Research On Training Effects And Influencing Factors Of Health Appropriate Techniques In Gansu Rural Areas

Objectives To evaluate the training effects of health appropriate techniques in rural areas of Gansu province and explore the potential influencing factors of it.This research can supply scientific evidences for selecting proper training patterns and improving training effects.Methods(1)Training patterns:Doctors were trained 24 health appropriate techniques with gathered-training pattern.Micro-traumatic evacuation of cerebral hemorrhage was taught with dispatch-training pattern,and rapid tests for cervical cancer screening with field-training pattern.(2)Investigation on training effects:①Survey on effects under gathered-training pattern:Training Effects Questionnaire was used to investigate the subjective appraisement on training contents and process of every technique.By comparing the changes of average scores among pre-training, post-lecture and post-interaction strengthening of every technique,short-time training effectiveness was estimated objectively.Application,treatment effects and et al were registered on the registration forms to appraise the long-time training application effects.②Survey on effects under dispatch-training pattern:Medical records about the treatment of cerebral hemorrhage happening before and after training were investigated in the county hospitals in two demonstration counties.Training effects were evaluated by comparing usage rates and effective rates of micro-traumatic evacuation and usage proportions of different methods to treat cerebral hemorrhage before and after training,and their treatment effects after training.③Survey on effects under field-training pattern:Recognition evaluation on rapid tests for cervical cancer screening was carried out before and after training.Furthermore,the level of operation was assessed after training.(3)Investigation on influencing factors of training effects:①Survey on influencing factors of short-time training effects: Influencing factors associated with training content,process and scores were explored with stratified analysis by trainees' titles,education backgrounds,hospital grades, majors,technique types and so on.②Survey on influencing factors of long-term training effects:In the final stage investigation,questionnaires were carried out on project directors at the province,county and village levels and sampled trainees to explore the influencing factors of application effects.Results(1)Training effects:①Effects of gathered-training pattern:The training effects of 22 techniques were evaluated.1)Training content:Demand rate of every technique was high.Only a few of techniques were difficult to be mastered:new concept electrocardiogram(difficulty rate,73.91%),standardized therapy for chronic heart failure(difficulty rate,55.07%),technique to treat flexor tendon stenosis tenosynovitis with the tendon sheath release knife(easiness rate,5.77%)and intrauterine device detection with b-mode ultrasonography(difficulty rate,31.11%).2) Training process:the satisfactory rates of trainees for interaction strengthening and teachers' lecture were 92.48%and 80.39%,respectively.83.76%of trainees chose the lecture given by the holder of technique.3)Learning effects:The average scores were elevated greatly from pre-training to post-lecture(P<0.05)and improved slowly from post-lecture to post-interaction strengthening(part of techniques,P<0.05).Average scores of appropriate techniques on western medicine at three training periods were 31.32,68.06,and 72.13,respectively.Among western medicine techniques,the average scores of standardized therapy for chronic heart failure at three training periods were all lower than 60,and scores of new concept electrocardiogram had the greatest increase(57.08).Average scores of appropriate techniques on Chinese traditional medicine at post-lecture and post-interaction strengthening were increased up to 48.09 and 50.77 compared with the scores at pre-training(17.33),respectively. Average score of the technique to treat flexor tendon stenosis tenosynovitis with the tendon sheath release knife at post-interaction strengthening(31.39)was the lowest among Chinese traditional medicine.Average scores of family planning techniques before and after training were 25.24 and 54.66,respectively.Scores of the other techniques for family planning were lower than 60 except subdermal contraceptive implant and mifepristone with misoprostol for the early stage abortion.Among the family planning techniques,intrauterine device detection with b-mode ultrasonography had the greatest increase(41.16).4)Training application effects: 13.69%,26.19%and 100.00%of trainees performed the techniques of western medicine,Chinese traditional medicine and family planning,respectively.Technique for treatment of hemorrhagic shock using hypertonic sodium chloride solution was not be used.The other 15 appropriate techniques for treatment under gathered-training pattern had the effective rates from 87.64%to 98.97%.