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Effect of Nursing Partnership Program on Preterm Birth in Pregnant Women at Risk For Preterm Birth* Usa Khongkha M.N.S. (Advanced Midwifery), Graduated student (Advanced Midwifery), Faculty of Nursing, Mahidol University.

Ameporn Rathinthorn Ph.D. (NURSING), Assistant Professor Chaweewan Yusamran Ph.D. (NURSING), Assistant Professor Faculty of Nursing, Mahidol University.

Amphan Chalermchockcharoenkit M.D., Dip Thai Board of Obstetrics and Gynecology, Associate Professor Faculty of Medicine Siriraj Hospital, Mahidol University. *Masterûs thesis, Faculty of Graduate studies, Mahidol University.

Abstract This study was a randomized control trial research which aimed at investigating the effects of a nursing partnership program on preterm birth of pregnant women at risk of preterm birth. The study sample consisted of 112 pregnant women at risk of preterm birth who sought prenatal care at the Kampangsean Hospital Nakhon Pathom Province, Thailand. The subjects were randomly assigned into two groups. The experimental group received the nursing partnership program which was an emphasis on raising awareness of their risks of preterm birth through collaboration to solve problems and reduce the risk of preterm births.

Partnership program included teaching pregnant women to observe and recognize signs and symptoms of preterm labor, and conducting one visit at the prenatal clinic and weekly follow up via telephone. The control subjects, on the other hand, received a manual on observation of signs and symptoms of preterm labor and appropriate self-care when having those signs and symptoms, in addition to routine nursing care.

Data were collected by following up on the gestational age at delivery. Data were analyzed in terms of relative risk and Mann Whitney-U. The findings showed that the experimental group had a lower preterm birth rate (9.3% and 13.5%, RR=0.688, 95% CI 0.233 and 2.031), higher mean gestational age at delivery (U=1292, Z=-0.709, P=0.479), and a higher mean gestational age at preterm delivery (U=15, Z=-0.407, P=0.755), but these were not statistically significant. These results may be influenced by the partnership development process. There are restrictions about time in establishing relationship and sharing information. In addition, some problems could not be solved and also required the family to get involved in solving problems. Further study should be conducted on a larger sample size and change follow up process to be at the clinic.

Keywords: Preterm Birth Nursing Partnership THAILAND JOURNAL OF HEALTH PROMOTION AND ENVIRONMENTAL HEALTH

October - December 2012

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ºŸâ«‘®—¬π”‡§√◊ËÕß¡◊Õ∑’Ë„™â„π°“√«‘®—¬‡ πÕµàÕºŸâ∑√ß §ÿ≥«ÿ≤‘∑’ˇªìπºŸâ‡™’ˬ«™“≠¥â“π Ÿµ‘»“ µ√å ª√–°Õ∫ ¥â«¬ Ÿµ‘·æ∑¬å 1 ∑à“π Õ“®“√¬å欓∫“≈¥â“π°“√ 欓∫“≈ Ÿµ‘»“ µ√å 2 ∑à“π ·≈–欓∫“≈ª√–®” °“√¥â“π°“√欓∫“≈ Ÿµ‘»“ µ√å 1 ∑à“π ‡æ◊ËÕ æ‘®“√≥“§«“¡∂Ÿ°µâÕߢÕ߇π◊ÈÕÀ“ §«“¡‡À¡“– ¡ ¢Õß¿“…“∑’Ë„™â·≈–¿“æª√–°Õ∫ ´÷Ëß¡’‡§√◊ËÕß¡◊Õ∑’Ë „™â„π°“√«‘®—¬ ¥—ßπ’È 1. ·∫∫ª√–‡¡‘𧫓¡‡ ’ˬߵàÕ°“√§≈Õ¥ °àÕπ°”Àπ¥ ∑’˪√–¬ÿ°µå®“°·∫∫ª√–‡¡‘𧫓¡ ‡ ’ˬߵàÕ°“√‡®Á∫§√√¿å§≈Õ¥°àÕπ°”Àπ¥¢Õß µ√’ µ—Èߧ√√¿å ¢ÕßÀπ૬Ω“°§√√¿å ‚√ß欓∫“≈»‘√‘√“™ ªï 25508 2. ‚ª√·°√¡°“√‡ªì π Àÿâ π à « π∑“ß°“√ 欓∫“≈„π µ√’µß—È §√√¿å∑¡’Ë ¿’ “«–‡ ’¬Ë ßµàÕ°“√§≈Õ¥ °àÕπ°”Àπ¥ ·∫àßÕÕ°‡ªìπ 4 √–¬– √–¬–∑’Ë 1 (°“√æ∫°—π§√—Èß·√° ∑’˧≈‘π‘° Ω“°§√√¿å) ‡æ◊ËÕ„À⺟â√à«¡«‘®—¬µ√–Àπ—°«à“ ¡’§«“¡ ‡ ’Ë ¬ ßµà Õ °“√§≈Õ¥°à Õ π°”Àπ¥ ·≈–√à « ¡¡◊ Õ «“ß·ºπ·°â‰¢·≈–≈¥§«“¡‡ ’ˬߵàÕ°“√§≈Õ¥°àÕπ °”Àπ¥ ¡’°“√·π–π”Õ“°“√·≈–Õ“°“√· ¥ß¢Õß ¿“«–‡®Á∫§√√¿å§≈Õ¥°àÕπ°”Àπ¥ √«¡∑—Èß«‘∏’°“√ ªØ‘∫—µ‘µ—«∑’ˇÀ¡“– ¡‡¡◊ËÕ‡°‘¥Õ“°“√ ·≈–·®°§Ÿà¡◊Õ —߇°µÕ“°“√‡®Á∫§√√¿å§≈Õ¥°àÕπ°”Àπ¥·≈–°“√ ªØ‘∫—µ‘µ—«‡¡◊ËÕ‡°‘¥Õ“°“√ ·°àºŸâ√à«¡«‘®—¬∑ÿ°§π √–¬–∑’Ë 2 Õ’ ° 1 — ª ¥“Àå µà Õ ¡“ ºŸâ «‘ ®— µ‘¥µ“¡‡¬’ˬ¡∑“ß‚∑√»—æ∑å ‡æ◊ËÕµ‘¥µ“¡ªí≠À“„π °“√ªØ‘∫—µ‘µ—« ·≈–°“√√—∫√Ÿâ‡°’ˬ«°—∫Õ“°“√·≈– Õ“°“√· ¥ß¢Õß¿“«–‡®Á∫§√√¿å§≈Õ¥°àÕπ°”Àπ¥ ·≈–„π°√≥’ºŸâ√à«¡«‘®—¬¡’ªí≠À“„π°“√ªØ‘∫—µ‘µ—« ºŸâ «‘®—¬‡ªî¥‚Õ°“ „À⺟â√à«¡«‘®—¬¡“æ∫‡ªìπ°“√ à«πµ—« ‰¥â∑’˧≈‘π‘°Ω“°§√√¿åÀ“°¡’§«“¡ª√– ߧå √–¬–∑’Ë 3 (°“√æ∫°—π§√—Èß∑’Ë 2 ∑’˧≈‘π‘° Ω“°§√√¿å) ´÷Ë߇ªìπ 2, 3, 4 À√◊Õ 5 —ª¥“ÀåµàÕ¡“

