基于循证理念的预防接种门诊空间环境对留观依从性的影响研究OA北大核心CSTPCD

The National Immunization Program is a systematic strategic project that mainly relies on primary healthcare facilities in China.Each child will take nearly thirty doses of vaccine,therefore,the vaccination clinics is a repeatedly experienced public health environment.Although people are aware of the 30-minute medical observation requirement,behavior observation shows that people's staying time is relatively short and the pass rate for observation is low.To explore the impact of spacial environment of vaccination clinics on users,promote medical safety and quality during the vaccination process,and improve the medical experience of immunization services,this study takes the waiting space of vaccination clinics as the entry point because wating takes the longest time during the entire process.Previous studies have conducted research on hospital observation spaces,but most of them rely on subjective measures such as satisfaction and comfort in waiting spaces through questionnaires and interviews.There is a gap of empirical evidence linking the spatial environment to post-vaccination observation compliance.However,these subjective measurements are not applicable in this study due to the Hawthorne effect,which states that people may make adjustments to their behavior when realizing they are the subject of study.This study transcends the collection of subjective feedback and focuses on the relationship between"environment as input and behavior as output",with external behavioral decisions as the ultimate influencing outcome.Therefore,non-interventional behavioral observation has become the first choice for research.This study selected four institutions with significant spatial environment differences as the research object in Wuhan and mapped the floor plan.Researchers observed 314 families randomly throughout the entire vaccination process,using"post-vaccination observation time"as the key measure for statistics.At the same time,physical environmental factors are synchronously collected,including illumination,sound pressure level,and number of people on site.A pre-designed observation record form was used to record the key time modes and other more detailed behavior information during the process.Data collection lasted for two months.Combining with on-site conditions,the study analyzes the correlation between spatial environment and observation compliance,aiming to provide empirical evidence for improving the public health service environment.The result reveals a low overall compliance rate with the 30-minute observation protocol,with only an average of 18.15%of families meeting the criteria across the four clinics.Significant correlations were found between the three indicators of spatial crowding,sound pressure level,and illumination in the observation space and the duration of observation.Specifically,increased crowding and noise levels were significantly associated with reduced observation times,while higher illumination was positively correlated with longer observation durations.Regression analysis takes observation duration as the dependent variable and various factors as the predictor variables.The significance level of the regression model is 0.024,indicating that the overall predictive power of the model is significant and has certain predictive value.However,the R-squared and F-squared values are both low,which means that the explanatory power of spatial environment on changes in observation duration is not strong,and improving observation compliance requires intervention from more perspectives.This study discussed the relationship between each factor and the current design indicators,and concluded that the recommended area value given by the current specifications is too small.Each vaccination clinic should estimate the area of observation space based on daily reception volume.When the number of people vaccinated in a single day is less than 40,the observation area should not be less than 30 square meters;The number of people vaccinated between 40～60 per day,and the observation area should not be less than 40 square meters;When the number exceeds 60,the observation area should not be less than 50 square meters.In addition,results does not show correlation between hot and humid environments and observation compliance,this finding should still be approached with great caution.Frontline staff feedback does not exclude possibility that inadequate thermal comfort may affect observation compliance in serious winter and summer seasons.This study uniquely contributes to the vaccination clinic design field by providing empirical evidence that the spatial environment may influence post-vaccination ovservation compliance.Furthermore,this study expands the behavioral measurement beyond subjective feelings such as satisfaction and comfort in waiting spaces,and strengthens the understanding that waiting spaces affect the waiting experience.