影响健康的四大因素

影响健康的四大因素 guide sex further enhanced, documents handle and running of speed obviously speed up, program gradually specification, conference service and Chief reception of quality and level has has new of improve, Logistics support capability further strengthened. Document management, confidential, confidentiality, duty, letters and other items have been significantly improved. 4, Office construction increased at all levels. City Government offices adhere to strengthen and improve the construction of the system as a breakthrough, has developed a series of code of conduct, continuous improvement of operational mechanism, sound and the implementation of the rules and regulations, and adhere to the system of managing people, according to the rules, the work gradually into the orbit of institutionalization and standardization. Focus on strengthening ideological and political construction of the contingent of cadres, and actively carried out various business training, knowledge of the Office team structure has been optimized, to broaden the range of knowledge and operational capacity grows, nurtured a political firm, sharp, professional and innovative staff, created solidarity, striving for the top, pragmatic, dedication, good image. However, with the State Council and the provincial Government of the national, the province's Secretary-General meeting of government offices under the new situation 一、基本概念 1、影响健康的四大因素 世界卫生组织经研究提示影响个人健康和寿命有四大因素:生物学基础占15%、环境因素占17%、保健设施占8%和生活方式占60%。 (一)生物学因素 是指遗传和心理。遗传不是可改的因素，但心理因素可以修改，保持一个积极心理状态是保持和增进健康的必要条件。影响健康的生物因素包括由病原微生物引起的传染病和感染性疾病; (二)环境因素 包括自然环境与社会环境，所有人类健康问题都与环境有关。污染、人口和贫困，是当今世界面临的严重威胁人类健康的三大社会问题。良好的社会环境是人民健康的根本保证。 (三)卫生服务因素 卫生服务的范围、内容与质量直接关系到人的生、老、病、死及由此产生的一系列健康问题。 (四)行为与生活方式因素 包括危害健康行为与不良生活方式。生活方式是指在一定环境条件下所形成的生活意识和生活行为习惯的统称。不良生活方式和有害健康的行为已成为当今危害人们健康，导致疾病及死亡的主因。在我国前三名死因中是恶性肿瘤、脑血管和心脏病，这些疾病是由生活习惯和不良卫生行为所引起的。 2、健康教育是旨在帮助对象人群或个体改善健康相关行为的系统的社会活动。 3、健康教育与卫生宣传的区别与联系 联系:我国当前的健康教育是在过去卫生宣教的基础上发展起来的;现在的健康教育主要措施仍可称为卫生宣教。 区别:(1)比之过去的卫生宣教，健康教育明确了自己特定的工作目标——促使人们改善健康相关行为，从而防治疾病、增进健康，而不是仅仅作为一种辅助方法为卫生工作某一时间的中心任务服务; (2)健康教育不是简单的、单一方向的信息传播，而是既有调查研究又有干预的，有、有组织、有评价的，涉及多层次多方面对象和内容的系统活动; (3)健康教育在融合医学科学和行为科学(社会科学、心理学、文化人类学等)、传播学、管理科学等学科知识的基础上，已经初步形成了自己的理论和方法体系。 4、WHO定义健康促进“是促使人们维护和提高他们自身健康的过程，是协调人类与环境的战略，它规定个人与社会对健康各自所负的责任。” 5、1986年在首届国际健康促进大会通过的《渥太华宣言》中明确指出，健康促进的五个活动领域: (1)制定促进健康的公共政策:健康促进的含义已超出卫生保健的范畴，各个部门、各级政府和组织的决策者都要把健康问题提到议事日程上。明确要求非卫生部门建立和实行健康促进政策，其目的就是要使人们更容易做出更有利健康的抉择; (2)创造健康支持环境:健康促进必须为人们创造安全、满意和愉快的生活和工作环境。系统地评估快速变化的环境对健康的影响，以保证社会和自然环境有利于健康的发展; (3)加强社区的行动:充分发动社区力量，积极有效地参与卫生保健计划的制定和执行，挖掘社区资源，帮助他们认识自己的健康问题，并提出解决问题的办法; (4)发展个人技能:通过提供健康信息和教育来帮助人们提高做出健康选择的技能，并支持个人和社会的发展; guide sex further enhanced, documents handle and running of speed obviously speed up, program gradually specification, conference service and Chief reception of quality and level has has new of improve, Logistics support capability further strengthened. Document management, confidential, confidentiality, duty, letters and other items have been significantly improved. 4, Office construction increased at all levels. City Government offices adhere to strengthen and improve the construction of the system as a breakthrough, has developed a series of code of conduct, continuous improvement of operational mechanism, sound and the implementation of the rules and regulations, and adhere to the system of managing people, according to the rules, the work gradually into the orbit of institutionalization and standardization. Focus on strengthening ideological and political construction of the contingent of cadres, and actively carried out various business training, knowledge of the Office team structure has been optimized, to broaden the range of knowledge and operational capacity grows, nurtured a political firm, sharp, professional and innovative staff, created solidarity, striving for the top, pragmatic, dedication, good image. However, with the State Council and the provincial Government of the national, the province's Secretary-General meeting of government offices under the new situation guide sex further enhanced, documents handle and running of speed obviously speed up, program gradually specification, conference service and Chief reception of quality and level has has new of improve, Logistics support capability further strengthened. Document management, confidential, confidentiality, duty, letters and other items have been significantly improved. 4, Office construction increased at all levels. City Government offices adhere to strengthen and improve the construction of the system as a breakthrough, has developed a series of code of conduct, continuous improvement of operational mechanism, sound and the implementation of the rules and regulations, and adhere to the system of managing people, according to the rules, the work gradually into the orbit of institutionalization and standardization. Focus on strengthening ideological and political construction of the contingent of cadres, and actively carried out various business training, knowledge of the Office team structure has been optimized, to broaden the range of knowledge and operational capacity grows, nurtured a political firm, sharp, professional and innovative staff, created solidarity, striving for the top, pragmatic, dedication, good image. However, with the State Council and the provincial Government of the national, the province's Secretary-General meeting of government offices under the new situation (5)调整卫生服务方向:调整卫生服务类型与方向，将健康促进和预防作为提供卫生服务模式的组成部分，让最广大的人群受益。 