Bridging the Urban-Rural Continuum to Improve Services in

Rural ChinaVirginia C. Li, PhD, MPH,

Professor of Community Health SciencesUCLA 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 Objectives1. 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.

Figure 1. Dissemination of information from IHSKMC Website 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

sit

e D

evel

op

me

nt

Design tree diagram

Domain application obtain hardware Install software

Upload web pages Pretest & modification

Bas

elin

e S

urv

ey

Site Selection Survey design Identify subjectIdentify 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.).

Eval

uatio

n Su

rvey

Survey design Training interviewers Organize survey team

Implement in fieldsAnalysisReports/papers

Imp

lem

enta

tio

ns

Mobile monitoring team Participatory planning Meeting Trouble shooting

Plan for dissemination of website information, strategies and practices

Tra

inin

g

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 Areas2. Core Messages3. 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).

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 MeanStandardDeviation

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 MeanStandard 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%

ChangeBaseline

% Change

Baseline%

ChangeNanhua/ 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 % changeBaseline

% change

Baseline%

changeNanhua/ 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.