THAILAND JOURNAL OF HEALTH PROMOTION AND ENVIRONMENTAL HEALTH

October - December 2012

57

∫ ∑ «‘ ∑ ¬ “ ° “ √ À≈—ß®“°æ∫°—π§√—Èß·√° ‡æ◊ËÕµ‘¥µ“¡°“√ªØ‘∫—µ‘µ—« ‡æ◊ËÕ≈¥§«“¡‡ ’ˬߵàÕ°“√§≈Õ¥°àÕπ°”Àπ¥ µ“¡ ∑’ˉ¥âµ°≈ß√à«¡°—π‰«â °“√ª√–‡¡‘π°“√√—∫√Ÿâ‡°’ˬ«°—∫ Õ“°“√·≈–Õ“°“√· ¥ß¢Õß¿“«–‡®Á∫§√√¿å§≈Õ¥ °àÕπ°”Àπ¥ ·≈–√à«¡«“ß·ºπ·°â‰¢ªí≠À“„π°“√ ªØ‘∫—µ‘µ—« À√◊ÕÀ“·π«∑“ß„À¡à„π°“√ªØ‘∫—µ‘‡æ◊ËÕ ≈¥§«“¡‡ ’ˬߵàÕ°“√§≈Õ¥°àÕπ°”Àπ¥ √–¬–∑’Ë 4 µ‘ ¥ µ“¡‡¬’Ë ¬ ¡∑“ß‚∑√»— æ ∑å ∑ÿ ° —ª¥“Àå ‡æ◊ËÕª√–‡¡‘π°“√√—∫√Ÿâ‡°’ˬ«°—∫Õ“°“√·≈– Õ“°“√· ¥ß¢Õß¿“«–‡®Á∫§√√¿å§≈Õ¥°àÕπ°”Àπ¥ ·≈–√à«¡«“ß·ºπ·°â‰¢ªí≠À“À√◊ÕÀ“·π«∑“ß„À¡à „π°“√ªØ‘∫—µ‘µ—«‡æ◊ËÕ≈¥§«“¡‡ ’ˬߵàÕ°“√§≈Õ¥ °àÕπ°”Àπ¥ ®π°√–∑—ßË §≈Õ¥À√◊Õ‡¡◊ÕË Õ“¬ÿ§√√¿å§√∫ 37 —ª¥“Àå 3. §Ÿà¡◊Õ —߇°µÕ“°“√‡®Á∫§√√¿å§≈Õ¥°àÕπ °”Àπ¥·≈–°“√ªØ‘∫—µ‘µ—«‡¡◊ËÕ‡°‘¥Õ“°“√ ∑’˺Ÿâ«‘®—√â“ߢ÷πÈ 4. ·∫∫∫— π ∑÷ ° √ÿ ª ·π«∑“ß°“√·°â ‰ ¢ ªí≠À“√à«¡°—π 5. ·∫∫∫—π∑÷°°“√µ‘¥µ“¡‡¬’ˬ¡ 6. ·∫∫∫— π ∑÷ ° ¢â Õ ¡Ÿ ≈ à « π∫ÿ § §≈ ·≈– ¢âÕ¡Ÿ≈°“√§≈Õ¥ °“√æ‘∑—°…å ‘∑∏‘Ï¢Õß°≈ÿࡵ—«Õ¬à“ß °“√«‘®—¬§√—Èßπ’Ⱥà“π°“√æ‘®“√≥“·≈–‰¥â√—∫ °“√√—∫√Õß®“°§≥–°√√¡°“√®√‘¬∏√√¡°“√«‘®—¬„π §π¢Õß¡À“«‘∑¬“≈—¬¡À‘¥≈ ™ÿ¥ C “¬æ¬“∫“≈ »“ µ√å ¢—ÈπµÕπ°“√¥”‡π‘π°“√«‘®—1. ‡≈◊ Õ °°≈ÿà ¡ µ— « Õ¬à “ ßµ“¡§ÿ ≥ ¡∫— µ‘ ∑’Ë °”Àπ¥ §◊Õ µ√’µß—È §√√¿å∑¡’Ë Õ’ “¬ÿ§√√¿å√–À«à“ß 2428 —ª¥“Àå ·≈–¡’§«“¡‡ ’ˬߵàÕ°“√‡®Á∫§√√¿å §≈Õ¥°àÕπ°”Àπ¥Õ¬à“ßπâÕ¬ 1 ¢âÕ ®“°°“√§—¥ °√Õߥ⠫ ¬·∫∫ª√–‡¡‘ 𠧫“¡‡ ’Ë ¬ ßµà Õ °“√‡®Á ∫ §√√¿å§≈Õ¥°àÕπ°”Àπ¥ ∑√“∫Õ“¬ÿ§√√¿å∑·’Ë πàπÕπ 58

