| Objective:1.Through literature analysis,expert correspondence,and pre-investigation,a questionnaire on the knowledge of colorectal cancer prevention and treatment was prepared.2.Health management interventions which based on Urban Cancer Early Diagnosis and Early Treatment Project screening platform and informationmotivation-behavioral skills modelare were carried out for residents after endoscopic resection of intestinal polyps under the guidance of the hospital-community linkage management model established earlier.To improve the compliance of colonoscopy reexamination and awareness rate of colorectal cancer prevention knowledge and healthy behavior level,reduce the recurrence rate of intestinal polyps and the incidence of colorectal cancer in urban areas,and improve the survival rate.Methods:1.Compilation of the knowledge questionnaire on colorectal cancer prevention and treatmentWe formed the dimension and item pool of the questionnaire through literature analysis,and formed the initial questionnaire used in the pre-survey through expert consultation.We used the item analysis,Cronbach’s α coefficient,retest reliability coefficient and exploratory factor analysis to test the reliability and validity of the questionnaire.And we formed the final knowledge questionnaire on colorectal cancer prevention and treatment.2.Hospital-community linkage management interventionWe applied a random sampling method to select 1,200 residents after microscopic resection of intestinal polyps in 97 communities in eight administrative districts of Nanchang City.They were randomly divided into the intervention and control groups according to their community.There were 170 people lost to follow-up because of job change,relocation,interruption of contact,and unwillingness to continue participating in the research.A total of 1030 residents completely participated in this research project(521 in the intervention group and 509 in the control group).The control group implemented routine health management,and the intervention group implemented hospital-community linkage management intervention on the basis of the control group 5 months,and regularly followed up the residents’ colonoscopy reexamination and intestinal polyp recurrence 2 years.The Chinese revised version of Health Promotion Lifestyle Profile-Ⅱ Revision(HPLP-ⅡR)was used to evaluate residents’ knowledge of colorectal cancer prevention and treatment and improvement of health behaviors before and after intervention.Results:1.The colorectal cancer prevention knowledge questionnaire compiled included 19 items in three dimensions:basic cognition,risk perception,and tertiary prevention cognition.Reliability and validity of the questionnaire:①Cronbach’s a coefficient:the overall Cronbach’s a coefficient of the questionnaire is 0.939,and the threedimensional Cronbach’s a coefficient is 0.899～0.956;The reliability coefficient is 0.809～0.855;③Expert content validity:I-CVI of each item is greater than 0.80,each dimension and the overall S-CVI/Ave of the questionnaire are greater than 0.90;④Construct validity:Bartlett’s spherical test of the questionnaire P<0.001,KMO was 0.796.We used the principal component analysis combined with orthogonal rotation to extract three common factors with Kaiser eigenvalue greater than 1.The cumulative explained variance variation was 75.007%and the factor loading values of each item were all greater than 0.4.2.Hospital-community joint management intervention2.1 Analysis of the general data of the residents in the two groups:the difference in the general data of the residents in the intervention group and the control group was not statistically significant(P>0.05),and they were comparable.2.2 The compliance of the colonoscopy reexamination of the two groups of residents:a total of 1030 people in the two groups completed the follow-up,and only 491 of them underwent the reexamination on time,resulting in a colonoscopy compliance rate of 47.67%.521 people in the intervention group completed the followup,308 of them were reexamined on time,and the compliance rate was 59.12%.509 people in the control group completed the follow-up visits,183 people had reexamined on time,and the compliance rate was 35.95%.2.3 The recurrence of intestinal polyps in the two groups of residents:a total of 491 people in the two groups were reexamined on time,192 people had a polyp recurrence.,resulting in a intestinal polyps’ recurrence rate of 39.10%.308 people in the intervention group were reexamined on time,105 people had a polyp recurrence,and the recurrence rate of intestinal polyps was 34.09%.183 people in the control group were reexamined on time,87 people had recurrence of polyps,and the recurrence rate of intestinal polyps was 47.54%.The difference in the recurrence rates of intestinal polyps between two groups was statistically different(P=0.003).2.4 Comparison of the knowledge of colorectal cancer prevention and treatment between two groups:the differences in the overall knowledge of colorectal cancer prevention and treatment and the three dimensions between two groups before the intervention were not statistically significant(P>0.05).The differences in the overall knowledge of colorectal cancer prevention and treatment and the three dimensions between two groups after the intervention were statistically significant(P<0.001).The differences in the overall knowledge of colorectal cancer prevention and treatment and the three dimensions before and after the intervention were not statistically significant in the control group(P>0.05)and statistically significant difference in the intervention group(P<0.001).Their differences of before and after the intervention in the intervention group were statistically significant from those in the control group(P<0.05).2.5 Comparison of the health behavior levels between two groups:there was not statistically significant difference in the scores of the six dimensions and the total score of the health behavior level of residents between two groups before the intervention(P>0.05).There were statistically significant differences in the scores of the five dimensions and the total score between two groups after the intervention(P<0.001),but there was no statistically significant difference only in the scores of the interpersonal relationship dimension(P=0.870).There was no significant difference in the total score of health behavior level and the scores of five dimensions before and after the intervention in tbe control group(P>0.05),but there was a statistically significant difference only in the score of physical activity(P=0.048).There were statistically significant differences in the total score of health behavior level and five dimensions of residents before and after the intervention in the intervention group(P<0.001),and there was no significant difference only in the score of interpersonal relationship dimension significance(P=0.055).Their differences in the total score of health behavior level and the scores of the five dimensions before and after the intervention in the intervention group were significantly different from those in the control group(P<0.001),but there was no significant difference only in the score of interpersonal relationship(P=0.707).Conclusions:1.The preparation process of the colorectal cancer prevention knowledge questionnaire is standardized and reasonable,and it has good reliability and validity.It can be used as an evaluation tool to measure the knowledge level of colorectal cancer prevention and treatment in the population after intestinal polypectomy.2.The hospital-community linkage management has positive significance for improving the compliance of colonoscopy reexamination after polypectomy,reducing the recurrence rate of intestinal polyps,improving the knowledge level of colorectal cancer prevention and promoting their health behaviors.It is of great significance for government departments to make cancer prevention and control decisions.It provides a reference and also provides a new way and new model for the health management of other high-risk groups of cancer,which has certain social promotion value. |
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