| ObjectiveThe aim of this subject is to use domestic and foreign advanced experience of assessment in the evaluation of Healthy Village for reference, and to evaluate the effect of Beijing's "health promotion model village project" with a combination of qualitative assessment and quantitative assessment comprehensive evaluation methods. The aim is to sum up the successful experience and explore the appropriate strategy and model in the construction of Healthy Village.MethodsThe combination of evaluation methods with both qualitative assessment and quantitative assessment were used in this subject. Qualitative assessment includes reviewing the literature and files, Focus group discussion, Individual in-depth interview, field observation, while quantitative assessment was carried out by questionnaires. We selected four counties (Daxing, Huairou, Mentougou, and Yanqing) from the east, west, south and north direction of Beijing. And we took four different levels including of the municipal level, district level, township level, village level to evaluate the effect. Among them, the assessment methods of municipal level, district level, and township level mainly included reviewing the create work-related documents and files, interviews the responsible person of construction, to understand the policy, funding, organization and implementation, technical support, experience and effectiveness, the problem and recommendations in the process of Health Village Construction, and filled out the record sheet in the end. There were four parts in the village level:The first was to interview one person who was responsible for the village health work in each of the selected village, and interview the group of 10 people who were from different families and were over 18 years; The second was to observe the health environment and health services and other basic condition in the selected villages, and to fill the record of village field observation; The third was to observe the family environment, personal heath behavior of the five selected demonstration families of each Health Village, and five families which are selected on random in each control village, and complete the Observation Record. The fourth was to select 30 people who were over 18 years and from different family in each selected village in order to do questionnaire survey, and the aim is to understand the basic situation, health knowledge and behavior, their support and satisfaction of Health Village, environmental facilities, the utilization of health services and so on.From April to June 2010, we conducted our assessment work in the selected 24 model villages and 24 control villages in Daxing, Huairou, Mentougou, and Yanqing. Interviews were conducted face to face, all the record sheets were recorded by investigators in the field observations, and the villagers'questionnaires were surveyed face to face.Interviews of villagers and village cadres were done by the members of the interview group to complete the summary and text transcripts, and were summarized by the researchers to classify and comprehensive analysis, and wrote qualitative research reports in the end. The observations of each village and household inspection record were recorded by investigators and were finally analyzed by the researchers to summarize and write observation report; Using Epi Data 3.1 to complete data entry and checking of quantitative data. Use statistical analysis software SPSS13.0 to complete description and analysis of the data.ResultsHealth ManagementIn policy of health promotion, the four counties all developed specific implementation plans. The 12 assessed towns also introduced some distinctive policies according to the actual situation. The entire model village had developed health promotion policies, which added up to 69.In management of health promotion,24 people were responsible for health in model village, all villages had established a leading group of village health promotion, there were part-time staff for village health promotion, all villages had established a village health promotion files,13 villages had established positive health education molecular network,22 villages had annual health promotion work-plan,21 villages have annual summary of health promotion work, at least 23 villages hold a regular meeting of health promotion. Health promotion management of model village was better than the control village in the whole. Healthy EnvironmentIn the construction of new countryside, model villages and control villages had both launched the construction of new countryside in general; about 90% of village road meet the standards in the model village,85% of the model village had completed the sewer reconstruction,60% of the model village had completed the construction of a public shower room, the rate of indoor toilet transformation was 75%. Model village had done better than the control village in construction of public toilet shower and transformation of households.In the governance of living environment, the implementation of all the model village constructed garbage removal and transportation system, more than 95% of the villages' environment were clean and tidy, non-cluttered, non-breeding ground for mosquitoes; No outbreaks of infectious diseases, food poisoning and pesticide poisoning happened in 2009. The situation of clean and tidy environment and breeding ground for mosquitoes in model village were better than the control village.In the sports facilities,100% of the model village had fitness equipment; the