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Article(id=1325531073287053552, tenantId=1146029695717560320, journalId=1256213402557890569, issueId=1325530655635039055, articleNumber=null, orderNo=null, doi=10.16835/j.cnki.1000-9817.2025300, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1750694400000, receivedDateStr=2025-06-24, revisedDate=1754496000000, revisedDateStr=2025-08-07, acceptedDate=null, acceptedDateStr=null, onlineDate=1793960835047, onlineDateStr=2026-11-06, pubDate=1761321600000, pubDateStr=2025-10-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793960835047, onlineIssueDateStr=2026-11-06, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793960835047, creator=13701087609, updateTime=1793960835047, updator=13701087609, issue=Issue{id=1325530655635039055, tenantId=1146029695717560320, journalId=1256213402557890569, year='2025', volume='46', issue='10', pageStart='1369', pageEnd='1520', issueExtLink='null', onlineDate='null', pubDate='1761321600000', pubDateStr='2025-10-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793960735472, creator='13701087609', updateTime=1793960735472, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=1406, endPage=1410, ext={EN=ArticleExt(id=1325531078324412657, articleId=1325531073287053552, tenantId=1146029695717560320, journalId=1256213402557890569, language=EN, title=Intervention effect of building social networks with medical backgrounds on college students' knowledge, attitudes, and practices in the HIV prevention and treatment, columnId=1259565859148804482, journalTitle=Chinese Journal of School Health, columnName=Health Education and Promotion, runingTitle=null, highlight=null, articleAbstract=
Objective

To evaluate the structural communication advantages of peers with medical background in social networks and their intervention effects on college students' knowledge, attitudes, and practices (KAP) levels in the prevention and control of human immunodeficiency virus (HIV), so as to provide theoretical support and practical pathways for structured health communication.

Methods

From April to June in 2025, 367 undergraduates were selected by stratified cluster random sampling in Nankai University. A multimodal strategy was employed to construct students' social networks. Fifty peer nodes were selected through a four-step screening process: betweenness centrality ≥0.3, eigenvector centrality ≥P90, serving as student leader for at least one year, being mentioned ≥2 times in classroom interactions and information exchanges, with a total of five rounds, each lasting five days. Peer leaders daily pushed five Micromessage (knowledge points, interactive topics, or videos) through WeChat/QQ groups. KAP scale scores for AIDS prevention and treatment were measured before and after the intervention, and intervention effectiveness and predictive factors were analyzed using paired t-tests and Logistic regression analysis.

Results

After the intervention, the total KAP score for AIDS prevention and treatment increased from (65.86±6.58) to (71.27±4.90) (t=-12.84, P < 0.01). The intermediary centrality (0.51±0.09) in the medical group was significantly higher than the non-medical group (0.34±0.12) (t=3.18, P < 0.01), with an average daily peak transmission rate of 8.71 people, and the network modularity increased from 0.39 to 0.47 (ΔQ=0.09, P < 0.01). The interaction between structural advantages and medical background significantly predicted KAP improvement (OR=4.21, 95%CI=1.89-9.38, P < 0.05).

Conclusions

Professional peers have significant structural communication advantages in HIV prevention and treatment interventions in colleges and universities. It is recommended to optimize sub-node screening strategies by combining network structure and professional background.

, authors=Jing XIANG1, Tao LIU2, Hui TAO*, 3, authorsList=Jing XIANG, Tao LIU, Hui TAO, authorCompany=null, correspAuthors=Hui TAO, authorNote=null, correspAuthorsNote=null, copyrightStatement=Copyright ©2025 Chinese Journal of School Health. All rights reserved., copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1325531088814366964, articleId=1325531073287053552, tenantId=1146029695717560320, journalId=1256213402557890569, language=CN, title=医学背景社交网络构建对大学生HIV防治知信行干预效果, columnId=1259565859903779205, journalTitle=中国学校卫生, columnName=健康教育与健康促进, runingTitle=null, highlight=null, articleAbstract=
目的

评估高校人类免疫缺陷病毒(HIV)防控中具备医学背景的同伴在社交网络中的结构传播优势及其对大学生知识-态度-实践(KAP)水平的干预效果, 为结构化健康传播提供理论支撑与实践路径。