µÿ≈“§¡ - ∏—𫓧¡ 2555

°√¡Õπ“¡—¬ à߇ √‘¡„Àâ§π‰∑¬ ÿ¢¿“楒

2. À ≈— ß ® “ ° ‰ ¥â ° ≈ÿà ¡ µ— « Õ ¬à “ ß ∑’Ë ¡’ §ÿ≥≈—°…≥–µ“¡‡°≥±å ºŸâ«‘®—¬ ÿà¡°≈ÿࡵ—«Õ¬à“ß ÕÕ°‡ªìπ 2 °≈ÿà¡ §◊Õ°≈ÿà¡∑¥≈Õß·≈–°≈ÿࡧ«∫§ÿ¡ °≈ÿà¡≈– 56 √“- ºŸâ√à«¡«‘®—¬∑—Èß Õß°≈ÿà¡ ‰¥â√—∫°“√¥Ÿ·≈ µ“¡ª°µ‘¢Õß‚√ß欓∫“≈ √«¡∑—È߉¥â√—∫§”·π–π” ‡ªìπ°≈ÿà¡„À⠗߇°µÕ“°“√º‘¥ª°µ‘ ‡™àπ √Ÿâ ÷°«à“∑âÕß ·¢Áß ª«¥‡¡◊ËÕ¬∫√‘‡«≥‡Õ« À√◊Õ¡’πÈ”‡¥‘πÕÕ°∑“ß ™àÕߧ≈Õ¥ „Àâ√’∫¡“‚√ß欓∫“≈ ·≈–‰¥â√—∫∑√“∫ «à“µπ‡Õß¡’¿“«–‡ ’¬Ë ßµàÕ°“√§≈Õ¥°àÕπ°”Àπ¥ À≈—ß ®“°π—Èπ - ºŸâ√à«¡«‘®—¬„π°≈ÿࡧ«∫§ÿ¡ ‰¥â√—∫§Ÿà¡◊Õ —߇°µÕ“°“√‡®Á∫§√√¿å§≈Õ¥°àÕπ°”Àπ¥·≈–°“√ ªØ‘∫—µ‘µ—«‡¡◊ËÕ‡°‘¥Õ“°“√∑’˺Ÿâ«‘®—¬ √â“ߢ÷Èπ - ºŸâ√à«¡«‘®—¬„π°≈ÿà¡∑¥≈Õß ‰¥â√—∫§Ÿà¡◊Õ —߇°µÕ“°“√‡®Á∫§√√¿å§≈Õ¥°àÕπ°”Àπ¥·≈–°“√ ªØ‘∫—µ‘µ—«‡¡◊ËÕ‡°‘¥Õ“°“√∑’˺Ÿâ«‘®—¬ √â“ߢ÷Èπ ·≈–‰¥â √—∫°“√¥Ÿ·≈µ“¡‚ª√·°√¡°“√‡ªìπÀÿâπ à«π∑“ß°“√ 欓∫“≈´÷ËߺŸâ«‘®—¬„™â·π«§‘¥°“√‡¢â“‰ª‡ªìπÀÿâπ à«π ∑“ß°“√欓∫“≈ (The nursing partnership) ´÷ßË ¡’À≈—°°“√¢Õß°“√¥Ÿ·≈§◊Õ ¡’°“√·≈°‡ª≈’ˬπ¢âÕ¡Ÿ≈ À√◊Õª√– ∫°“√≥å√–À«à“ß欓∫“≈·≈–ºŸâªÉ«¬ ‡æ◊ËÕ √à « ¡¡◊ Õ °— π À“·π«∑“ß„π°“√·°â ‰ ¢ªí ≠ À“∑“ß ÿ ¢ ¿“æ¢ÕߺŸâ ªÉ « ¬ ‚¥¬„Àâ µ√’ µ—È ß §√√¿å ‡ ªì π ºŸâ µ— ¥ ‘ π „®‡≈◊ Õ °«‘ ∏’ ° “√·°â ‰ ¢ªí ≠ À“¥â « ¬µπ‡Õß ª√–°Õ∫¥â«¬ °“√‡πâπ„À⺟â√à«¡«‘®—¬µ√–Àπ—°«à“¡’ §«“¡‡ ’ˬߵàÕ°“√§≈Õ¥°àÕπ°”Àπ¥ °“√√à«¡¡◊Õ «“ß·ºπ·°â‰¢·≈–≈¥§«“¡‡ ’ˬߵàÕ°“√§≈Õ¥°àÕπ °”Àπ¥ °“√·π–π”Õ“°“√·≈–Õ“°“√· ¥ß¢Õß ¿“«–‡®Á∫§√√¿å§≈Õ¥°àÕπ°”Àπ¥ √«¡∑—Èß«‘∏’°“√ ªØ‘∫—µ‘µ—«∑’ˇÀ¡“– ¡‡¡◊ËÕ‡°‘¥Õ“°“√ ·≈–¡’°“√ µ‘ ¥ µ“¡‡¬’Ë ¬ ¡∑’Ë § ≈‘ π‘ ° Ω“°§√√¿å 1 §√—È ß ·≈– ‚∑√»—æ∑嵑¥µ“¡‡¬’ˬ¡∑ÿ° —ª¥“Àå®π°√–∑—Ëߧ≈Õ¥ À√◊Õ‡¡◊ËÕÕ“¬ÿ§√√¿å§√∫ 37 —ª¥“Àå

º≈¢Õß‚ª√·°√¡°“√‡ªìπÀÿâπ à«π∑“ß°“√欓∫“≈µàÕ°“√§≈Õ¥°àÕπ°”Àπ¥„π µ√’µ—Èߧ√√¿å∑’Ë¡’¿“«–‡ ’ˬߜ

