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目的采用德尔菲法探讨引起贵州省报告接种率偏高的关键影响因素,为制定相应的适宜管理措施提供依据。方法通过文献获得目前国内导致报告免疫接种率偏高的一些因素,设计咨询表;采用德尔菲法对选取的20名专家开展咨询,经过三轮咨询后通过统计分析计算导致偏高的各影响因素各级条目的权重,最后筛选出关键影响因素。结果三轮咨询专家的积极系数分别为100.0%、95.0%和94.7%;克朗巴赫α系数分别为0.92、0.98、0.89;专家权威系数为0.79。影响因素共筛选出7个一级条目,19个二级条目,4个三级条目,变异系数范围为0.117 5~0.247 1。一级条目中,接种对象底数不清、接种对象监护人、免疫服务人员、免疫服务可及性的问题所占权重最高,分别为0.155 4、0.150 4、0.149 0、0.143 8,其次级条目中的“流入儿童数量不清楚”、“超生儿童父母不带儿童接种”、“留守儿童由文化程度更低的祖父母和外祖父母监护”、“基层免疫服务人员人数不够”、“基层免疫服务人员收入低”和“交通不便”所占其权重较高,分别达到0.504 6、0.260 6、0.255 7、0.192 0、0.190 6、1.000 0。结论贵州省引起报告接种率偏高的关键影响因素有4个:无法掌握流入儿童底数;超生儿童和留守儿童的特性造成免疫不及时和免疫脱漏;免疫服务人员人数不够和收入低;交通不便。应采取针对性措施,切实改变现状。
Objective To explore the key influential factors that lead to the high vaccination rate in Guizhou Province by using Delphi method and provide the basis for formulating appropriate management measures. Methods We obtained some factors that cause the high immunization coverage rate in our country through literature and designed the consultation form. We used Delphi method to consult the selected 20 experts, and after three rounds of consultation, we calculated the influential factors At all levels of the weight of the entries, the final screen out the key influencing factors. Results The positive coefficients of three rounds of consulting experts were 100.0%, 95.0% and 94.7% respectively; the Cronbach’s alpha coefficients were 0.92, 0.98 and 0.89; the expert’s coefficient was 0.79. Influencing factors were screened a total of seven first-level entries, 19 second-level entries, four third-level entries, the coefficient of variation ranged from 0.117 5 to 0.247 1. Among the first-level entries, the number of vaccinated subjects is not clear enough, and the immunization service personnel, immunization service personnel and guardians of immunization objects occupy the highest weightings, accounting for 0.155 4,0.150 4,0.149 0,0.143 8, respectively “Number of infants into the unclear ”, “Children without parental childbirth ”, “Children left behind by the less educated grandparents and grandparents ” “Number of grassroots immunization services ” , “Low income of grassroots immunization service staff” and “traffic inconvenience” accounted for a high proportion, reaching 0.504 6,0.260 6,0.255 7,0.192 0,0.190 6,1.000 0 respectively. Conclusion There are 4 key factors causing high coverage of vaccination in Guizhou Province: the inability to grasp the inflow of children; the outdated and immunodeficiency caused by the characteristics of children and left-behind children; the insufficient number of immunization workers and low income; and the inconvenient transportation. Targeted measures should be taken to effectively change the status quo.