6、健康促进的核心策略——社会动员。 7、健康教育与健康促进的区别与联系 1)健康教育要求人们通过自身认知、态度、价值观和技能的改变而自觉采取有益于 ( 健康的行为和生活方式。因此，从原则上讲，健康教育最适于改变自身因素即可改变行为的人群;而健康促进是在组织、政策、经济、法律上提供支持环境，它对行为改变有支持性或约束性。 (2)健康教育作为健康促进的重要组成部分，与健康促进一样，不仅即涉及整个人群，而且涉及人们社会生活的各个方面。在疾病三级预防中健康促进强调一级预防甚至更早阶段。 (3)健康教育是健康促进的核心，健康促进需要健康教育的推动和落实，营造健康促进的氛围，没有健康教育，健康促进就缺乏基础。而健康教育必须有环境、政策的支持，才能逐步向健康促进发展，否则其作用会受到极大的限制。 (4)与健康教育相比，健康促进融客观支持与主观参与于一体。健康促进包括健康教育和环境支持，健康教育是个人与群体的知识、信念和行为的改变。 总之，健康教育必须以健康促进战略思想为指导和支持，不仅通过健康教育改变个体与群体的认知水平与采纳有益于健康行为的能力，同时还须借助健康促进中政策、资源、环境等提供的支持，最终促使人们行为生活方式的改变;而健康促进也需要健康教育和卫生宣传来推动和落实，即通过传播与教育活动，促进各部门对健康的关注与参与，促进政策制定者、社会领导群体观念与行为的变化，实现对健康相关事业与活动的支持。 8、21世纪健康促进的发展战略 2005年8月在泰国曼谷举行了第六届世界健康促进大会，通过《曼谷宣言》，这个宣言是一份21世纪全球化健康促进发展战略的纲领性文件。 ?重申健康是基本人权，获得最高的健康是每个人的基本权利之一。改善健康和卫生保健的平等性政策与伙伴关系应当是全球和国家发展的核心。 ?健康促进是公共卫生的一项核心职能，健康促进的发展有助于应对传染病、非传染病及其他健康危险。 ?各级政府和官方人员、民间组织、私立部门、公共卫生机构以及国际组织是实现健康促进战略目标的至关重要的人群、团体和组织。 ?自制定渥太华宪章以来，全球健康促进的背景发生了显著变化，当今影响健康的关键因素主要有:国家内部和国家之间不断增多的不平等现象、全球环境的变化以及城市化和商业化、消费和通讯模式的变化等。这些变化影响着人们的工作条件、学习环境、家庭模式以及社会结构、社会文化等，形成对健康的进一步挑战。 ?为了应对全球化挑战，各国政府、联合国相关机构以及其他组织，包括私立部门必须做到政策的一致性，认真履行有关健康的国际协定和条约。 ?为了促进向更健康的世界发展，必须采取强有力的政治行动、广泛的参与和持久的倡导。倡导以人权和团结为基础的健康;投资可持续地应对健康决定因素的政策和基础设施;在政策制定、领导作用、健康促进措施、知识传播和普及等方面均须加强能力建设;加强卫生立法以确保健康危害的防范，使人人获得健康和幸福的平等机会。 ?建立伙伴和同盟关系，与公立、私立、非政府组织和国际组织以及民间社会建立伙伴the functions and priorities compared to the requirements of our gap is still very big. Main is daily in the passive meet of more, active research of less, service also has not timely, and not in place of problem; work in the meet Yu traditional of, and program of of work way, develop innovation spirit and service innovation capacity not strong; supervision information work and promoted decision implementation of contact enough close, feedback situation not active; research resources of using enough full, research results of into degree not high; some sector documents running not specification; Municipal Government Office on the County (district) and municipal government sector Office work of guide enough, No real form interaction and close collaboration, promote the implementation of the work. These problems, we must effectively be addressed in the future work. Second, serve the overall situation, carry out their duties, improve quality, and strive to create a new situation of system of government offices in the city since last season, meeting the Secretary-General of the State Council and the provincial government has held a government system, from a global and strategic height, scientifically analyzed the new situation and the newTasks on the system of government offices bring new situations and new problems and new challenges, profoundly expounded the work of government departments at all levels in the new era should be put in the situation to understand, to grasp, to deploy at any time and under any circumstances, should always focus on the big picture, firmly grasp the overall situation, increasing in the overall implementing in earnest the work of spontaneity, initiative and steadfastness. And explicitly put forward the "surrounding situation, pay attention to implementation" is the core of government offices, requiring government departments at all levels cannot be "Gramophone", "mail room" and "the Messenger" is not confined to paper communications, yinglaisongwang and upload issue. Must to has strongly of implementation guide sex further enhanced, documents handle and running of speed obviously speed up, program gradually specification, conference service and Chief reception of quality and level has has new of improve, Logistics support capability further strengthened. Document management, confidential, confidentiality, duty, letters and other items have been significantly improved. 4, Office construction increased at all levels. City Government offices adhere to strengthen and improve the construction of the system as a breakthrough, has developed a series of code of conduct, continuous improvement of operational mechanism, sound and the implementation of the rules and regulations, and adhere to the system of managing people, according to the rules, the work gradually into the orbit of institutionalization and standardization. Focus on strengthening ideological and political construction of the contingent of cadres, and actively carried out various business training, knowledge of the Office team structure has been optimized, to broaden the range of knowledge and operational capacity grows, nurtured a political firm, sharp, professional and innovative staff, created solidarity, striving for the top, pragmatic, dedication, good image. However, with the State Council and the provincial Government of the national, the province's Secretary-General meeting of government offices under the new situation 与同盟关系，使健康促进可持续发展有组织保障。 ?对21世纪全球健康目标——人人享有基本保健，提出了四项主要承诺:使健康促进成为全球发展议程的中心;使健康促进成为各级政府的一项核心责任;使健康促进成为社区和民间组织的一个主要重点;使健康促进成为公司规范的一项基本要求。 9、健康教育与健康促进的意义 1)是实现初级卫生保健的基础。健康教育是能否实现初级卫生保健任务的关键，( 健康教育在实现所有健康目标、社会目标和经济目标中具有重要的地位和价值。 (2)是卫生保健事业发展的必然趋势。慢性非传染性疾病成为当今发达国家和中 国的主要死因。不良行为和生活方式是这些慢性疾病的危险因素，而健康教育和健康促 进的方式有益于减低危险因素，预防各种“生活方式病”。 (3)是一项底投入、高产出的保健措施。从成本――效益的角度上看，健康教育 和健康促进的成本投入所产生的效益，远远大于医疗费用高昂投入所产生的效益。 (4)是提供群众自我保健意识的重要渠道。