3. °“√‡°Á ∫ √«∫√«¡¢â Õ ¡Ÿ ≈ ‚¥¬ºŸâ «‘ ®— µ‘ ¥ µ“¡Õ“¬ÿ § √√¿å ∑’Ë § ≈Õ¥®“°∫— π ∑÷ ° „π‡«™ √–‡∫’¬πÀ√◊Õ‚∑√»—æ∑å Õ∫∂“¡ºŸâ√à«¡«‘®—¬‚¥¬µ√ß À“°¢âÕ¡Ÿ≈‰¡à§√∫∂â«π 4. π”¢âÕ¡Ÿ≈¡“«‘‡§√“–Àå ‡æ◊ËÕ‡ª√’¬∫‡∑’¬∫ ¢âÕ¡Ÿ≈√–À«à“ß°≈ÿà¡∑¥≈Õß·≈–°≈ÿࡧ«∫§ÿ¡ ‚¥‡ª√’¬∫‡∑’¬∫Õ—µ√“°“√§≈Õ¥°àÕπ°”Àπ¥ ¥â«¬ ∂‘µ‘ Relative risk ·≈–‡ª√’ ¬ ∫‡∑’ ¬ ∫Õ“¬ÿ § √√¿å ‡©≈’ˬ∑’˧≈Õ¥¥â«¬ ∂‘µ‘ Mann-Whitney U ‚¥„™â‚ª√·°√¡ SPSS version 17 °“√«‘‡§√“–Àå¢âÕ¡Ÿ≈ 1. π”¢âÕ¡Ÿ≈ à«π∫ÿ§§≈ ¡“·®°·®ß§«“¡∂’Ë §”π«≥§à“√âÕ¬≈– ·≈–§à“‡∫’ˬ߇∫π¡“µ√∞“π ·≈– ‡ª√’¬∫‡∑’¬∫¢âÕ¡Ÿ≈ à«π∫ÿ§§≈ ≈—°…≥–∑“ß Ÿµ°‘ √√¡ ·≈–ªí®®—¬‡ ’ˬߵàÕ°“√§≈Õ¥°àÕπ°”Àπ¥ ‚¥¬°“√

∑¥ Õ∫¥â«¬ ∂‘µ‘ Independent t-test, Chisquare test ·≈– Fisherûs exact test 2. ‡ª√’ ¬ ∫‡∑’ ¬ ∫Õ— µ √“°“√§≈Õ¥°à Õ π °”Àπ¥ √–À«à“ß°≈ÿà¡∑¥≈Õß°—∫°≈ÿࡧ«∫§ÿ¡ ‚¥°“√∑¥ Õ∫¥â«¬ ∂‘µ‘ Relative risk 3. ‡ª√’ ¬ ∫‡∑’ ¬ ∫Õ“¬ÿ § √√¿å ‡ ©≈’Ë ¬ ∑’Ë § ≈Õ¥ √–À«à “ ß°≈ÿà ¡ ∑¥≈Õß°— ∫ °≈ÿà ¡ §«∫§ÿ ¡ ‚¥¬°“√ ∑¥ Õ∫¥â«¬ ∂‘µ‘ Mann-Whitney U

º≈°“√»÷°…“ µ“√“ß∑’Ë 1 º≈°“√«‘®—¬æ∫«à“ºŸâ√à«¡«‘®—¬„π °≈ÿà¡∑¥≈Õß·≈–°≈ÿࡧ«∫§ÿ¡ ¡’≈—°…≥–¢âÕ¡Ÿ≈ à«π ∫ÿ§§≈ ·≈–≈—°…≥–∑“ß Ÿµ‘°√√¡ ‰¡à·µ°µà“ßÕ¬à“ß ¡’π¬— ”§—≠∑“ß ∂‘µ‘

µ“√“ß∑’Ë 1 ¢âÕ¡Ÿ≈ à«π∫ÿ§§≈¢ÕߺŸâ‡¢â“√à«¡«‘®—¢âÕ¡Ÿ≈ à«π∫ÿ§§≈

∑—ÈßÀ¡¥ (N=106) ®”π«π (√âÕ¬≈–)

°≈ÿà¡∑¥≈Õß (N=54) ®”π«π (√âÕ¬≈–)

°≈ÿࡧ«∫§ÿ¡ (N=52) ®”π«π (√âÕ¬≈–)

Õ“¬ÿ Mean ± SD✝ 23.42±6.23 23.96±5.80 22.87±6.66 √“¬‰¥â‡©≈’ˬ¢Õߧ√Õ∫§√—«/‡¥◊Õπ 8,209±5139.55 8,588 ± 4842.80 7,815.38±5447.88 Mean ± SD✝ √–¥—∫°“√»÷°…“< ¡—∏¬¡»÷°…“ 55 (51.9) 26 (48.1) 29 (55.8) Õ“™’æ ‰¡à‰¥â∑”ß“π 58 (54.7) 30 (55.6) 28 (53.8) ∂“π∑’Ë∑”ß“π ¡’ “√‡§¡’/ΩÿÉπ≈–ÕÕß 10 (9.4) 5 (9.3) 5 (9.6) ∂“π¿“æ ¡√ Õ¬Ÿà°—∫ “¡’ 101 (95.3) 52 (96.3) 49 (94.2) ®”π«π°“√µ—Èߧ√√¿å §√√¿å·√° 46 (43.4) 19 (35.2) 27 (51.9) √–¬–Àà“ߢÕß°“√µ—Èߧ√√¿å§√—Èß ÿ¥∑â“53 (50) 32 (59.3) 21 (40.4) µ—Èß·µà 2 ªï ¢÷Èπ‰ª ¡’ª√–«—µ‘°“√‡®Á∫ªÉ«2 (1.9) 2 (3.7) 0 - ÀÕ∫À◊¥ 1 (0.9) 1 (1.9) 0 - ‰∑√Õ¬¥å(hyper thyroid) 1 (0.9) 1 (1.9) 0 SD ✝ standard deviation # Fisherûs exact-test ## χ2 -test

###

P-value

0.368### 0.442### 0.698## 1.000## 0.950## 0.675# 0.446## 0.171#

Independent t-test

THAILAND JOURNAL OF HEALTH PROMOTION AND ENVIRONMENTAL HEALTH

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∫ ∑ «‘ ∑ ¬ “ ° “ √ µ“√“ß∑’Ë 2 ®”π«π·≈–√âÕ¬≈–¢ÕߺŸâ‡¢â“√à«¡«‘®—¬ ‚¥¬®”·π°µ“¡ªí®®—¬‡ ’ˬߵàÕ°“√‡®Á∫§√√¿å §≈Õ¥°àÕπ°”Àπ¥ ∑—ÈßÀ¡¥ (N=106)

