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1、2019/4/19,SUDA-MYN,1,第八章 健康教育诊断,SUDA-MYN,2,2019/4/19,内容提要,健康教育诊断的基本思路 健康教育诊断的基本步骤 健康教育诊断资料的收集和分析 案例分析见P186,SUDA-MYN,3,2019/4/19,应掌握的重点,健康教育诊断的概念？ 何谓格林模式？ 健康教育诊断有哪几个步骤？各诊断要点如何？,SUDA-MYN,4,2019/4/19,一、健康教育诊断的基本思路,（一）健康教育诊断的概念*,健康教育诊断指通过系统地调查、测量人群的健康问题资料，并对这些资料进行分析、归纳、推理、判断，确定或推测与此问题有关的行为、行为影响因素和健康教育资源
2、的可得性，从而为确定健康教育干预目标、策略和措施及健康教育干预效果提供基本依据和基线资料的过程。,SUDA-MYN,5,2019/4/19,图1 健康教育诊断图示,健康问题,系统调查、 测量收集 资料,分析、归 纳、推理、 判断,确定健康 相关行为 及影响因 素，资源 可得情况,为确定干预 目标、策略、 措施和效果 评价提供 基本依据,SUDA-MYN,6,2019/4/19,（二）健康教育诊断的基本思路,联合国儿童基金会（UNICEF） 格林模式 PATCH,（1）问题与政策分析 （2）形势分析 （3）目标人群分析,SUDA-MYN,7,2019/4/19,格林模式（PRECEDE-PROC
3、EED）,格林模式是目前最有代表性、使用最为广泛的健康教育诊断。 它是美国学者Green等在20世纪70年代提出的。 PRECEDE：predisposing, reinforcing and enabling constructs in education/environmental diagnosis and evaluation PROCEED：policy, regulatory and organization constructions in educational and environmental development,SUDA-MYN,8,2019/4/19,PRECEDE
4、-PROCEED,Planning model for health promotion programming Good programs based on models. Models used by planners as means of structuring ; organizing planning process. This lectures focus is on the PRECEDE Predisposing, Reinforcing and Enabling Constructs in Educational Diagnosis and Evaluation. PROC
5、EED stands for Policy, Regulatory and Organizational Constructs in Educational and Environmental Development. The model is theoretically grounded and comprehensive in nature. It combines planning, implementation and evaluation. The greatness of the model is seen in that it takes into account the mul
6、tiple factors that shape health status and helps the planner arrive at a highly focused subset of those factors as targets for evaluation. PRECEDE also generates specific objectives and criteria for evaluation. PROCEED - elaboration and extension of the administrative diagnosis step of PRECEDE.,2019
7、/4/19,SUDA-MYN,9,图2 PRECEDE-PROCEED模式,2019/4/19,SUDA-MYN,10,2019/4/19,SUDA-MYN,11,SUDA-MYN,12,2019/4/19,PRECEDE-PROCEED,Social diagnosis - Subjectively define QOL ( problems & priorities ) of target population, individual or community. The best programs have the individuals involved in a self-study
8、of their own needs. This empowers people and gathers needed input in order to determine the solution. Indicators include absenteeism, crime, illegitimacy, self-esteem, votes, welfare, unemployment and good things too.,SUDA-MYN,13,2019/4/19,PRECEDE-PROCEED,Epidemiological diagnosis - Planners use dat
9、a to identify and rank health goals or problem of phase 1. Data - morbidity, mortality, functional level, disability, longevity and prevalence. Have to rank health problems because there is not enough money to fix us all.,SUDA-MYN,14,2019/4/19,PRECEDE-PROCEED,Behavioral and environmental diagnosis -
10、 Determining and prioritizing the behavioral and environmental factors linked to phase 2. Behavioral indicators - compliance, consumption patterns, coping, preventative actions. Expressed as frequency, persistence and quality. Environmental indicators - economic, physical, services and social. Dimen
11、sions include - access, affordability and equity.,SUDA-MYN,15,2019/4/19,PRECEDE-PROCEED,Educational and organizational diagnosis - identifies factors with potential influence on behavior.,SUDA-MYN,16,2019/4/19,THREE FACTORS,Predisposing factors- personal preferences that a group or individual brings
12、 to a behavioral choice. Include KAB, values, existing skills, perceived needs and abilities. They support or inhibit behavior and include the cognitive and affective dimensions of knowing, feeling, believing, valuing and having self confidence or self efficacy.,SUDA-MYN,17,2019/4/19,THREE FACTORS,E
13、nabling factors - facilitate the performance of an action. Environmental conditions - availability, accessibility affordability of resources. New skills needed to carry out a behavioral or environmental change.,SUDA-MYN,18,2019/4/19,THREE FACTORS,Reinforcing - positive and negative consequences of a
14、n action, including social support, peer influences, advice and feed back of health-care provides and physical consequences of behavior. They determine weather the individual receives positive feed back for the behavior and is socially supported after behavior.,2019/4/19,SUDA-MYN,19,格林模式思路,在健康教育干预之前
15、对所面对的问题进行系统的调查研究，并制定干预计划； 从目标终点着手开始问题的分析，而解决问题时则是由原因到目标； 应用多层次、多维度的生态观点和思辨与实证相结合的方法看待影响健康问题和健康相关行为的因素，并将影响因素分为倾向因素、促成因素和强化因素； 格林模式不是理论，而是一种立足于实际的调查研究思路和一个可以实践操作的概念框架。,SUDA-MYN,20,2019/4/19,PATCH（planned approach to community health）,社区动员 调查社区情况 确定主要健康问题及其行为影响因素 制定干预计划并实施计划 评价效果,SUDA-MYN,21,2019/4/19
16、,二、健康教育诊断的基本步骤,社会诊断 流行病学诊断 行为与环境诊断 教育与生态诊断 管理与政策诊断,SUDA-MYN,22,2019/4/19,1.社会诊断,生活质量 社会环境 社会动员和社区组织,健康问题,生活质量,社会政策/社会状况 健康教育干预,图3 健康问题与生活质量相互影响,SUDA-MYN,23,2019/4/19,2.流行病学诊断,社区中主要疾病或健康问题在时间和空间上的分布情况及分布特点； 这些健康问题中哪些是严重影响社区居民健康或居民最为关注的； 受影响最大的人群具有的人口学特征； 什么因素影响最大，哪些可以改变； 改变这些因素需要的条件和资源； 健康教育对控制或改变这些健康问题所起的作用。,SUDA-MYN,24,2019/4/19,3.行为与环境诊断,行为诊断的步骤： 区分引起健康问题的行为和非行为原因 拟出行为目录 依据重要性将行为分级 依据可变性将行为分级 选择目标行为,SUDA-MYN,25,2019/4/19,表1 用四格表选择目标行为,重要 不重要,可变,不可变,SUDA-MYN,26,2019/4/19,
