Impact of a Web-Based Intervention on Reproductive Health Services in Rural China
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Impact of a Web-Based Intervention on Reproductive Health Services in Rural China

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Virginia Li, PhD, MPH

Virginia Li, PhD, MPH
Professor, UCLA School of Public Health,
Department of Community Health Sciences
November 14, 2006

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Impact of a Web-Based Intervention on Reproductive Health Services in Rural China Impact of a Web-Based Intervention on Reproductive Health Services in Rural China Presentation Transcript

  • Bridging the Urban-Rural Continuum to Improve Services in Rural China Virginia C. Li, PhD, MPH, Professor of Community Health Sciences UCLA School of Public Health and Songyuan Tang, MB, MPH, MA, Associate professor Lichun Tian, MB, M.P.H., Junior Lecturer Kaining Zhang, M.B., M.S., Professor and Director, Institute for Health Studies and Development, Kunming Medical College, Yunnan, China. Roger Detels, M.D., M.S., is Professor of Epidemiology, UCLA School of Public Health
  • Specific Objectives 1. Upgrade the quality of family planning and contraceptive programs, sexually transmitted disease services and services promoting safe motherhood in the rural areas. 2. Disseminate the necessary computer skills to 26 demonstration township health centers through development and evaluation of primary, secondary and tertiary workshops (“train-the-trainers”). 3. Develop a team at IHS to assist township health workers in developing strategies to disseminate the knowledge, strategies and policies from the IHS website to the rural residents. 4. Strengthen capacity for long-term institutional collaboration between IHS and the UCLA School of Public Health Bixby Program to enhance reproductive health research and practice in China.
  • to rural health professionals and the other target groups. 服务提供者 Website Village Doctors/ Teachers/ Women’s Cadres Villagers/ Students
  • Figure 2. Website Development, Implementation, and Evaluation. Web Design tree diagram Domain application obtain hardware Install software Upload web pages Pretest & modification BaselineSurvey Site Selection Survey design Identify subject Identify core areas Identify central messages Develop questionnaires Finalize pretest Qs Training interviewers Field implementation Analysis Survey organization Supervision Website Development, Maintenance and Management + Interactivities
  • Figure 2. Website Development, Implementation, and Evaluation (Cont.). Evalu Survey Survey design Training interviewersOrganize survey team Implement in fieldsAnalysisReports/papers Implementations Mobile monitoring team Participatory planning MeetingTrouble shooting Plan for dissemination of website information, strategies and practices Training Training IHS Team 1. Communication and health promotion 2. Strategies for HIV/STD prevention and control in resource-poor and low prevalence settings 3. MCH: Nutrition for mother and infant Primary target training Secondary target training 1. Overview of Project; 2. Role and responsibility; 3. Website use and management; 4. Computer skills; 5. Dissemination Plan; 6. Interactive skills; 7. Feedback from field; 8. Health education; 9. Record keeping of IMS; 10. Reporting. 1. Core Areas 2. Core Messages 3. Interactive activities 4. Educating villagers
  • Figure 3. Frequency of browsing the reproductive health website and time spent on the website per week (July 1, 2003 to January 12, 2004). 0 0. 5 1 1. 5 2 2. 5 3 3. 5 4 7. 1- 7. 14 7. 15- 7. 28 7. 29- 8. 11 8. 12- 8. 25 8. 26- 9. 8 9. 9- 9. 22 9. 23- 10. 6 10. 7- 10. 20 10. 21- 11. 3 11. 4- 11. 17 11. 18- 12. 1 12. 2- 12. 15 12. 16- 12. 29 12. 29- 1. 12 Ti me pi erod Browsingfrequencyperweek 0. 00 10. 00 20. 00 30. 00 40. 00 50. 00 60. 00 70. 00 80. 00 90. 00 Duration Browsing frequency Duration
  • Table 1. Frequency of visiting and total time spent on the reproductive health website per week in minutes (July 1, 2003 to January 12, 2004). * Indicators Mean Standard Deviation Maximum Minimum Frequency of browsing website per week 2.3 0.7 6 0 Total time spent on website per week (minutes) 64.4 6.6 147 2 Duration per browsing (minutes) 27.6 4.6 - - *Log System Data
  • Table 2. Utilization of the interactive functions of the reproductive health website (July 1, 2003 to January 12, 2004). Indicators Mean Standard Deviation Frequency of browsing BBS per week 0.9 0.13 Frequency of using “Ask the Experts” from 2003 to 2004 2.2 0.34
