基于计划行为理论的进城务工者乙肝高危行为模型与干预策略研究

China has a large number of migrant workers who almost account for the whole of floating population. Migrant workers are usually in low education level, lack of social support, and weak in self-protection awareness, thus they are likely to have risk behaviors such as unprotected sex behavior, commercial sex behavior, selling blood and even injecting drug use, and thus become susceptible to Hepatitis B. Meanwhile, their frequent movements increase the probability of HBV spreading, which would significantly impact Hepatitis B prevention and control in China. The present study aims to introduce three new variables of Anticipative Regret, Experienced Behavior and Protective Measure to improve the Ajzen’s Theory of Planned Behavior, and then design the appropriate survey scale of Attitude Toward Behavior, Subjective Norm and Perceived Behavioral Control for risk behavior among migrant workers, to understand awareness and behavior characteristics of migrant workers on Hepatitis B. Collected data were introduced in to the Global Sensitivity Analysis Model, to detect the coupling and synergistic effects, Logistic Regression Model and Structural Equation Model are also used to compute the major effective factors, identify the key effective routes and establish theoretical statistical model. Subsequently, a prospective cohort is set to follow-up supervise and assess the risk behaviors of migrant workers, verify, complete and improve the theoretical statistical model by empirical research, and provide scientific evidence for reasonable and feasible intervention approach and prevention strategy.

我国进城务工者数量庞大，几乎占据流动人口的全部。他们普遍文化水平低、社会支持少、自我保护意识弱，易出现无保护性行为、商业性行为、卖血甚至注射吸毒等高危行为，成为感染乙肝的脆弱人群，而其频繁流动的特点又增加了乙肝病毒传播扩散的可能，对我国乙肝防治工作造成巨大影响。本研究在Ajzen计划行为理论的基础上引入预期后悔、行为经验和保护措施三个新变量，建立和完善理论框架，编制适用于进城务工者的乙肝高危行为态度、主观规范及知觉行为控制调查量表，收集进城务工者乙肝认知状况和行为特征数据，导入全局敏感性分析模型，探索各变量间耦合作用及协同效应，并结合Logistic回归模型和结构方程模型，测量主要作用因子，识别关键作用路径，构建理论模型。接着，建立前瞻性队列对进城务工者乙肝高危行为情况进行长期随访监测和评价，通过实证研究验证、补充和完善理论模型，为进一步制定合理可行的干预措施和防控策略提供科学依据。

目前，乙肝仍是我国传染病防治面临的重大挑战之一。性接触和使用被污染的针头是成年人感染乙肝病毒的主要途径。作为备受关注的社会群体，农民工大多为青壮年，处于性活跃期，却因文化程度低，自我保护意识弱，家庭及社会支持少，而更易发生无保护性行为、商业性行为甚至注射吸毒等，增加感染乙肝的风险。而其频繁流动的特点又增大乙肝病毒传播扩散的可能，对我国乙肝综合防控工作造成巨大影响。本研究在计划行为理论基础上，引入行为经验与后悔感受两大维度多个变量，丰富和完善理论模型，并据此编制适用于定量与定性探索农民工乙肝危险行为的调查工具，通过横断面研究及队列研究，追踪分析农民工乙肝危险行为与行为意愿特征及其动态发展规律，识别与测定行为态度、知觉行为控制、主观规范、行为经验和行为意向等影响农民工发生乙肝危险行为关键变量的作用路径及影响程度，研究结果对于揭示农民工乙肝危险行为特征与规律具有重要的理论价值和现实意义，为制定合理可行的干预措施及防控策略提供研究证据。