摘要目的 分析影响婚前医学检查行为的影响因素,探讨可能的干预策略.方法 采取分层随机拦截方法从浙江省12个县(市、区)民政婚姻登记处调查2572名新婚登记者,根据人口学变量、健康信念模式和合理行为理论的互补维度等自行设计结构式问卷,采用多水平多因素logistic回归拟合相关变量,个体为低水平,县(市、区)为高水平.结果 婚检行为在县(市、区)水平具有聚集性(P=0.018),各变量的方差成分系数为15.40％～ 17.58％.不同性别、年龄、户籍、文化程度、经济收入、医疗保险类型、是否曾婚检过等人群间婚检率差异无统计学意义,但婚检率与职业相关；近6个月内无医学体检人群婚检率是医学体检人群的1.31倍(95％CI:1.05～1.65)；与初婚未孕人群相比,初婚已孕和再婚人群婚检率是其1.51倍(95％CI:1.14～2.00)和0.35倍(95％CI:0.23～ 0.51).婚检行为与感知易感、严重感、遵从动机等无关,与益处感、障碍感、行为态度和规范信念等相关,OR直分别为2.32(95％CI:1.18～ 4.60)、0.71 (95％CI:0.57 ～ 0.90)、1.69(95％CI:1.10～2.58)和1.72(95％CI:1.34～ 2.20).结论 地域环境因素对婚检行为影响力约占16％,但婚检行为主要受个体认知、态度、信念等决定.提高婚检率要注重益处的认知,培养正向行为态度,降低行为障碍和顾虑,并要注意发挥影响婚检决策具有影响力人群的间接作用.

abstractsObjective To explore the factors influencing the premarital medical examination in Chinese population and to discuss the related possible intervention strategies.Methods Data were collected through self-designed questionnaires on 2572 newly married respondents,selected under a stratified randomized sampling method,at Marriage Registration Office in 12 counties in Zhejiang province.Predictive factors were derived from the integrating complementary constructs of Health Belief Model,Theory of Reasoned Action as well as individual demographic characteristics.Multiple logistic multilevel analyses was used as the main statistical method,with individuals as the ' low' and counties as the 'high' levels.Results Behaviors on premarital medical examination showed a clustering trait at the county level (P=0.018) and variance partition coefficients (VPC) of each variables was between 15.40％ and 17.58％.There were no statistical significances found in the rates of premarital medical examination among gender,age,residence of Household Registration,education,income,health insurance and history of premarital medical examination.However,significant correlation was seen on occupation of the respondents.The rate of premarital medical examination among the respondents who had not attended medical examination during the last six moths was 1.31times (95％ confidence intervals,1.05 -1.65 ) more than those who had,with OR (odds ratio) as 1.51 (95％CI:1.14-2.00) for the pregnant respondents in their first marriage and 0.35 (95％CI:0.23-0.51 )for remarried respondents,compared with women at first marriage but remained unpregnant.Regarding premarital medical examination,the respondents reported greater benefits,less barriers,greater positive behavioral attitudes and normative beliefs to it,with an ORs as 2.32 (95％ CI:1.18-4.60),0.71 (95％CI:0.57-0.90),1.69 (95％CI:1.10-2.58) and 1.72 (95％CI:1.34-2.20)respectively,but with no significant association with perceived susceptibility,perceived severity and motivation to comply.Conclusion Factors such as individual perceived benefits,barriers,attitudes and normative beliefs etc.,were determinants of premarital medical examination accompanied by minor (16％) influence coming from the geographical environment.