average area of activities was 763.8 square meters, the construction rate of movie screening room was 100%, the average possession number of the village health science library books was 769. The average fitness sites area and the number of health science books in model villages were significantly higher than the control villages.In health promotion facilities and environment, the model village clinics had an average of 75.6 square meters area which reaches Beijing's construction standards, the average number allocation of doctors was 1.4, and the annual average number of health funding was 1.7 million. The average area of Health Education Room was 81.4 square meters, the average annual health education and promotion update 3.7 bar,100% of the villages had radio station, and 75% of this had a fixed period of health education broadcasting, the main play frequency was 2 weeks to 1 month. Area of health education room, radio station set rate, health education, radio broadcast frequency and so on in Model village were significantly higher than the control villages. More than 90% of the model villages offices has no-smoking signs, about 60% of them placed ashtray, about 70% of the control village has no-smoking signs, about 80% of them placed ashtray, tobacco control environment in model villages were better than the control villages. In the household's environment, the overall environment of 88.3% observed model households were clean and tidy,75.8% of them had tape water,84.2% of them have domestic sewage disposal facilities,97.5% of household waste was placed in designated bins,75.8% of the toilets were clean, no smile and no urine base,77.5% of them did not keep livestock,16.7% of them had captive animal,80.8% of them had shower room,84.2% of them hold the gas for home energy,17.5% used solar and other clean energy sources. The whole environments in model families were better than no model family.Health ServicesIn the provision of basic public health services, all the model villages had developed a health examination, child immunization rate run up to 100%, the rate of prenatal care was 97.1%, hospital delivery rate was 92.0%, the rate of diabetes management was 90.4%, hypertension management rate was 79.9%, and the filing rate of residents' health was 56.8%. Indicators in model villages were all above the national average, which the filing rate of resident's health was significantly higher than control villages (37.6%).In the medical insurance, the rate of medical insurance in model village was 96.8%, which was higher than the national average. The rate of new rural cooperative medical care was 89.2%, which was consistent with the national average and was slightly lower than the level of Beijing city. Model village provide certain amount money to the villagers based on their economic situation in new rural cooperative medical care, ranging from 20 to 50 Yuan per person, which will help increase the participation rate of the villagers.In use of the community health service stations (village health), the model village community health service stations (village health) utilization rate was 85.1%, of which medical treatment was the most common use of medical services, utilization rate was more than 50%, followed by health counseling, participate in health education activities and the establishment of health records, which the utilization rate was 10% to 30%. Utilization of various health services in model villages was higher than the control villages.In health education activities, model villages carried out health education activities in an annual average of 3.4 times and the scale of each event was about 200 people, health large classroom 2.8 times, the number of participants was about 180 people, about 70% of the villagers had participated in activities. Health education activities were in various forms. The content was based on hypertension, diabetes, influenza, Hand, Foot and Mouth Disease and other infectious diseases, which was consistent with the health needs of the villagers, and achieved some success in the villagers' change in smoking, high salt, high-oil, etc.. The number, size, participation rate of health education in model village was significantly higher than control villages.Health Knowledge and BehaviorIn knowledge of the prevention and control of infectious diseases, model villagers had a certain level of infectious disease prevention and control knowledge, but they did not grasp the comprehensive knowledge, correct answer rate of 8 knowledge points was from 21.0% to 93.6%, and cockroaches can spread dysentery, transmission of hepatitis B and the proper channels after animal bite was only 21.0%,27.9% and 54.0% respectively.In knowledge of chronic disease prevention and control, the correct answer of the risk factors of hypertension in model village was 29.4%, the awareness on more salt, obesity and high fat diet of these three risk factors for hypertension were lower than 75%, and awareness of lack of exercises was especially penurious which was only 43.9%. The correct answer rate to the complications of diabetes in model villages was 12.4%, the awareness of stroke and foot ulcers were 31.6% and 47.7% only, and awareness of retinopathy was slightly higher (80.2%).In the personal health behavior, the rate of smoking and drinking of the villagers in model villages were 25.4% and 19.5%; the proportions of washing hands before eating, brushing teeth each day and washing at least a week were all high, respectively 74.7%,98.4% and 86.1%, regular