②Effects of dispatch-training pattern:The percentage of doctors mastering micro-traumatic evacuation of cerebral hemorrhage increased from 18.18%to 50.00%in two demonstration counties.The usage rate of this technique after training(49.68%)was significantly elevated by 10.16%comparing with the one before training(39.52%)(χ~2=5.20,P<0.05),and had a significant increase year by year(γ_s=0.14,P<0.01).Internal medicine(50.48%) was dominant at the treatment of cerebral hemorrhage before training,but micro-traumatic evacuation(49.68%)became dominant after training.The effective rates of micro-traumatic evacuation,traditional operation and internal medicine after training were 84.42%,72.00%and 63.36%(χ~2=16.62,P<0.01),and correspondingly fatalities of them were 7.14%,20.00%and 10.69%,respectively(P>0.05).③Effects of field-training pattern:The scores on recognition of rapid tests for cervical cancer screening before and after training were 66.67 and 100.00,respectively.Average score on the level of operation was 90.83 after training.(2)Influencing factors on training effects:①Influencing factors on short-time training effects:1)Trainees' qualities: The higher trainees' titles were,the greater the demand rates of appropriate techniques were(τ=0.06,P<0.05).Trainees with undergraduate or more background had the highest average score at post-lecture of appropriate techniques on western medicine (F=0.02,P<0.05)and had the highest average score before the training of Chinese traditional medicine(Hc=12.18,P<0.05).2)Trainees' majors:Trainees who majored in western medicine had the highest average score at post-interaction strengthening of appropriate techniques on western medicine(F=3.18,P<0.05).3)Levels of hospitals where trainees worked in:The demand rate of trainees from county hospitals was significantly higher than the ones from village hospitals(τ=0.10,P<0.01).County trainees' satisfactory rate to the lectures given by the holders of techniques was significantly higher than village trainees'(χ~2=10.11,P<0.01).However,village trainees' satisfactory rate to the lectures given by local teachers and using the textbooks written by the holders of techniques was significantly higher than county trainees'(χ~2=4.24,P<0.05).4)Types of appropriate techniques:Trainees had the highest demands of appropriate techniques on western medicine(Hc=52.68,P<0.01). Meanwhile,techniques on western medicine was more difficult than ones of Chinese traditional medicine and family planning(Hc=75.10,P<0.01).5)Title of teacher:The higher the title of teacher was,the greater trainees' satisfactory rate tothe teacher's lecture was(τ=0.12,P<0.01).②Influencing factors on long-time training effects: Doctors and managers of hospitals were thought to perform the appropriate techniques actively by 91.11%and 82.22%of project directors,respectively.Project directors regarded prevalence and incidence rates of diseases(57.78%),difficulties of techniques(57.78%)and promotion expenses(55.56%)as the most important influencing factors of technique applications.They also considered lack of promotion expenses(71.11%),lack of corresponding hardware and software facilities(44.44%) and no reception of appropriate techniques by rural residents(35.56%)as the main reasons for holdbacks of technique applications.Lack of corresponding equipment and instruments(30.95%)and lack of medicine(26.19%)were the most dominating reasons for trainees' no usage of appropriate techniques.Conclusion(1)Training of appropriate health techniques in rural areas in Gansu province achieved excellent effects.Doctors in two demonstration counties mastered the simply,easy,economic,effective and appropriate techniques to treat the frequent diseases in local areas,and their knowledge and ability were significantly improved. Some techniques had played active roles in improving the local medical levels and health statuses of rural residents.In the future training process,proper training patterns should be chosen based on the technique characters,requirements of equipment,the ability of training organization,levels of teachers,qualities of trainees and the number of them to fit for the realistic conditions.(2)This study showed that trainee's title,background,major and level of hospitals,level of teachers,technique characters,promotion expenses,software and hardware of hospitals,attitudes of hospital managers and doctors had different effects on the short-time and long-time training effectiveness.As a result,strict training rules should be made,and strategies of training and application should be studied in the future training and promotion process of appropriate techniques in order to elevate the short-time and long-time training effects at the same time and maximize the benefit of finite training resources.