¢âÕ¡Ÿ≈ à«π∫ÿ§§≈

¡’√–¥—∫°“√»÷°…“µË”°«à“ ¡—∏¬¡»÷°…“ ¡’√“¬‰¥â¢Õߧ√Õ∫§√—«‚¥¬‡©≈’Ë< 5,000 ∫“∑/‡¥◊Õπ °àÕπµ—Èߧ√√¿å¡’πÈ”Àπ—°πâÕ¬°«à“ 45°‘‚≈°√—¡ ¡’Õ“¬ÿ < 17 ªï À√◊Õ > 35 ªï ¡’°“√∑”ß“πÀπ—° ¡’¿“«–‡§√’¬¥∑—Èߥâ“π√à“ß°“¬·≈–®‘µ„® ¡’πÈ”Àπ—°≈¥ À√◊ÕπÈ”Àπ—°¢÷ÈπµË” °«à“‡°≥±å ¡’°“√µ—Èߧ√√¿å·Ω¥ ¡’ª√–«—µ‘·∑âß„π‰µ√¡“ ∑’Ë Õß ¡’°“√µ‘¥‡™◊ÈÕ·∫§∑’‡√’¬„πªí “«– ¡’‡≈◊Õ¥ÕÕ°∑“ß™àÕߧ≈Õ¥À≈—ß Õ“¬ÿ§√√¿å 12 —ª¥“Àå ¡’¿“«–´’¥ ¡’ª√–«—µ‘‡§¬§≈Õ¥°àÕπ°”Àπ¥ ¡’°“√µ‘¥‡™◊ÈÕ Bacterial vaginosis

°≈ÿࡧ«∫§ÿ¡ (N=52) ®”π«π (√âÕ¬≈–)

P-value

®”π«π (√âÕ¬≈–)

°≈ÿà¡∑¥≈Õß (N=54) ®”π«π (√âÕ¬≈–)

55 (51.9) 21 (19.8)

26 (48.1) 9 (16.7)

29 (55.8) 12 (23.1)

0.698## 0.563##

22 (20.8)

12 (22.2)

10 (19.2)

0.704##

22 (20.8) 41 (38.7) 39 (36.8) 38 (35.8)

6 (11.1) 18 (33.3) 23 (42.6) 20 (37)

16 (30.8) 23 (44.2) 16 (30.8) 18 (34.6)

0.007## 0.249## 0.207## 0.795##

3 (3.8) 7 (6.6) 6 (5.7) 5 (4.7)

2 (3.7) 4 (7.4) 4 (7.4) 3 (5.6)

1 (1.9) 3 (5.8) 2 (3.8) 2 (3.8)

1.000# 1.000# 0.679# 1.000#

5 (4.7) 7 (6.6) 1 (0.9)

3 (5.6) 2 (3.7) 1 (1.9)

2 (3.8) 5 (9.6) 0

1.000# 0.26#

ºŸâ‡¢â“√à«¡«‘®—¬ à«π„À≠à¡’ªí®®—¬‡ ’ˬߡ“°°«à“ 1 ¢âÕ # Fisherûs exact-test ## χ2 -test

µ“√“ß∑’Ë 2 º≈°“√«‘®—¬æ∫«à“ ºŸâ√à«¡«‘®—¬„π °≈ÿà¡∑¥≈Õß·≈–°≈ÿࡧ«∫§ÿ¡¡’ªí®®—¬‡ ’ˬߵàÕ°“√ ‡®Á∫§√√¿å°“√§≈Õ¥°àÕπ°”Àπ¥ ‰¡à·µ°µà“ßÕ¬à“ß

¡’π—¬ ”§—≠∑“ß ∂‘µ‘ ¬°‡«âπ ªí®®—¬‡ ’ˬ߇√◊ËÕßÕ“¬ÿ (πâÕ¬°«à“ 17 ªïÀ√◊Õ¡“°°«à“ 35 ªï)

µ“√“ß∑’Ë 3 °“√‡ª√’¬∫‡∑’¬∫Õ—µ√“°“√§≈Õ¥°àÕπ°”Àπ¥√–À«à“ß°≈ÿà¡∑¥≈Õß·≈–°≈ÿࡧ«∫§ÿ¡

§≈Õ¥°àÕπ°”Àπ¥

60

µÿ≈“§¡ - ∏—𫓧¡ 2555

°≈ÿà¡∑¥≈Õß (N=54) ®”π«π (√âÕ¬≈–)

°≈ÿࡧ«∫§ÿ¡ (N=52) ®”π«π (√âÕ¬≈–)

RR (95% CI)

5 (9.3)

7 (13.5)

0.688 ( 0.233, 2.031)

°√¡Õπ“¡—¬ à߇ √‘¡„Àâ§π‰∑¬ ÿ¢¿“楒

º≈¢Õß‚ª√·°√¡°“√‡ªìπÀÿâπ à«π∑“ß°“√欓∫“≈µàÕ°“√§≈Õ¥°àÕπ°”Àπ¥„π µ√’µ—Èߧ√√¿å∑’Ë¡’¿“«–‡ ’ˬߜ

µ“√“ß∑’Ë 3 º≈°“√«‘®—¬æ∫«à“ºŸâ√à«¡«‘®—¬„π °≈ÿà ¡ ∑¥≈Õß¡’ Õ— µ √“°“√§≈Õ¥°à Õ π°”Àπ¥πâ Õ °«à“ºŸâ√à«¡«‘®—¬„π°≈ÿࡧ«∫§ÿ¡ ·≈–‡¡◊ËÕ‡ª√’¬∫ ‡∑’¬∫Õ—µ√“°“√§≈Õ¥°àÕπ°”Àπ¥¢Õß∑—Èß Õß°≈ÿà¡