方法

2025年4—6月在南开大学采用分层整群随机抽样方法选取367名本科生。采用多模态策略构建学生社交网络, 并以中介中心性≥0.3、特征向量中心性≥P90、担任学生干部≥1年、在课堂或信息互动中被提及≥2次的标准筛选50名同伴节点实施共5轮、每轮5 d的干预, 同伴领袖每日通过微信/QQ群推送5次微信息(知识点、互动话题或视频), 干预前后测量艾滋病防治KAP量表得分, 采用配对t检验和Logistic回归分析干预成效与预测因子。

结果

干预后艾滋病防治KAP总得分由(65.86±6.58)分提升至(71.27±4.90)分, 差异有统计学意义(t=-12.84, P < 0.01)。医学组中介中心性高于非医学组[(0.51±0.09) (0.34±0.12), t = 3.18, P<0.01], 平均每天传播速率峰值达8.71人, 网络模块度由0.39提升至0.47(ΔQ=0.09, P < 0.01)。结构优势与医学背景交互作用显著预测KAP改善(OR=4.21, 95%CI=1.89~9.38, P < 0.05)。

结论

专业同伴在高校HIV防治干预中具有显著结构传播优势, 建议结合网络结构和专业背景优化种子节点筛选策略。

, authors=项晶1, 刘涛2, 陶慧*, 3, authorsList=项晶, 刘涛, 陶慧, authorCompany=null, correspAuthors=陶慧, authorNote=

项晶(1983-), 女, 湖北黄冈人, 硕士, 主治医师, 主要从事妇科生殖内分泌疾病临床管理、性与生殖健康服务策略与健康促进工作

, correspAuthorsNote=
陶慧，E-mail:
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JMIR Hum Factors, 2022, 9(3): e32330., articleTitle=null, refAbstract=null)], funds=[Fund(id=1325531128706392348, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325531073287053552, awardId=null, language=CN, fundingSource=天津市性病艾滋病防治协会《2025年青年学生青春健康项目》(TJXAX202501);教育部人文社会科学基金青年项目(19YJC840030), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1325531092207558901, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325531073287053552, xref=1, ext=[AuthorCompanyExt(id=1325531093071585526, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325531073287053552, companyId=1325531092207558901, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1Department of Obstetrics and Gynecology, Nankai University Hospital, Tianjin 300191, China), AuthorCompanyExt(id=1325531093436489975, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325531073287053552, companyId=1325531092207558901, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1南开大学医院妇产科, 天津 300191)]), AuthorCompany(id=1325531093847531768, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325531073287053552, xref=2, ext=[AuthorCompanyExt(id=1325531093889474809, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325531073287053552, companyId=1325531093847531768, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2南开大学医院预防科)]), AuthorCompany(id=1325531094308905210, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325531073287053552, xref=3, ext=[AuthorCompanyExt(id=1325531094346653947, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325531073287053552, companyId=1325531094308905210, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3南开大学医院眼耳鼻喉科)])], figs=[ArticleFig(id=1325531117423714582, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325531073287053552, language=EN, label=Fig.1, caption=S-curve fitting of HIV information diffusion during the intervention and its evolutionary stages, figureFileSmall=bxeY9tgvLed8AMi7VsXDQw==, figureFileBig=H17Xrs5HsvqwbjGOsYivCg==, tableContent=null), ArticleFig(id=1325531118182883607, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325531073287053552, language=CN, label=图1, caption=干预期间高校HIV信息传播的拟合趋势及演化阶段划分

注：圆点为观测值，黑实线为拟合曲线。

, figureFileSmall=bxeY9tgvLed8AMi7VsXDQw==, figureFileBig=H17Xrs5HsvqwbjGOsYivCg==, tableContent=null), ArticleFig(id=1325531122888892696, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325531073287053552, language=EN, label=Tab.1, caption=

Comparison of KAP level of HIV prevention and treatment among different groups of college students