健康教育和健康促进能提高人们的自 我保健意识和能力，增强其自觉性和主动性，增强人们实行躯体上的自我保护、心理上 的自我调节、行为生活方式上的自我控制、人际关系上的自我调整。 二、健康相关行为 1、健康相关行为是指个体或团体的与健康或疾病有关联的行为。按行为对行为者自身和他人健康状况的影响，可分为促进健康的行为和危害健康的行为。 2、促进健康行为指个人或团体表现出的客观上有利自身和他人健康的行为，可分为5大类: (1)基本健康行为:指日常生活中一系列有益于健康的基本行为，如合理营养、平衡膳食、适当的身体活动、积极的休息与适量睡眠等。 (2)戒除不良嗜好:不良嗜好指的是对健康有危害的个人偏好，如吸烟、酗酒与滥用药物等。戒烟、戒毒、戒除酗酒、滥用药物、网络成瘾等属于戒除不良嗜好行为。 (3)预警行为:指对可能发生的危害健康的事件预先采取预防措施从而预防事故发生，以及能在事故发生后正确处置的行为，如驾车使用安全带，溺水、车祸、火灾等意外事故发生后的自救和他救行为。 (4)避免环境危害行为:这里的环境危害是广义的，包括了人们生活和工作的自然环境与心理社会环境中对健康有害的各种因素。此外，避开不利于健康的环境也可以采取积极或消极两类方式，如离开被二手烟污染的环境、在存在污染的环境中工作时穿戴防护用具属于消极避免环境危害的行为，而采取措施减轻环境污染、积极应对那些引起人们心理应激的紧张生活事件等则属于积极避免环境危害行为。 (5)合理利用卫生服务:指有效、合理地利用现有卫生保健服务，以实现三级预防，维护自身健康的行为，包括定期体检、预防接种、患病后及时就诊、遵从医嘱、配合治疗、积极康复等。其中: 1)求医行为(health-seeking behavior):指人们感到不适，或察觉到自己患有疾病时，主动寻求科学可靠的医疗帮助的行为。 2)遵医行为(compliance behavior):指个体在确诊患有疾病后，积极遵从医嘱检查、用药，配合治疗的一系列行为。 3、危害健康行为是指不利于自身或他人健康的一组行为，可分为4大类: (1)不良生活方式与习惯:不良生活方式则是一组习以为常的、对健康有害的行为习guide sex further enhanced, documents handle and running of speed obviously speed up, program gradually specification, conference service and Chief reception of quality and level has has new of improve, Logistics support capability further strengthened. Document management, confidential, confidentiality, duty, letters and other items have been significantly improved. 4, Office construction increased at all levels. City Government offices adhere to strengthen and improve the construction of the system as a breakthrough, has developed a series of code of conduct, continuous improvement of operational mechanism, sound and the implementation of the rules and regulations, and adhere to the system of managing people, according to the rules, the work gradually into the orbit of institutionalization and standardization. Focus on strengthening ideological and political construction of the contingent of cadres, and actively carried out various business training, knowledge of the Office team structure has been optimized, to broaden the range of knowledge and operational capacity grows, nurtured a political firm, sharp, professional and innovative staff, created solidarity, striving for the top, pragmatic, dedication, good image. However, with the State Council and the provincial Government of the national, the province's Secretary-General meeting of government offices under the new situation 3 guide sex further enhanced, documents handle and running of speed obviously speed up, program gradually specification, conference service and Chief reception of quality and level has has new of improve, Logistics support capability further strengthened. Document management, confidential, confidentiality, duty, letters and other items have been significantly improved. 4, Office construction increased at all levels. City Government offices adhere to strengthen and improve the construction of the system as a breakthrough, has developed a series of code of conduct, continuous improvement of operational mechanism, sound and the implementation of the rules and regulations, and adhere to the system of managing people, according to the rules, the work gradually into the orbit of institutionalization and standardization. Focus on strengthening ideological and political construction of the contingent of cadres, and actively carried out various business training, knowledge of the Office team structure has been optimized, to broaden the range of knowledge and operational capacity grows, nurtured a political firm, sharp, professional and innovative staff, created solidarity, striving for the top, pragmatic, dedication, good image. However, with the State Council and the provincial Government of the national, the province's Secretary-General meeting of government offices under the new situation 惯，包括能导致各种成年期慢性退行性病变的生活方式，如吸烟、酗酒、缺乏运动锻炼、高盐高脂饮食、不良进食习惯等。不良的生活方式与肥胖、心血管系统疾病、早衰、癌症等的发生关系密切。 (2)致病行为模式:致病行为模式是导致特异性疾病发生的行为模式，国内外研究较多的是A型行为模式和C型行为模式。 A型行为模式是一种与冠心病密切相关的行为模式，表现为争强好胜，工作节奏快，有时间紧迫感;警戒性和敌对意识较强，勇于接受挑战并主动出击，而一旦受挫就容易不耐烦。有关研究表明，具有A型行为者冠心病的发生率、复发率和死亡率均显著高于非A型行为者。 C型行为模式是一种与肿瘤发生有关的行为模式，其核心行为表现是情绪过分压抑和自我克制，爱生闷气，表面隐忍而内在情绪起伏大。研究表明:C型行为者患宫颈癌、胃癌、结肠癌、肝癌、恶性黑色素瘤的发生率高出其他人三倍左右。 (3)不良疾病行为:指在个体从感知到自身有病到疾病康复全过程所表现出来的不利于健康的行为。常见的行为表现形式有:疑病、恐惧、讳疾忌医、不及时就诊、不遵从医嘱、迷信、乃至自暴自弃等。 (4)违规行为:指违反社会法律法规、道德的危害健康行为，如吸毒贩毒、药物滥用、性乱等，既直接危害行为者个人健康，有严重影响社会健康。 4、影响人类行为形成和发展的因素 (1)遗传因素:遗传因素对行为的影响已经在大量的动物实验和人类学研究中得到了证实。研究发现，基因具有相当大的稳定性，这使得人类在长期进化过程中获得的行为优势得以承袭;基因的突变、选择和整合，又使得人类的行为能够不断丰富和发展。基因除了影响行为，还能决定人的行为特征和行为倾向，同卵双胞胎行为特征和行为倾向的相似正是遗传物质影响的结果。然而，基因又是复杂的，这一特点决定了人类行为的复杂性和多样性。 2)环境因素:自然环境和社会环境共同构成人类的行为环境，是人类行为的基本要 ( 素之一。人类行为是环境刺激作用于机体的产物，这就决定了环境因素必将对人类行为的形成和发展产生重要的影响。环境对于人类行为的影响有大小、强弱之分。比较而言，性别、年龄、知识、技术等主要影响行为者个体，且能决定个体接受环境作用的程度，行为者对这些因素的控制能力也较大;而生态环境、风俗习惯、卫生服务、社会经济、法律等因素会在更大范围内影响人群的行为，个体对这些因素的控制能力非常有限。 (3)学习因素:学习是人类行为形成和发展过程中必不可少的要素，人类的很多行为，尤其是社会行为，都需要通过学习来形成和发展。 学习分为三个层次，最低层次的学习是模仿，包括无意模仿、有意模仿和强迫模仿。系统教育和强化教育是第二、第三层次的学习，这种较高层次的学习过程比较复杂，主要是在教育者的启发下，使学习者全面理解和认识目标行为，使之对行为习得的需要上升到理性层面，再实现主动的行为学习，并使这些行为在不断的强化中得以巩固。 学习因素对于个体工作和生活技能的形成、发展，改变不利于健康的行为起着非常重要的作用。健康教育主要通过系统教育和强化教育的学习模式，改变不良行为和生活方式，培养有益于健康的新行为。 5、健康相关行为改变的基本理论 (1)知信行理论(knowledge, attitude, belief, practice, KABP或KAP)，是改变人类健康相关行为的模式之一，它将人类行为的改变分为获取知识，产生信念及形成行为三个连续过程，即知识——信念——行为。 