‚¥¬„™â ∂‘µ§‘ «“¡‡ ’¬Ë ß —¡æ—∑∏å (relative risk) æ∫ «à“Õ—µ√“°“√§≈Õ¥°àÕπ°”Àπ¥„π°≈ÿà¡∑¥≈Õß·≈– °≈ÿࡧ«∫§ÿ¡ ‰¡à·µ°µà“ßÕ¬à“ß¡’π—¬ ”§—≠∑“ß ∂‘µ‘ (RR = 0.668, 95% CI 0.233, 2.031)

µ“√“ß∑’Ë 4 °“√‡ª√’¬∫‡∑’¬∫Õ“¬ÿ§√√¿å‡©≈’ˬ∑’˧≈Õ¥√–À«à“ß°≈ÿà¡∑¥≈Õß·≈–°≈ÿࡧ«∫§ÿ¡ Õ“¬ÿ§√√¿å‡©≈’ˬ∑’˧≈Õ¥

Mean ± SD✝ ∑¥≈Õß

§≈Õ¥∑—ßÈ À¡¥ §≈Õ¥°àÕπ°”Àπ¥

272.37 (±11.97) 246.80 (±7.25)

Mean of Rank

MannWhitney §«∫§ÿ¡ ∑¥≈Õß §«∫§ÿ¡ U 269.1 55.57 51.35 1292 (±16.55) 238.80 7.00 6.14 15 (±21.35)

Z

P-value

-0.709

0.479

-0.407

0.755

SD✝ standard deviation

µ“√“ß∑’Ë 4 º≈°“√«‘®—¬æ∫«à“ºŸâ√à«¡«‘®—¬„π °≈ÿà¡∑¥≈Õß¡’Õ“¬ÿ§√√¿å‡©≈’ˬ∑’˧≈Õ¥ ¡“°°«à“ºŸâ √à«¡«‘®¬— „π°≈ÿ¡à §«∫§ÿ¡Õ¬à“߉¡à¡π’ ¬— ”§—≠∑“ß ∂‘µ‘ (U = 1292, Z = -0.709, P = 0.479) ·≈–‡¡◊ËÕ ‡ª√’¬∫‡∑’¬∫Õ“¬ÿ§√√¿å‡©≈’ˬ∑’˧≈Õ¥°àÕπ°”Àπ¥ ¢ÕߺŸâ√à«¡«‘®—¬∑—Èß Õß°≈ÿà¡ º≈°“√«‘®—¬æ∫«à“Õ“¬ÿ

§√√¿å‡©≈’ˬ∑’˧≈Õ¥°àÕπ°”Àπ¥¢ÕߺŸâ√à«¡«‘®—¬„π °≈ÿ¡à ∑¥≈Õß ¡“°°«à“ºŸ√â «à ¡«‘®¬— „π°≈ÿ¡à §«∫§ÿ¡ Õ¬à“ß ‰¡à¡’π—¬ ”§—≠∑“ß ∂‘µ‘ (U = 15, Z = -0.407, P = 0.755) ‚¥¬∑¥ Õ∫¥â«¬ ∂‘µ‘ Mann-Whitney U ‡π◊ËÕß®“°°“√·®°·®ß‰¡à‡ªìπ‚§âߪ°µ‘

µ“√“ß∑’Ë 5 º≈≈—æ∏å¢Õß°“√§≈Õ¥·≈–º≈≈—æ∏å¢Õß∑“√° √–À«à“ß°≈ÿà¡∑¥≈Õß·≈–°≈ÿࡧ«∫§ÿ¡

Õ“¬ÿ§√√¿å∑’˧≈Õ¥°àÕπ°”Àπ¥( —ª¥“Àå) 28-31+6 32-33+6 34-36+6 πÈ”Àπ—°∑“√°·√°‡°‘¥ (°√—¡) < 1,500 1,500- 2499 ≥2500 *§√√¿å·Ω¥ 1 √“¬ **§√√¿å·Ω¥ 2 √“¬

∑—ÈßÀ¡¥ ®”π«π (√âÕ¬≈–)

°≈ÿà¡∑¥≈Õß** ®”π«π (√âÕ¬≈–)

°≈ÿ¡à §«∫§ÿ¡* ®”π«π (√âÕ¬≈–)

2 (1.9) 3 (2.8) 7 (6.6)

0 1 (1.9) 4 (7.4)

2 (3.8) 2 (3.8) 3 (5.8)

1 (0.9) 13 (11.9) 95 (87.2)

0 5 (8.9) 51 (91.1)

1 (1.9) 8 (15.1) 44 (83)