, figureFileSmall=null, figureFileBig=null, tableContent=
组别选项人数低中高χ2值Cramer's V值
性别女1814(2.2)71(39.2)106(58.6)23.06*0.25
男18621(11.3)96(51.6)69(37.1)
年龄/岁18~2016110(6.2)73(45.3)78(48.4)6.710.10
21~231236(4.9)51(41.5)66(53.7)
24~26839(10.8)43(51.8)31(37.3)
年级大一936(6.5)45(48.4)42(45.2)3.370.07
大二917(7.7)44(48.4)40(44.0)
大三957(7.4)36(37.9)52(54.7)
大四885(5.7)42(47.7)41(46.6)
专业医学78010(12.8)68(87.2)65.45*0.42
非医学28925(8.7)157(54.3)107(37.0)
月消费水平/元< 1 0008313(15.7)42(50.6)28(33.7)29.70*0.28
1 000~2 0001066(5.7)59(55.7)41(38.7)
2 001~3 000882(2.3)31(35.2)55(62.5)
>3 000904(4.4)35(38.9)51(56.7)
班干部否17814(7.9)79(44.4)85(47.8)0.660.04
是18911(5.8)88(46.6)90(47.6)
Cb中心度分组低20517(8.3)92(44.9)96(46.8)1.610.07
高1628(4.9)75(46.3)79(48.8)
标注次数分组/次0~117112(7.0)73(42.7)86(50.3)1.030.05
≥219613(6.6)94(48.0)89(45.4)
合计36725(6.8)167(45.5)175(47.7)
), ArticleFig(id=1325531124906352921, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325531073287053552, language=CN, label=表1, caption=

不同组别大学生艾滋病防治KAP水平分布比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别选项人数低中高χ2值Cramer's V值
性别女1814(2.2)71(39.2)106(58.6)23.06*0.25
男18621(11.3)96(51.6)69(37.1)
年龄/岁18~2016110(6.2)73(45.3)78(48.4)6.710.10
21~231236(4.9)51(41.5)66(53.7)
24~26839(10.8)43(51.8)31(37.3)
年级大一936(6.5)45(48.4)42(45.2)3.370.07
大二917(7.7)44(48.4)40(44.0)
大三957(7.4)36(37.9)52(54.7)
大四885(5.7)42(47.7)41(46.6)
专业医学78010(12.8)68(87.2)65.45*0.42
非医学28925(8.7)157(54.3)107(37.0)
月消费水平/元< 1 0008313(15.7)42(50.6)28(33.7)29.70*0.28
1 000~2 0001066(5.7)59(55.7)41(38.7)
2 001~3 000882(2.3)31(35.2)55(62.5)
>3 000904(4.4)35(38.9)51(56.7)
班干部否17814(7.9)79(44.4)85(47.8)0.660.04
是18911(5.8)88(46.6)90(47.6)
Cb中心度分组低20517(8.3)92(44.9)96(46.8)1.610.07
高1628(4.9)75(46.3)79(48.8)
标注次数分组/次0~117112(7.0)73(42.7)86(50.3)1.030.05
≥219613(6.6)94(48.0)89(45.4)
合计36725(6.8)167(45.5)175(47.7)
), ArticleFig(id=1325531125384503578, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325531073287053552, language=EN, label=Tab.2, caption=

Binary Logistic regression analysis of factors associated with KAP improvement in HIV/AIDS prevention and treatment among college students (n=367)

, figureFileSmall=null, figureFileBig=null, tableContent=
自变量选项B值标准误Z值P值OR值(95%CI)
性别男-0.110.23-0.500.620.89(0.57~1.39)
月消费水平/元2 001~3 0000.040.330.110.911.04(0.54~1.99)
< 1 0000.200.330.620.541.22(0.64~2.33)
>3 0000.140.320.450.661.15(0.62~2.15)
专业医学0.310.320.980.331.37(0.73~2.56)
结构优势节点Cb≥0.3且被提名≥2次1.100.293.83< 0.013.00(1.71~5.27)
交互作用结构优势×医学专业0.470.670.70< 0.014.21(1.89~9.38)
), ArticleFig(id=1325531127578124571, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325531073287053552, language=CN, label=表2, caption=

大学生艾滋病防治KAP改善预测因子的二元Logistic回归模型(n=367)

, figureFileSmall=null, figureFileBig=null, tableContent=
自变量选项B值标准误Z值P值OR值(95%CI)
性别男-0.110.23-0.500.620.89(0.57~1.39)
月消费水平/元2 001~3 0000.040.330.110.911.04(0.54~1.99)
< 1 0000.200.330.620.541.22(0.64~2.33)
>3 0000.140.320.450.661.15(0.62~2.15)
专业医学0.310.320.980.331.37(0.73~2.56)
结构优势节点Cb≥0.3且被提名≥2次1.100.293.83< 0.013.00(1.71~5.27)
交互作用结构优势×医学专业0.470.670.70< 0.014.21(1.89~9.38)
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医学背景社交网络构建对大学生HIV防治知信行干预效果
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项晶 1 , 刘涛 2 , 陶慧 *, 3
中国学校卫生 | 健康教育与健康促进 2025,46(10): 1406-1410
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中国学校卫生 |健康教育与健康促进 2025 , 46 (10) : 1406 -1410
医学背景社交网络构建对大学生HIV防治知信行干预效果
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项晶1, 刘涛2, 陶慧*, 3
作者信息
  • 1南开大学医院妇产科, 天津 300191
  • 2南开大学医院预防科
  • 3南开大学医院眼耳鼻喉科
通讯作者:
陶慧，E-mail:
作者简介:

项晶(1983-), 女, 湖北黄冈人, 硕士, 主治医师, 主要从事妇科生殖内分泌疾病临床管理、性与生殖健康服务策略与健康促进工作

Intervention effect of building social networks with medical backgrounds on college students' knowledge, attitudes, and practices in the HIV prevention and treatment
Jing XIANG1, Tao LIU2, Hui TAO*, 3
Affiliations
  • 1Department of Obstetrics and Gynecology, Nankai University Hospital, Tianjin 300191, China
出版时间: 2025-10-25 doi: 10.16835/j.cnki.1000-9817.2025300
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摘要
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目的

评估高校人类免疫缺陷病毒(HIV)防控中具备医学背景的同伴在社交网络中的结构传播优势及其对大学生知识-态度-实践(KAP)水平的干预效果, 为结构化健康传播提供理论支撑与实践路径。

方法

2025年4—6月在南开大学采用分层整群随机抽样方法选取367名本科生。采用多模态策略构建学生社交网络, 并以中介中心性≥0.3、特征向量中心性≥P90、担任学生干部≥1年、在课堂或信息互动中被提及≥2次的标准筛选50名同伴节点实施共5轮、每轮5 d的干预, 同伴领袖每日通过微信/QQ群推送5次微信息(知识点、互动话题或视频), 干预前后测量艾滋病防治KAP量表得分, 采用配对t检验和Logistic回归分析干预成效与预测因子。

结果

干预后艾滋病防治KAP总得分由(65.86±6.58)分提升至(71.27±4.90)分, 差异有统计学意义(t=-12.84, P < 0.01)。医学组中介中心性高于非医学组[(0.51±0.09) (0.34±0.12), t = 3.18, P<0.01], 平均每天传播速率峰值达8.71人, 网络模块度由0.39提升至0.47(ΔQ=0.09, P < 0.01)。结构优势与医学背景交互作用显著预测KAP改善(OR=4.21, 95%CI=1.89~9.38, P < 0.05)。

结论

专业同伴在高校HIV防治干预中具有显著结构传播优势, 建议结合网络结构和专业背景优化种子节点筛选策略。

人免疫缺陷病毒蛋白质类  /  健康知识, 态度, 实践  /  干预性研究  /  回归分析  /  学生
Objective

To evaluate the structural communication advantages of peers with medical background in social networks and their intervention effects on college students' knowledge, attitudes, and practices (KAP) levels in the prevention and control of human immunodeficiency virus (HIV), so as to provide theoretical support and practical pathways for structured health communication.

Methods

From April to June in 2025, 367 undergraduates were selected by stratified cluster random sampling in Nankai University. A multimodal strategy was employed to construct students' social networks. Fifty peer nodes were selected through a four-step screening process: betweenness centrality ≥0.3, eigenvector centrality ≥P90, serving as student leader for at least one year, being mentioned ≥2 times in classroom interactions and information exchanges, with a total of five rounds, each lasting five days. Peer leaders daily pushed five Micromessage (knowledge points, interactive topics, or videos) through WeChat/QQ groups. KAP scale scores for AIDS prevention and treatment were measured before and after the intervention, and intervention effectiveness and predictive factors were analyzed using paired t-tests and Logistic regression analysis.

Results

After the intervention, the total KAP score for AIDS prevention and treatment increased from (65.86±6.58) to (71.27±4.90) (t=-12.84, P < 0.01). The intermediary centrality (0.51±0.09) in the medical group was significantly higher than the non-medical group (0.34±0.12) (t=3.18, P < 0.01), with an average daily peak transmission rate of 8.71 people, and the network modularity increased from 0.39 to 0.47 (ΔQ=0.09, P < 0.01). The interaction between structural advantages and medical background significantly predicted KAP improvement (OR=4.21, 95%CI=1.89-9.38, P < 0.05).