the functions and priorities compared to the requirements of our gap is still very big. Main is daily in the passive meet of more, active research of less, service also has not timely, and not in place of problem; work in the meet Yu traditional of, and program of of work way, develop innovation spirit and service innovation capacity not strong; supervision information work and promoted decision implementation of contact enough close, feedback situation not active; research resources of using enough full, research results of into degree not high; some sector documents running not specification; Municipal Government Office on the County (district) and municipal government sector Office work of guide enough, No real form interaction and close collaboration, promote the implementation of the work. These problems, we must effectively be addressed in the future work. Second, serve the overall situation, carry out their duties, improve quality, and strive to create a new situation of system of government offices in the city since last season, meeting the Secretary-General of the State Council and the provincial government has held a government system, from a global and strategic height, scientifically analyzed the new situation and the newTasks on the system of government offices bring new situations and new problems and new challenges, profoundly expounded the work of government departments at all levels in the new era should be put in the situation to understand, to grasp, to deploy at any time and under any circumstances, should always focus on the big picture, firmly grasp the overall situation, increasing in the overall implementing in earnest the work of spontaneity, initiative and steadfastness. And explicitly put forward the "surrounding situation, pay attention to implementation" is the core of government offices, requiring government departments at all levels cannot be "Gramophone", "mail room" and "the Messenger" is not confined to paper communications, yinglaisongwang and upload issue. Must to has strongly of implementation guide sex further enhanced, documents handle and running of speed obviously speed up, program gradually specification, conference service and Chief reception of quality and level has has new of improve, Logistics support capability further strengthened. Document management, confidential, confidentiality, duty, letters and other items have been significantly improved. 4, Office construction increased at all levels. City Government offices adhere to strengthen and improve the construction of the system as a breakthrough, has developed a series of code of conduct, continuous improvement of operational mechanism, sound and the implementation of the rules and regulations, and adhere to the system of managing people, according to the rules, the work gradually into the orbit of institutionalization and standardization. Focus on strengthening ideological and political construction of the contingent of cadres, and actively carried out various business training, knowledge of the Office team structure has been optimized, to broaden the range of knowledge and operational capacity grows, nurtured a political firm, sharp, professional and innovative staff, created solidarity, striving for the top, pragmatic, dedication, good image. However, with the State Council and the provincial Government of the national, the province's Secretary-General meeting of government offices under the new situation 知(知识和学习)是基础，信(信念和态度)是动力，行(促进健康行为)是目标。以吸烟有害为例，健康教育工作者通过多种方法和途径把吸烟有害健康、吸烟引发的疾病以及与吸烟有关的死亡数字等知识传授给群众;群众接受知识，通过思考，加强了保护自己和他人健康的责任，形成信念;在信念支配下，逐步建立起不吸烟的健康行为模式。 (2)健康信念模式(the health belief model, HBM) 健康信念模式认为，人们要采取某种促进健康行为或戒除某种危害健康行为，必须具备以下3方面的认识: 一、认识到某种疾病或危险因素的威胁，并进一步认识到问题的严重性。 1、对疾病严重性的认识:指个体对罹患某种疾病严重性的看法，包括人们对疾病引起的临床后果的判断，如死亡、伤残、疼痛等;对疾病引起的社会后果的判断，如工作烦恼、失业、家庭矛盾等。 2、对疾病易感性的认识:指个体对罹患某种疾病可能性的认识，包括对医师判断的接受程度和自身对疾病发生、复发可能性的判断等。 二、认识到采取某种行为或戒除某种行为的困难及益处。 1、对行为有效性的认识:指人们对采取或放弃某种行为后，能否有效降低患病危险性或减轻疾病后果的判断，包括减缓病痛、减少疾病产生的社会影响等。只有当人们认识到自己行为的有效时，人们才能自觉采取行为。 2、对采取或放弃某种行为障碍的认识:指人们对采取或放弃某种行为所遇困难的认识，如费用的高低、痛苦的程度、方便与否等。只有当人们对这些困难具有足够认识，才能使行为维持和巩固。 三、对自身采取或放弃某种行为能力的自信 ，也称效能期待或自我效能。即一个人对自己的行为能力有正确的评价和判断，相信自己一定能通过努力，克服障碍，完成这种行动，到达预期结果。 (3)行为改变阶段理论(stages of change model, SCM) 行为改变是一个连续、动态、逐步推进的过程;人们改变不利于健康的行为，采纳有益于健康的行为是一个个人决策的过程;认知水平的不断提高是行为改变的基础。 (1)前预期:不打算改变阶段，在未来6个月不打算改变，或有意坚持不改; (2)预期:打算改变阶段，打算在未来6个月改变不利于健康的行为; (3)准备:改变准备阶段，为行为改变做必要准备，未来1个月会改变行为; (4)行动:行为改变阶段，在过去6个月中，目标行为已有所改变; (5)保持:行为维持阶段，持续新行为6个月以上。 6、健康相关行为干预 (1)个体健康相关行为干预 (2)团体健康相关行为干预 三、健康传播 传播是一种社会性传递信息的行为，是个人之间、集体之间以及个人与集体之间交换、传递新闻、事实、意见的信息过程。 健康传播是指通过各种渠道，运用各种传播媒介和方法，为维护和促进人类健康而收集、制作、传递、分享健康信息的过程。 1、传播要素 guide sex further enhanced, documents handle and running of speed obviously speed up, program gradually specification, conference service and Chief reception of quality and level has has new of improve, Logistics support capability further strengthened. Document management, confidential, confidentiality, duty, letters and other items have been significantly improved. 