  • Table 3. KAP of HIV/AIDS among health providers in three rural counties in Yunnan, China.   Nanhua County Moding County Dayao County baseline % change baseline % change baseline % change Mean # of correct answers 9.96 1.63 10.22 1.25 10.16 0.31 Correct answers % 62.24 10.2 63.88 7.81 63.5 1.94 Condoms can easily break if applied with oil-base lubricants 9.3 16.00** 7 13.90** 4.3 3.9 You can’t tell by looking whether someone has HIV infection 50.5 23.10** 37 30.40** 51.6 5.5 ‘Window period’ means the period between HIV infected and having a positive AIDS test. 62.9 19.50** 59 16.60** 60.2 9.2 AIDS can be cured now 66 13.10* 69 5.4 72 4.5 One does get HIV by sharing bathtub with a person with HIV infection or AIDS 36.1 22.10** 56 -0.2 30.1 7.70* Only people who have multiple sexual partners may get HIV infection 39.2 17.90** 46 9.80* 43 -0.1 HIV can be transmitted by mosquitoes 43.3 21.50** 51 17.60* 49.5 4.6 *Statistical significance between baseline and 1 year followup with P<0.05 **Statistical significance between baseline and 1 year followup with P<0.01
  • Table 4. KAP of HIV/AIDS among teachers and women’s cadres in three rural counties in Yunnan, China. *Statistical significance between baseline and 1 year followup with P<0.05 **Statistical significance between baseline and 1 year followup with P<0.01   Nanhua County Moding County Dayao County baseline % change baseline % change baseline % change Mean # of correct answers 9.02 0.76 9.4 -0.14 8.61 0.81 Correct answers % 56.37 4.75 58.77 -0.9 53.83 5.07 All people are at risk of HIV infection 51.44 12.15* 63.49 -11.55* 50.54 -16.09* AIDS can be cured now 45.5 -12.82** 49.44 -10.8* 35.71 0.71 Mother with HIV infection can transmit the virus to the baby through breast feeding 45.05 14.93** 59.84 7.92* 54.31 7.22* One could get HIV infection through eating with a person with HIV infection or AIDS 84.23 8.43 84.13 -10.21 71.96 10.98 One does get HIV by sharing bathtub with a person with HIV infection or AIDS 43.87 -9.38* 39.96 3.54 34.87 16.63 Only people who have multiple sexual partners may get HIV infection 58.11 7.37* 41.48 13.79* 44.01 -0.96 HIV can be transmitted by mosquitoes 31.26 23.21** 36.5 -5.3 19.13 17.84**
  • Table 5. Villagers knowledge and attitudes on HIV/AIDS and Hepatitis B in three rural counties, Yunnan, Chin Nanhua County Mouding County Dayao County P value of % Change Baseline % Change Baseline % Change Baseline % Change Nanhua/ Mouding Nanhua/ Dayao Mouding / Dayao 13 Knowledge statements on HIV/AIDS Mean score 36.1 8.3** 45.5 0.0 41.7 1.7 <0.0001 0.0008 0.41 Everyone can get infected by HIV 33.8 -2.9 31.4 2.0 48.7 -15.8 0.33 0.01 0.001 Some STDs increase risk of HIV infection 49.9 6.6 55.6 0.1 57.9 4.2 0.22 0.65 0.44 You can’t tell someone has HIV infection by looking 27.9 14.5** 32.1 7.2 35.8 16.2** 0.15 0.92 0.12 ‘Window period’ means the period between HIV infected and having a positive HIV test 16.4 11.7** 10.6 13.0** 5.2 8.4** 0.36 0.26 0.77 AIDS can not be cured now 32.7 -4.9 37.9 -1.0 43.6 -4.4 0.41 0.81 0.55 HIV infected pregnant woman can transmit HIV to her infant 65.4 7.7* 71.0 8.9* 81.4 -0.2 0.61 0.12 0.06 HIV can be transmitted from an infected mother to infant by breastfeeding 60.3 2.2 68.6 -1.4 67.1 -8.8 0.49 0.03 0.18 HIV can not be transmitted by eating with an infected person 40.0 8.2* 56.3 -7.7 54.4 2.1 0.003 0.23 0.07 HIV can not be transmitted by sharing bathtub with an infected person 20.1 -9.7 73.0 -6.2 9.5 7.9** 0.07 <0.0001 0.0006 Not only people who have multiple sexual partners can get HIV infection 33.2 37.0** 21.2 4.9 34.4 -3.0 <0.0001 <0.0001 0.1 Injection drug users can get HIV by sharing needles 35.7 17.5** 57.3 -11.8 41.3 10.3** <0.0001 0.14 <0.0001 Condoms can protect against HIV infection 33.2 16.4** 50.2 -8.1 41.0 -0.8 <0.0001 0.0004 0.21 HIV can not be transmitted by mosquitoes 20.1 4.2 26.3 -0.6 21.5 5.9 0.28 0.75 0.16 Attitudes toward a HIV infected person 24.3 17.0** 24.6 1.6 32.5 1.5 0.007 0.002 0.95 Hepatitis B can be sexually transmitted 33.2 3.0 32.1 -10.7 33.0 1.5 0.004 0.76 0.01 * Statistically significant difference between baseline and one year follow-up surveys with a P-value less than 0.05. ** Statistically significant difference between baseline and one year follow-up surveys with a P-value less than 0.01.
