选择实验对少数民族妇女利用产前检查、住院分娩和产后访视服务的偏好测量结果，对遴选出的“健康教育”“分娩计划”“质量提升”“经济补偿”“互助交通”“待产点”和“早孕试纸”等干预手段提高当地孕产妇卫生服务利用的可行性进行了评估；结合德尔菲专家咨询结果，提出了以县为单位的包含了“识别重点人群”“实施分类管理”“严防遗漏人群”“提供财政保障”“提升服务质量”“健全信息体系”和“提高健康素养”七大要素的偏远地区少数民族孕产妇精准管理模式工作框架，以及基于结构-过程-结果概念框架的孕产妇精准管理能力评估三级指标体系。研究结果为改善基层孕产妇卫生服务的供给方式，提高孕产妇的卫生服务利用水平，缩小少数族裔人群健康差距、促进健康公平的政策制定提供依据。