4, Office construction increased at all levels. City Government offices adhere to strengthen and improve the construction of the system as a breakthrough, has developed a series of code of conduct, continuous improvement of operational mechanism, sound and the implementation of the rules and regulations, and adhere to the system of managing people, according to the rules, the work gradually into the orbit of institutionalization and standardization. Focus on strengthening ideological and political construction of the contingent of cadres, and actively carried out various business training, knowledge of the Office team structure has been optimized, to broaden the range of knowledge and operational capacity grows, nurtured a political firm, sharp, professional and innovative staff, created solidarity, striving for the top, pragmatic, dedication, good image. However, with the State Council and the provincial Government of the national, the province's Secretary-General meeting of government offices under the new situation 5 guide sex further enhanced, documents handle and running of speed obviously speed up, program gradually specification, conference service and Chief reception of quality and level has has new of improve, Logistics support capability further strengthened. Document management, confidential, confidentiality, duty, letters and other items have been significantly improved. 4, Office construction increased at all levels. City Government offices adhere to strengthen and improve the construction of the system as a breakthrough, has developed a series of code of conduct, continuous improvement of operational mechanism, sound and the implementation of the rules and regulations, and adhere to the system of managing people, according to the rules, the work gradually into the orbit of institutionalization and standardization. Focus on strengthening ideological and political construction of the contingent of cadres, and actively carried out various business training, knowledge of the Office team structure has been optimized, to broaden the range of knowledge and operational capacity grows, nurtured a political firm, sharp, professional and innovative staff, created solidarity, striving for the top, pragmatic, dedication, good image. However, with the State Council and the provincial Government of the national, the province's Secretary-General meeting of government offices under the new situation (1)传播者又称传者，是传播行为的引发者，即在传播过程中信息的主动发出者。在社会传播过程中，传播者可以是个人，也可以是群体或组织。 (2).受传者信息的接受者和反应者，传播者的作用对象。同样，受传者可以是个人、群体或组织。大量的受传者称为受众。 (3)信息与讯息 信息泛指人类社会传播的一切内容;讯息是由一组相关联的、有完整意义的信息符号所构成的具体信息。讯息是一种信息，通过讯息，传受双方发生意义的交换，达到互动的目的。 (4)传播媒介 又称传播渠道，是讯息的载体，也是将传播过程中各种要素相互联系起来的纽带。 (5)传播效果 是传播对人的行为产生的有效结果。具体指受传者接受信息后，在知识、情感、态度、行为等方面发生的变化，通常意味着传播活动在多大程度上实现了传播者的意图或目的。 2、传播模式 (1)拉斯韦尔五因素传播模式 即:谁(who)、说什么(says what)、通过什么渠道(in which channel)、对谁说 (to whom)、产生什么效果(with what effect)。西方认为“5W”模式概括性强，对大众传播的研究起了很大的推动作用，但它忽略“反馈”传播因素，有局限性。 (2)施拉姆双向传播模式 这一传播模式强调双方都是传播的主体，在传播过程中，传受双方的角色并不是固定不变的，一个人在发出讯息时是传播者，在接受讯息时则为受传者。在施氏传播模式中，引入了两个重要的传播要素: 1? 传播符号 符号是信息的载体，即人们在进行传播之际，将自己的意思转换成语言、文字、图画、动作或其他形式的感知觉符号。 2? 反馈 指传播者获知受传者接受信息后的心理和行为反应。反馈是体现信息交流的重要机制。 3、人际传播的概念及特点 人际传播，也称人际交流，是指人与人之间的面对面的直接信息沟通的交流活动。这种交流主要是通过语言来完成，但也可以通过非语言的方式来进行，如动作、手势、表情、信号(包括文字和符号)等。有以下特点: (1)是全身心的传播，即人要用多种感官来传递和接受信息。 (2)是全信息传播，即信息比较全面、完整、接近事实。人际传播是面对面的，多媒体的，可以通过形体语言、情感表达来传递和接受语言和文字传达不出的信息。 (3)以个体信息化为主。情感信息的交流在人际传播中占了很大部分。 (4)交流充分，反馈及时。人际传播中，交流双方互为传者和受者，可及时了解对方对信息的理解和接受程度，从而根据对方的反应来随时调整传播策略、交流方式和内容。 4、人际传播的基本沟通技巧 人际传播技巧有许多种，但都与人体的"传播器官"有关，它们是语言器官——口;听觉器官一一耳;视觉器官——眼。 (1)说话技能 讲话者首先要让对方能听懂自己的话，理解自己的话。讲话人与听话人应该具有"共同的范围"。如果对一个不懂医学的人讲话使用了很多的医学术语，对方理解不了医学术语的含义，讲话的人也就不能达到预期目的。讲话者应注意速度，掌握讲话的节奏和音调高低，避免平铺直叙。 (2)问话技巧 提出问题应是在人际交流的合适时机。问话要有所间隔，不给对方造the functions and priorities compared to the requirements of our gap is still very big. Main is daily in the passive meet of more, active research of less, service also has not timely, and not in place of problem; work in the meet Yu traditional of, and program of of work way, develop innovation spirit and service innovation capacity not strong; supervision information work and promoted decision implementation of contact enough close, feedback situation not active; research resources of using enough full, research results of into degree not high; some sector documents running not specification; Municipal Government Office on the County (district) and municipal government sector Office work of guide enough, No real form interaction and close collaboration, promote the implementation of the work. These problems, we must effectively be addressed in the future work. Second, serve the overall situation, carry out their duties, improve quality, and strive to create a new situation of system of government offices in the city since last season, meeting the Secretary-General of the State Council and the provincial government has held a government system, from a global and strategic height, scientifically analyzed the new situation and the newTasks on the system of government offices bring new situations and new problems and new challenges, profoundly expounded the work of government departments at all levels in the new era should be put in the situation to understand, to grasp, to deploy at any time and under any circumstances, should always focus on the big picture, firmly grasp the overall situation, increasing in the overall implementing in earnest the work of spontaneity, initiative and steadfastness. And explicitly put forward the "surrounding situation, pay attention to implementation" is the core of government offices, requiring government departments at all levels cannot be "Gramophone", "mail room" and "the Messenger" is not confined to paper communications, yinglaisongwang and upload issue. Must to has strongly of implementation guide sex further enhanced, documents handle and running of speed obviously speed up, program gradually specification, conference service and Chief reception of quality and level has has new of improve, Logistics support capability further strengthened. Document management, confidential, confidentiality, duty, letters and other items have been significantly improved. 