THAILAND JOURNAL OF HEALTH PROMOTION AND ENVIRONMENTAL HEALTH

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∫ ∑ «‘ ∑ ¬ “ ° “ √ °“√Õ¿‘ª√“¬º≈ Õ—µ√“°“√§≈Õ¥°àÕπ°”Àπ¥·≈–Õ“¬ÿ§√√¿å ‡©≈’¬Ë ∑’§Ë ≈Õ¥∑’‰Ë ¡à·µ°µà“ß°—πÕ¬à“ß¡’π¬— ”§—≠ Õ“® ‡π◊Ë Õ ß¡“®“°¢â Õ ®”°— ¥ „π°“√æ— ≤ π“°“√‡ªì π Àÿâ π à « π∑“ß°“√欓∫“≈„π µ√’ µ—È ß §√√¿å ∑’Ë ¡’ ¿ “«– ‡ ’ˬߵàÕ°“√§≈Õ¥°àÕπ°”Àπ¥ ´÷ËߺŸâ«‘®—¬·≈–ºŸâ√à«¡ «‘®—¬√à«¡¡◊Õ°—π«“ß·ºπ·°â‰¢ªí≠À“ ·µàæ∫«à“ºŸâ √à«¡«‘®—¬ à«π„À≠à (30 √“¬ „π 46 √“¬) ‰¡à· ¥ß §«“¡§‘ ¥ ‡ÀÁ π „π°“√À“·π«∑“ß„π°“√·°â ‰ ¢ ªí≠À“¢Õßµπ‡Õß ·µà‡≈◊Õ°·π«∑“ß„π°“√·°â‰¢ ªí≠À“µ“¡∑’˺Ÿâ«‘®—¬‡ªìπºŸâ‡ πÕ ´÷Ëß·π«∑“ߥ—ß °≈à “ «Õ“®‡ªì π °“√·°â ‰ ¢ªí ≠ À“∑’Ë ‰ ¡à ¡’ ≈— ° …≥– ®”‡æ“–µ“¡√“¬∫ÿ§§≈ À√◊Õ¡’ªí≠À“∑’ˉ¡à “¡“√∂ ª√—∫‡ª≈’ˬπÀ√◊Õ·°â‰¢§«“¡‡ ’ˬ߉¥â ‡™àπ °√≥’ ¢ÕߺŸâ√à«¡«‘®—¬∑’Ë∑”ß“πÀπ—° ®”π«π 8 √“¬ „π 18 √“¬ ∑’ˉ¡à “¡“√∂À≈’°‡≈’ˬßÀ√◊Õª√—∫‡ª≈’ˬπ«‘∏’°“√ ∑”ß“π‰¥â Õ¥§≈âÕß°—∫ß“π«‘®¬— ∑’ºË “à π¡“´÷ßË æ∫«à“ À“° µ√’µ—Èߧ√√¿å∑’Ë¡’¿“«–‡ ’ˬߵàÕ°“√§≈Õ¥°àÕπ °”Àπ¥‰¡à “¡“√∂ª√— ∫ ‡ª≈’Ë ¬ π°“√∑”ß“πÀπ— ° À√◊Õ≈¥°“√∑”ß“πÀπ—° ®–¡’Õ—µ√“°“√§≈Õ¥°àÕπ °”Àπ¥¡“°°«à “ °≈ÿà ¡ ∑’Ë “¡“√∂ª√— ∫ ‡ª≈’Ë ¬ π°“√ ∑”ß“π‰¥â9 À√◊Õ°√≥’¢Õß°“√®—¥°“√§«“¡‡§√’¬¥ ´÷Ëß à«π„À≠à (13 √“¬ „π 23 √“¬) ‡ªìπªí≠À“ ‡°’ˬ«°—∫ —¡æ—π∏¿“æ°—∫ “¡’∑’ˉ¡à “¡“√∂·°â‰¢‰¥â ®“°ß“π«‘®—¬∑’˺à“π¡“æ∫«à“ µ√’∑’Ë¡’ªí≠À“¢—¥·¬âß ·≈–¡’ —¡æ—π∏¿“æ√–À«à“ßÀ≠‘ßµ—Èߧ√√¿å·≈– “¡’ ‰¡à¥’ ‡™àπ “¡’‰¡à‡Õ“„®„ य़·≈ À√◊Õ‰¡à™à«¬‡À≈◊Õ ‡√◊ËÕß√“¬‰¥â ®–¡’‚Õ°“ ‡°‘¥°“√§≈Õ¥°àÕπ°”Àπ¥ ¡“°°«à“ 2.5 ‡∑à“10 πÕ°®“°π’È∫“ߪí≠À“Õ“®‡°‘¥ ®“°∫ÿ§§≈¿“¬„π§√Õ∫§√—« (3 √“¬ „π 23 √“¬) ´÷Ë ß Õ“®µâ Õ ß¡’ ° “√·°â ‰ ¢∑’Ë ∫ÿ § §≈Õ◊Ë π ®–‡ÀÁ π ‰¥â «à“°“√µ‘¥µ“¡∑“ß‚∑√»—æ∑嬗ߡ’¢âÕ®”°—¥„π°“√ ª√–‡¡‘πªí≠À“·≈–°“√®—¥°“√·°â‰¢ªí≠À“„Àâ°—∫ µ√’µ—Èߧ√√¿å√“¬∫ÿ§§≈ 62

µÿ≈“§¡ - ∏—𫓧¡ 2555

°√¡Õπ“¡—¬ à߇ √‘¡„Àâ§π‰∑¬ ÿ¢¿“楒

πÕ°®“°π’ȇ¡◊ËÕæ‘®“√≥“ªí®®—¬‡ ’ˬߵàÕ°“√ §≈Õ¥°àÕπ°”Àπ¥¢Õß°≈ÿࡵ—«Õ¬à“ß æ∫«à“ºŸâ√à«¡ «‘®—¬ à«π„À≠à‡°◊Õ∫√âÕ¬≈– 80 ‡ªìπºŸâ∑’Ë¡’§«“¡ ‡ ’¬Ë ß∑’‡Ë °’¬Ë «¢âÕß°—∫‡√◊ÕË ß‡»√…∞°‘® ·≈–®‘µ —ߧ¡ ‡™àπ ¡’√–¥—∫°“√»÷°…“µË” ¡’°“√∑”ß“πÀπ—° ¡’¿“«– ‡§√’¬¥ ¡’√“¬‰¥âπâÕ¬ ¡’Õ“¬ÿπâÕ¬°«à“ 17 ªï ¡’πÈ” Àπ—°°àÕπ µ—Èߧ√√¿åπâÕ¬ ‡ªìπµâπ º≈°“√»÷°…“∑’Ë ºà“π¡“æ∫«à“ µ√’µ—Èߧ√√¿å∑’Ë¡’¿“«–‡ ’ˬß≈—°…≥– ‡¥’¬«°—ππ’È®—¥‡ªìπ°≈ÿࡇ ’ˬߵ˔ ·≈–¡’Õ—µ√“°“√ §≈Õ¥°àÕπ°”Àπ¥πâÕ¬11 „π°“√«‘®—¬§√—Èßπ’Ȭ—ßæ∫«à“ µ√’µ—Èߧ√√¿å∑’Ë §≈Õ¥°àÕπ°”Àπ¥∑’ËÕ“¬ÿ§√√¿åµ—Èß·µà 34 —ª¥“Àå ¢÷πÈ ‰ª „π°≈ÿ¡à ∑¥≈Õß¡“°°«à“°≈ÿ¡à §«∫§ÿ¡ (µ“√“ß ∑’Ë 5) ´÷Ëßµ“¡·π«∑“ß°“√¥Ÿ·≈ µ√’µ—Èߧ√√¿å¡’ ¿“«–‡®Á∫§√√¿å§≈Õ¥°àÕπ°”Àπ¥ ¡—°‰¡à¡’¬—∫¬—Èß °“√§≈Õ¥ ∑’ÕË “¬ÿ§√√¿åµß—È ·µà 34 —ª¥“Àå¢π÷È ‰ª12 ·≈– ®“°°“√µ‘¥µ“¡¢âÕ¡Ÿ≈¢Õß∑“√° æ∫«à“∑“√°∑’Ë¡’ πÈ”Àπ—°πâÕ¬°«à“ 2,500 °√—¡ „π°≈ÿà¡∑¥≈ÕßπâÕ°«à“„π°≈ÿࡧ«∫§ÿ¡ (µ“√“ß∑’Ë 5) ·≈–∑“√°∑’Ë §≈Õ¥°àÕπ°”Àπ¥„π°≈ÿà¡∑¥≈Õß∑ÿ°√“¬¡’ ÿ¢¿“æ ·¢Áß·√ߥ’ ·≈–¡’√–¬–‡«≈“∑’ËÕ¬Ÿà‚√ß欓∫“≈‰¡à‡°‘π 3 «—π „π¢≥–∑’Ë°≈ÿࡧ«∫§ÿ¡¡’∑“√°∑’˧≈Õ¥Õ“¬ÿ §√√¿åπâÕ¬°«à“ 32 —ª¥“Àå ®”π«π 2 √“¬ ·≈–¡’ ¿“«–·∑√°´âÕπ√ÿπ·√ß ∑”„Àâ¡’√–¬–‡«≈“∑’ËÕ¬Ÿà‚√ß æ¬“∫“≈‡ªìπ‡«≈“π“π (πÕπ‚√ß欓∫“≈π“π 1 ‡¥◊Õπ 1 √“¬ ·≈–Õ’° 1 √“¬ πÕπ‚√ß欓∫“≈π“π 3 ‡¥◊Õπ·≈–‡ ’¬™’«‘µ„π‡«≈“µàÕ¡“)