physical exercise run a higher proportion, the proportion of physical activity 1, 3,5times or more a week were 88.9%,57.1% and 34.4%.In health behavior of the householders, the possession of the observed model households on salt restriction spoon and oil control pots were 70.8% and 83.3%, and the utilization rates were 27.5% and 45.0%. The rates of having two or more chopping boards and not sharing towels in model households were 63.3% and 80.0%. The proportion of replacing the brush on a regular basis in model households was 72.5%, which was higher than the 59.2% of non-model households.Conclusion1 The construction of Health Promotion Model Village in Beijing got obvious effect Through the impact assessment of four counties for the construction of Health Promotion Model Village, in health management, health environment, and health services, the model villages were better than the control villages. In most areas of health knowledge and health behavior, there was no significant difference between model villages and control villages. The construction of Healthy Village was still in its initial exploratory stage, the investment of funds, manpower, material resources were limited. Work patterns, techniques, strategies, methods need to be summed up and improved, the improving of health knowledge and behavior is a long-term efforts. Therefore, compared with the control villages, the construction of Healthy Village achieved good results, and accessed a high degree of satisfaction and support.2 Basic public health services was popular, and villagers actively participate in activities in constructionThe observed villages had carried out health examination, immunization, resident's health record establishment, hypertension and diabetes management, and other basic public health services in general. Health examination rates, immunization rates, rates of hypertension and diabetes management, prenatal care rate and hospital delivery rate were all at high levels, about 80% of the villagers made use of community health service stations (village health), about 20% of the villagers used 3 or more kinds of community health services, the rate of community health service utilization was high. The number and form of health education activities were various, and the proportion of involving in health education programs, often hearing radio of health education, getting health communication materials in model villages were significantly higher than the control villages. The sports activities carried out in 2009 and the number of participants in model villages were higher than the number of control villages.3 The construction of Healthy Village played a certain role in changing the attitude of village health and improved health knowledge, health behaviors of villagersThe organization of Big Health Class, distribution of health communication materials, health consultation, and a variety of activities which were held in the construction of Healthy Village enhanced health awareness of the villagers. The rates of different infectious diseases prevention and control knowledge were higher than 75%. The rates of brushing teeth at least once a day, doing physical exercise at least once a week, bathing at least once a week were higher than 84%.The rates of washing hand before meals, never smoking in 2009, no drinking were higher than 66%. The proportion of getting health knowledge mainly through billboards, flyers, brochures and health class model villages (35.6%) was significantly higher than the control villages (17.7%), indicating that the health education activities that were carried out in the construction of Healthy Village had become an important way to obtain health information.4 There were some shortcomingsIn health environment, a few villages took water of the river or pond or other surface water as the main source of drinking water. Firewood usage was high (44.2%), biogas, solar and other clean energy should be strengthened. A few meeting rooms placed ashtray, tobacco control policy enforcement was not enough.In health services, community health services was still low in utilization of health education function, indicating that basic health agencies in health management and health education need to be enhanced and the working capacity need to be improved, health management and problems of the mechanism of education also must be resolved.In health knowledge, the health knowledge especially health knowledge of chronic disease was not accurate and comprehensive, there were some misunderstandings, for example, the rate of "risk factors of hypertension," "route of transmission of hepatitis B", "diabetic complications" were low than 30%.In health behavior, the use of spoon for salt restriction and pot for oil control were low, some residents did not control salt and oil; some villagers shared towels, neglect raw and cooked, not replaced the brush on time. There were misunderstandings in some residents about the need for physical exercise, they though daily fanning were manual labor, and there was no need for additional physical exercise, and some residents said they did not have time to participate in physical exercise.Suggestions1 The funds for investment in rural health education and technical support should be increased2To arrange activities according to farmer characteristics3 To carry out health services on the base of the demand and the weak point of the villagers4 To summarize the successful experience of the construction of Health Promotion Model Village in Beijing... |