4, Office construction increased at all levels. City Government offices adhere to strengthen and improve the construction of the system as a breakthrough, has developed a series of code of conduct, continuous improvement of operational mechanism, sound and the implementation of the rules and regulations, and adhere to the system of managing people, according to the rules, the work gradually into the orbit of institutionalization and standardization. Focus on strengthening ideological and political construction of the contingent of cadres, and actively carried out various business training, knowledge of the Office team structure has been optimized, to broaden the range of knowledge and operational capacity grows, nurtured a political firm, sharp, professional and innovative staff, created solidarity, striving for the top, pragmatic, dedication, good image. However, with the State Council and the provincial Government of the national, the province's Secretary-General meeting of government offices under the new situation 成紧张和心理压力;提问要明确和简练，要求回答者做出肯定或否定的答复医学教。回答名称、数量、时间等固定要素的问题要使用封闭式问题;要求回答者开放思维，根据自己的理解和感受作答的问题，属于开放式问题，例如，"你对×××怎样看,"，应避免使用复合型问题，如"经常大量吸烟喝酒吗,"，以使对方能够准确地回答出问题的要点;避免使用诱导型问题，如"你一定同意我们的吧,"，因为诱导型问题带有一定倾向性，所得到的信息不可靠;在使用索究型问题(即问"为什么"的问题)时要特别注意使用缓和的语气。 (3)听话技巧 听话技巧也就是倾听技巧。在听对方谈话时要专心，避免注意力不集中;不要轻易打断对方的讲话，必要时可以恰当地引导;对对方的讲话要适时地做出恰当的反应;明确对方要表达的内容。 (4)反馈技巧 反馈技巧分三种不同的性质:积极性反馈、消极性反馈和模糊性反馈。传者向受传者做出赞同、支持、理解的反应为积极性反馈，而与其相反的反应，如不赞同和反对则为消极性反馈。没有明确立场、态度和感情色彩的反应为模糊性反馈。 5、大众传播的概念及特点 大众传播是指专业化的媒介组织通过一定的传播媒介，在接受国家管理下，对受众进行大规模的信息传播活动。有如下鲜明特点: (1)传播者是职业性的传播机构和人员，控制着传播的过程和内容; (2)大众传播的信息是公开的，公共的，面向全社会人群，且传播速度快，扩散距离远，覆盖区域广泛; (3)传播材料的统一成批生产和重复利用，可保证信息的标准化和规范化; 4)受众为数众多，分散广泛，是匿名的，自由的; ( (5)信息反馈间接延缓，且缺乏自发性; (6)大众传播媒介事宜先进技术为基础的分发系统和设备，决定着信息的物理形式、时空范围、速度和数量。 6、大众传播媒介的选择原则 (1)针对性原则 针对目标人群状况，选择传播媒介; (2)速度快原则 力求将健康信息以最快的速度、最畅通的渠道传递给目标人群; (3)可及性原则 根据媒介在当地的覆盖情况、受众对媒介的拥有情况和使用习惯来选择媒介; (4)经济性原则 从经济实用的角度考虑媒介的选择。 7、健康传播效果的影响因素 (1)健康传播者方面 虽然人人都可以是传播者，但并非人人都能充当健康传播者。健康传播者既要具有健康教育意识和以“人人健康”为传播的出发点，又要有医学科学知识和必要的传播与教育技能。健康教育工作者与所有负有健康教育职责的人是健康传播的主体。 (2)健康信息方面 健康传播就是用健康信息的刺激，来激发受传者的某些健康需求，它还提醒受传者健康与不健康，快感或不快即将来临，应该采取何种行动来使其发生或避免。内容因素包括信息内容、符号使用与讯息表达形式三个方面。 (3)媒介渠道方面 1? 媒介渠道的选择; 2? 注意多媒介渠道的组合策略。 (4)受传者(受众)方面 健康传播的受众是社会人群，他们有着不同的健康需求和信息需求。传播内容要符合听众的年龄生理与心理特点。 guide sex further enhanced, documents handle and running of speed obviously speed up, program gradually specification, conference service and Chief reception of quality and level has has new of improve, Logistics support capability further strengthened. Document management, confidential, confidentiality, duty, letters and other items have been significantly improved. 4, Office construction increased at all levels. City Government offices adhere to strengthen and improve the construction of the system as a breakthrough, has developed a series of code of conduct, continuous improvement of operational mechanism, sound and the implementation of the rules and regulations, and adhere to the system of managing people, according to the rules, the work gradually into the orbit of institutionalization and standardization. Focus on strengthening ideological and political construction of the contingent of cadres, and actively carried out various business training, knowledge of the Office team structure has been optimized, to broaden the range of knowledge and operational capacity grows, nurtured a political firm, sharp, professional and innovative staff, created solidarity, striving for the top, pragmatic, dedication, good image. However, with the State Council and the provincial Government of the national, the province's Secretary-General meeting of government offices under the new situation 7 guide sex further enhanced, documents handle and running of speed obviously speed up, program gradually specification, conference service and Chief reception of quality and level has has new of improve, Logistics support capability further strengthened. Document management, confidential, confidentiality, duty, letters and other items have been significantly improved. 4, Office construction increased at all levels. City Government offices adhere to strengthen and improve the construction of the system as a breakthrough, has developed a series of code of conduct, continuous improvement of operational mechanism, sound and the implementation of the rules and regulations, and adhere to the system of managing people, according to the rules, the work gradually into the orbit of institutionalization and standardization. Focus on strengthening ideological and political construction of the contingent of cadres, and actively carried out various business training, knowledge of the Office team structure has been optimized, to broaden the range of knowledge and operational capacity grows, nurtured a political firm, sharp, professional and innovative staff, created solidarity, striving for the top, pragmatic, dedication, good image. However, with the State Council and the provincial Government of the national, the province's Secretary-General meeting of government offices under the new situation (5)环境方面 除了上述传播过程的四要素外，还有一个重要方面不可忽视，那就是传播活动赖以发生的自然环境和社会环境。 