  • Table 6. Students knowledge on HIV/AIDS and Hepatitis B in three rural counties, Yunnan, China Nanhua County Mouding County Dayao County P value of % Change Baseline % change Base line % change Baseline % change Nanhua/ Mouding Nanhua/ Dayao Mouding / Dayao 15 Knowledge statements on HIV/AIDS Mean score 28.6 21.5** 32.9 8.7** 31.9 0.2 <0.0001 <0.0001 <0.0001 Everyone can get infected by HIV 30.6 17.5** 25.8 15.4** 22.0 1.7 0.84 0.005 0.006 Some STDs increase risk of HIV infection 50.0 45.9** 62.8 8.6** 39.3 3.4 <0.0001 <0.0001 0.21 Condoms can protect against HIV infection 25.1 24.9** 31.3 7.1* 29.9 3.6 0.0004 <0.0001 0.48 You can’t tell someone has HIV infection by looking 19.7 22.9** 22.4 12.8** 34.6 1.8 0.04 <0.0001 0.009 ‘Window period’ means the period between HIV infected and having a positive HIV test 16.8 17.0** 26.5 -2.5 21.0 2.9 <0.0001 0.002 0.19 AIDS cannot be cured now 27.2 0.3 32.9 1.8 39.8 -3.1 0.78 0.50 0.29 HIV infected pregnant woman can transmit HIV to her infant 57.2 30.9** 63.2 5.4 49.9 3.3 <0.0001 <0.0001 0.58 HIV can be transmitted from an infected mother to infant by breastfeeding 50.6 21.3** 54.3 12.9** 55.8 -0.2 0.09 <0.0001 0.005 HIV can not be transmitted by eating with an infected person 16.2 22.6** 16.2 18.9** 22.7 0.7 0.52 <0.0001 <0.0001 HIV can not be transmitted by sharing a swimming pool with an infected person 16.2 22.9** 20.8 14.1** 26.7 -0.8 0.04 <0.0001 0.0006 One does not get HIV by shaking hands with a infected person 25.1 17.7** 25.1 14.9** 31.4 -1.0 0.61 0.0001 0.0004 HIV can not be transmit by sharing bathtub with an infected person 12.1 15.7** 16.0 11.0** 19.0 1.3 0.18 0.0004 0.02 Not only people who have multiple sexual partners can get HIV infection 27.5 21.9** 27.6 1.4 25.2 -4.0 <0.0001 <0.0001 0.18 Injecting drug users can get HIV by sharing needles 41.3 35.2** 56.9 5.0 44.7 -1.8 <0.0001 <0.0001 0.15 HIV cannot be transmitted by mosquitoes 13.0 6.7* 11.9 3.7 17.3 -5.2 0.54 0.001 0.008 Hepatitis B can be sexually transmitted 13.0 20.1** 23.3 -6.1 13.3 6.1* <0.0001 0.006 0.001* Statistically significant difference between baseline and one year follow-up surveys with a P-value less than 0.05. ** Statistically significant difference between baseline and one year follow-up surveys with a P-value less than 0.01.
  • Conclusion:  Using the website for information, education, and communication in remote area is feasible.  Impact can be achieved even with one computer per agency at the township level.  Logistic support and monitoring is a critical element to success.  There is urgent need for licensing and recertification of village doctors.