¢âÕ®”°—¥¢Õß°“√«‘®—„π°“√«‘®—¬§√—Èßπ’Ȭ—ß¡’¢âÕ®”°—¥∫“ߪ√–°“√ ´÷Ë߉¥â·°à 1) °“√§—¥°√Õß µ√’µ—Èߧ√√¿å∑’Ë¡’§«“¡ ‡ ’ˬߵàÕ°“√§≈Õ¥°àÕπ°”Àπ¥ ¬—߉¡à¡’°“√·∫àß √–¥— ∫ §«“¡‡ ’Ë ¬ ß„π µ√’ µ—È ß §√√¿å ∑’Ë ‡ ªì π §π‰∑Õ¬à“ß™—¥‡®π ·≈– 2) ≈—°…≥–¢ÕߺŸâ√à«¡«‘®—¬∑’Ë

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‡Õ° “√Õâ“ßÕ‘ß 1. Iams J. Prediction and early detection of preterm labor. Obstetric & Gynecology 2003 ; 101 : 402-12.

2. Khashu M, Narayanan M, Bhargava S, & Osiovich H. Perinatal outcomes associated with preterm birth at 33 to 36 weeks' gestation : A population-based cohort study. Pediatrics 2009 ; 123 : 109-13.

3. Brooten D, Youngblut J, Brown L, Finkler S, Neff D, & Madigan E. A randomized trial of nurse specialist home care for women with high-risk pregnancies: Outcomes and costs. American Journal of Manage Care 2001 ; 7 : 793-803.

4. Moutquin J. Classification and heterogeneity of preterm birth. An International Journal of Obstetric & Gynecology 2003 ; 110 : 30-33.

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∫ ∑ «‘ ∑ ¬ “ ° “ √ 6. ∂π‘¡π—π∑å ªíπ≈âÕ¡. ª√– ‘∑∏‘º≈¢Õß°“√„™â·π«∑“ߪؑ∫—µ‘∑“ߧ≈‘π‘° ”À√—∫°“√ªÑÕß°—π°“√‡°‘¥¿“«–‡®Á∫ §√√¿å§≈Õ¥°àÕπ°”Àπ¥„π µ√’¡’§√√¿å∑’Ë¡’¿“«–‡ ’Ë¬ß ≥ §≈‘π‘°Ω“°§√√¿å „πÕ”‡¿Õ·¡à –‡√’¬ß. «‘∑¬“π‘æπ∏åª√‘≠≠“欓∫“≈»“ µ√¡À“∫—≥±‘µ ( “¢“«‘™“°“√º¥ÿߧ√√¿å¢—Èπ Ÿß) ∫—≥±‘µ«‘∑¬“≈—¡À“«‘∑¬“≈—¬‡™’¬ß„À¡à ; 2551.

7. Cohen J. Statisticcal power analysis for the behavioral 2 nd ed. New Jersey : Lawrene Erlbaum associates ; 1988.

8. “¬Ωπ ™«“≈‰æ∫Ÿ≈¬å. ·π«∑“ß°“√¥Ÿ·≈√—°…“ µ√’µ—Èߧ√√¿å∑’Ë¡’¿“«–‡®Á∫§√√¿å§≈Õ¥°àÕπ°”Àπ¥. °√ÿ߇∑æœ: ¬Ÿ‡π’ˬπ §√’‡Õ™—Ëπ ®”°—¥ ; 2550.

9. Freda, M. C., Andersen, H. F., Damus, K., Poust, D., Brustman, L., & Merkatz, I. R. Lifestyle modification as an intervention for inner city women at high risk for preterm birth.

Journal of Advanced Nursing 1990 ; 15 : 364-72.3 10. Ghosh, J. K., Wilhelm, M. H., Dunkel-Schetter, C., Lombardi, C. A., & Ritz, B. R. Paternal support and preterm birth, and the moderation of effects of chronic stress: a study in Los Angeles County mothers. Arch Womens Ment Health 2010 ; 13 : 327-38.

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