1? 自然环境:如传播活动地点、场所、距离、环境布置等。 2? 社会环境:如社会经济状况、文化习俗、社会规范、政府及社区的政策法规，以及受传者生活圈子内的所有人对其态度和行为的影响等。 四、健康教育与健康促进的计划设计 1、计划设计是一个组织机构根据实际情况，通过科学的预测和决策，提出在未来一定时期内所要达到的目标及实现这一目标的方法、途径的所有活动的过程，也即包括计划、实施及评价的全过程。(即确认问题和解决问题的决策与预测过程) 2、计划设计的原则 (1)目标原则 (2)整体性原则 (3)前瞻性原则 (4)弹性原则 (5)从实际出发原则(实际性、可行性) (6)参与性原则 3、计划设计的基本步骤(收集资料、分析资料、确认问题、优先项目) 、问题与政策分析 1 2、形势分析 3、目标人群分析 计划前研究:即确定要解决的问题。(核心:评估需求) 4(制定目标 5(确定教育策略 6、材料制作与预试验 7、活动与日程管理 8、监测与评价 ?计划活动研究(中心:确立对策) 4、健康教育诊断是指在面对人群健康问题时，通过系统地调查、测量来收集各种有关事实资料，并对这些资料进行分析、归纳、推理、判断，确定或推测与此健康问题有关的行为和行为影响因素，以及获取健康教育资源的过程，从而为确定健康教育干预目标、策略和措施提供基本依据。 5、根据格林模式，健康教育诊断主要从社会、流行病学、行为、环境、教育和管理与政策六个方面进行诊断。 (一)社会诊断 社会诊断是生物-心理-社会医学模式的具体体现。社会诊断的主要目的是从分析广泛的社会问题入手，了解社会问题与健康问题的相关性，其重点内容包括社会环境和生活质量。 1.社会环境:包括经济、文化、卫生服务、社会政策、社区资源等多方面情况及其历年化情况。 (1)经济指标——人均国民生产总值、人均年收入水平、人均住房面积、人均绿化面the functions and priorities compared to the requirements of our gap is still very big. Main is daily in the passive meet of more, active research of less, service also has not timely, and not in place of problem; work in the meet Yu traditional of, and program of of work way, develop innovation spirit and service innovation capacity not strong; supervision information work and promoted decision implementation of contact enough close, feedback situation not active; research resources of using enough full, research results of into degree not high; some sector documents running not specification; Municipal Government Office on the County (district) and municipal government sector Office work of guide enough, No real form interaction and close collaboration, promote the implementation of the work. These problems, we must effectively be addressed in the future work. Second, serve the overall situation, carry out their duties, improve quality, and strive to create a new situation of system of government offices in the city since last season, meeting the Secretary-General of the State Council and the provincial government has held a government system, from a global and strategic height, scientifically analyzed the new situation and the newTasks on the system of government offices bring new situations and new problems and new challenges, profoundly expounded the work of government departments at all levels in the new era should be put in the situation to understand, to grasp, to deploy at any time and under any circumstances, should always focus on the big picture, firmly grasp the overall situation, increasing in the overall implementing in earnest the work of spontaneity, initiative and steadfastness. And explicitly put forward the "surrounding situation, pay attention to implementation" is the core of government offices, requiring government departments at all levels cannot be "Gramophone", "mail room" and "the Messenger" is not confined to paper communications, yinglaisongwang and upload issue. Must to has strongly of implementation guide sex further enhanced, documents handle and running of speed obviously speed up, program gradually specification, conference service and Chief reception of quality and level has has new of improve, Logistics support capability further strengthened. Document management, confidential, confidentiality, duty, letters and other items have been significantly improved. 4, Office construction increased at all levels. City Government offices adhere to strengthen and improve the construction of the system as a breakthrough, has developed a series of code of conduct, continuous improvement of operational mechanism, sound and the implementation of the rules and regulations, and adhere to the system of managing people, according to the rules, the work gradually into the orbit of institutionalization and standardization. Focus on strengthening ideological and political construction of the contingent of cadres, and actively carried out various business training, knowledge of the Office team structure has been optimized, to broaden the range of knowledge and operational capacity grows, nurtured a political firm, sharp, professional and innovative staff, created solidarity, striving for the top, pragmatic, dedication, good image. However, with the State Council and the provincial Government of the national, the province's Secretary-General meeting of government offices under the new situation 积等。 (2)文化指标——入学率、文盲率、风俗习惯等。 (3)卫生服务指标——医疗卫生服务机构的分布、人员的组成等。 (4)社会政策——卫生法规、政策的建立、执行情况。 (5)社区资源——主要指健康教育和健康促进可利用的资源，如健康教育机构的专业人员组成、设备条件等。 2.生活质量:测量生活质量的指标包括主观指标和客观指标两个方面。 (1)主观指标包括目标人群对生活满意程度的感受; (2)客观指标包括目标人群生活环境的物理、经济、文化和疾病等状况。 (二)流行病学诊断 流行病学诊断的主要任务是要客观地确定目标人群的主要健康问题以及引起健康问题的行为因素和环境因素。流行病学诊断最终应回答以下五个问题: 1.威胁目标人群生命与健康的疾病或健康问题是什么, 2.影响该疾病或健康问题的危险因素是什么,其中最重要的危险因素是什么, 3.这些疾病或健康问题的受害者在性别、年龄、种族、职业上有何特征, 4.这些疾病或健康问题在地区、季节、持续时间上有何规律, 5.对那些(哪个)问题进行干预可能最敏感,预期效果和效益可能最好, (三)行为诊断 行为诊断的主要目的是确定导致目标人群疾病或健康问题发生的行为危险因素，其主要任务包括三个方面: 1.区别引起疾病或健康问题的行为与非行为因素 2.区别重要行为与相对不重要行为，标准:与疾病或健康问题联系密切程度及该行为发生频度 3.区别高可变性行为与低可变性行为，即评估行为的预期干预效果。所谓高可变性行为与低可变性行为是指通过健康教育干预，某行为发生定向改变的难易程度。 (四)环境诊断 环境诊断是为确定干预的环境目标奠定基础，其主要步骤为: 1.从众多的社会环境因素中，找出与行为相互影响的环境因素。 2.根据环境因素与健康和生活质量关系的强度，以及该环境因素所导致的发病率、患病率、罹患率状况，确定其重要性。 3.根据环境因素是否可通过政策、法规等干预而发生变化，从而确定其可变性。 4.将重要性与可变性结合分析。确定干预的环境目标。 (五)教育诊断 行为受多种因素的影响，主要包括遗传因素、环境因素和学习因素。在格林模式中，将这些因素划分为倾向因素、强化因素和促成因素三类。任何一种健康行为均会受到这三类因素的影响，教育诊断主要分析这三类因素。 1.倾向因素——是指产生某种行为的动机、愿望，或诱发某行为的因素。倾向因素包括知识、信念、态度和价值观。 