基于结构方程模型的青春期前期生殖健康水平的影响路径分析

A structural equation modeling approach to analyze pathways influencing reproductive health in early adolescence

摘要

目的 了解青春期前期青少年的生殖健康知信行水平,探讨其影响因素及路径。方法 采用横断面研究设计,于2023年3月至2024年6月在深圳市福田区纳入2546名10~14岁青春期前期学生为研究对象,分析其知信行健康水平及其影响因素,并构建结构方程模型分析影响路径。结果 本研究中青春期前期青少年知信行水平整体得分(总分75分)为60(54,65)分,其中知识、态度、行为模块各条目得分最低的分别为避孕方法、讨论性与生殖健康的意愿、寻求生殖健康帮助;青春期前期生殖健康知信行水平存在性别差异,女生显著高于男生(Z=11.534,P<0.001);身体健康、心理健康、多种形式的健康教育、同伴交流、社会文化的开放度、以及避孕用具的易获度均是青春期前期生殖健康知信行水平的正向影响因素,差异均具有统计学意义(Z/H介于21.456到333.386之间,P<0.001).以上影响因素经主成分分析提取为健康宣教因子、社会环境因子、身心健康因子三个公因子,其中健康宣教因子(总效应为2.691)、社会环境因子(总效应4.707)对青春期前期生殖健康知信行水平有直接作用,社会环境因子在健康教育影响路径中还起到中介间接作用(间接效应0.497),均P<0.001。结论 加强青春期前期男生生殖健康教育、通过多种途径的健康教育提升青春期前期生殖健康的社会环境支持,对青少年生殖健康促进具有重要的实践意义.

Abstract

Objective To assess the levels of knowledge, attitudes, and practices (KAP) related to reproductive health among early adolescents and to explore influencing factors and their pathways. Methods A cross-sectional study was conducted from March 2023 to June 2024 in Futian District, Shenzhen. A total of 2546 early adolescents aged 10-14 years were enrolled. The study analyzed their reproductive health-related KAP levels and influencing factors. A structural equation model (SEM) was constructed to examine the pathways of influence. Results The overall score of KAP among early adolescents in this study (total score of 75) was 60 (54, 65), with the lowest scores in the knowledge, attitude, and practice modules being contraceptive methods, the willingness to discuss sexual and reproductive health, and seeking reproductive health help, respectively. Significant gender differences were found, with girls scoring significantly higher than boys (Z=11.534, P<0.001). Physical health, mental health, various forms of health education, peer communication, the openness of social culture, and the accessibility of contraceptives were all significant positive influencing factors, with statistically positive association with higher KAP scores (Z/H=21.456 to 333.386, all P<0.001). These influencing factors were extracted as three common factors through principal component analysis: health education factor, social environment factor, and physical and mental health factor. Among them, the health education factor (total effect=2.691) and sociocultural environment factor (total effect=4.707) had direct effects on reproductive health KAP levels, while the sociocultural environment factor also played a mediating role in the influence pathway of health education (indirect effect=0.497, P<0.001). Conclusion Enhancing reproductive health education for early adolescent boys and improving the sociocultural environment through diversified health education strategies are of practical significance for promoting adolescent reproductive health.

关键词

青春期前期 / 青少年 / 生殖健康 / 知信行 / 结构方程模型

Key words

early adolescence / adolescent / reproductive health / knowledge, attitude and practice / structural equation modeling

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基金资助

深圳市科创委科技计划项目(20220519085216001)