2.促成因素——是指使行为动机和意愿得以实现的因素，即实现或形成某行为所必须的技能、资源和社会条件。包括保健设施、医务人员、诊所、医疗费用、交通工具、个人保健技术及相应的政策法规等。 3.强化因素——是指激励行为维持、发展或减弱的因素。主要来自社会的支持、同伴的影响和领导、亲属以及保健人员的劝告等。 (六)管理与政策诊断 guide sex further enhanced, documents handle and running of speed obviously speed up, program gradually specification, conference service and Chief reception of quality and level has has new of improve, Logistics support capability further strengthened. Document management, confidential, confidentiality, duty, letters and other items have been significantly improved. 4, Office construction increased at all levels. City Government offices adhere to strengthen and improve the construction of the system as a breakthrough, has developed a series of code of conduct, continuous improvement of operational mechanism, sound and the implementation of the rules and regulations, and adhere to the system of managing people, according to the rules, the work gradually into the orbit of institutionalization and standardization. Focus on strengthening ideological and political construction of the contingent of cadres, and actively carried out various business training, knowledge of the Office team structure has been optimized, to broaden the range of knowledge and operational capacity grows, nurtured a political firm, sharp, professional and innovative staff, created solidarity, striving for the top, pragmatic, dedication, good image. However, with the State Council and the provincial Government of the national, the province's Secretary-General meeting of government offices under the new situation 9 guide sex further enhanced, documents handle and running of speed obviously speed up, program gradually specification, conference service and Chief reception of quality and level has has new of improve, Logistics support capability further strengthened. Document management, confidential, confidentiality, duty, letters and other items have been significantly improved. 4, Office construction increased at all levels. City Government offices adhere to strengthen and improve the construction of the system as a breakthrough, has developed a series of code of conduct, continuous improvement of operational mechanism, sound and the implementation of the rules and regulations, and adhere to the system of managing people, according to the rules, the work gradually into the orbit of institutionalization and standardization. Focus on strengthening ideological and political construction of the contingent of cadres, and actively carried out various business training, knowledge of the Office team structure has been optimized, to broaden the range of knowledge and operational capacity grows, nurtured a political firm, sharp, professional and innovative staff, created solidarity, striving for the top, pragmatic, dedication, good image. However, with the State Council and the provincial Government of the national, the province's Secretary-General meeting of government offices under the new situation 管理与政策诊断的核心内容是组织评估和资源评估。组织评估包括组织内分析和组织间 分析两个方面;资源评估则是对实施健康教育与健康促进的资源进行分析。 组织内分析系指对健康教育与健康促进内部的分析，如有无实施健康教育和健康促进的 机构、该机构有无实践经验和组织能力、以及资源的配置等问题;组织间分析系指主办健康 教育和健康促进的组织外部环境，分析外环境对计划执行可能产生的影响。包括此健康教育 项目与本地区卫生规划的关系、政府卫生行政部门对健康教育的重视程度和资源投入状况， 本地区其他组织机构参与健康教育的意愿和现况、社区群众接受和参与健康教育的意愿和现 状、社区是否存在志愿者队伍等 the functions and priorities compared to the requirements of our gap is still very big. Main is daily in the passive meet of more, active research of less, service also has not timely, and not in place of problem; work in the meet Yu traditional of, and program of of work way, develop innovation spirit and service innovation capacity not strong; supervision information work and promoted decision implementation of contact enough close, feedback situation not active; research resources of using enough full, research results of into degree not high; some sector documents running not specification; Municipal Government Office on the County (district) and municipal government sector Office work of guide enough, No real form interaction and close collaboration, promote the implementation of the work. These problems, we must effectively be addressed in the future work. Second, serve the overall situation, carry out their duties, improve quality, and strive to create a new situation of system of government offices in the city since last season, meeting the Secretary-General of the State Council and the provincial government has held a government system, from a global and strategic height, scientifically analyzed the new situation and the newTasks on the system of government offices bring new situations and new problems and new challenges, profoundly expounded the work of government departments at all levels in the new era should be put in the situation to understand, to grasp, to deploy at any time and under any circumstances, should always focus on the big picture, firmly grasp the overall situation, increasing in the overall implementing in earnest the work of spontaneity, initiative and steadfastness. And explicitly put forward the "surrounding situation, pay attention to implementation" is the core of government offices, requiring government departments at all levels cannot be "Gramophone", "mail room" and "the Messenger" is not confined to paper communications, yinglaisongwang and upload issue. Must to has strongly of implementation