Conclusions

Professional peers have significant structural communication advantages in HIV prevention and treatment interventions in colleges and universities. It is recommended to optimize sub-node screening strategies by combining network structure and professional background.

Human immunodeficiency virus proteins  /  Health knowledge, attitudes, practice  /  Intervention studies  /  Regression analysis  /  Students
项晶, 刘涛, 陶慧. 医学背景社交网络构建对大学生HIV防治知信行干预效果. 中国学校卫生, 2025 , 46 (10) : 1406 -1410 . DOI: 10.16835/j.cnki.1000-9817.2025300
Jing XIANG, Tao LIU, Hui TAO. Intervention effect of building social networks with medical backgrounds on college students' knowledge, attitudes, and practices in the HIV prevention and treatment[J]. Chinese Journal of School Health, 2025 , 46 (10) : 1406 -1410 . DOI: 10.16835/j.cnki.1000-9817.2025300
正文
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15~24岁人群处于性行为模式初建期，人类免疫缺陷病毒(human immunodeficiency virus, HIV)感染风险较高。联合国数据显示，该年龄段HIV感染者占全球感染者总数的34%，为新增感染主力[1]；我国2010—2019年报告数增长了68.4%[2]。尽管高校健康教育工作不断推进，但HIV认知与相关行为脱节问题仍显著。如某高校调查显示，HIV传播知晓率达87.3%，但42.1%的学生半年内发生过无保护性行为[3]，反映出传统知识主导干预在行为转化中的结构性瓶颈[4]。
社会网络理论为健康干预提供了结构路径视角。研究表明，个体在网络中的位置决定其信息获取与模仿行为[5-6]，高中心性节点有助于信息高效扩散，已广泛用于干预传播者筛选[7]。然而，高校社群中常见“结构优势者知识薄弱”与“专业个体连接有限”的错配问题，导致干预信源效能受限。为突破上述局限，本文提出“结构中心性×医学背景”双因子耦合干预框架，探讨其在高校HIV防控中的传播与行为转化作用机制，并基于自然实验进行实证评估，为结构化健康传播提供理论支撑与实践路径。
1　对象与方法
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1.1　对象
于2025年4—6月在南开大学实施研究，前期开展量表开发与预实验(n=96)。纳入标准为18~26岁全日制本科生，简易精神状态量表(Mini-Mental State Examination，MMSE)得分≥27[8]。排除精神障碍、重大躯体疾病及干预期离校＞30 d者。采用分层整群随机抽样方法，以院系—班级为抽样框，按照年级与性别进行比例分层，将大一、大二合并为低年级，大三、大四合并为高年级，共划分为四个分层单元：低年级男、女生，高年级男、女生。在每个分层中，根据各院系学生数量占比确定样本配额，采用随机数字表法抽取班级，每个被抽中的班级作为整体纳入调查；若出现班级整体缺席或人数不足的情况，则启用预先设定的同层替补班级。共回收396份基线问卷，最终获得367份有效配对样本(有效率为92.7%)。其中男生186名，女生181名；医学专业78名，非医学专业289名；平均年龄(21.1±2.7)岁。调查方案经南开大学生物医学伦理委员会审批(批号：NKU-IRB-2025104)，所有参与者均签署电子知情同意书。
1.2　方法
1.2.1　一般人口学资料
通过基线问卷自报获得，包括性别、年级、消费水平及班干部情况。
1.2.2　知识-态度-实践(knowledge, attitudes, practices, KAP)量表构建与信效度检验
研究基于KAP理论构建结构化量表，条目参考国内外成熟工具[3, 9-10]，引入Tourangeau认知模型[11]优化语义，经3轮认知访谈(n=24)及2名具有10年以上艾滋病防控研究经验的专家逐条审阅，确保语言适配性与专业性。量表共设20题，分为知识(7题)、态度(7题)、行为(6题)3个维度，每题采用Likert 5级评分，按1~5分赋值，总分20~100分，维度评分越高表示认知辨析能力、情境态度反应与行为自主性的水平越高。KAP水平划分采用“语义锚点+标准测量误差校准(standard error of measurement, SEM)”方法，以单题中性值3分(总分60)为中位锚，根据信度(α=0.81)与SEM得分置信带，划定等级区间[12]，并定义低水平(≤55分)、中等水平(56~65分)、高水平(≥66分)。信效度检验基于预试验样本完成。探索性因子分析支持三因子结构(累计方差解释率62.4%)，验证性分析模型拟合良好(χ2/df=1.92，比较拟合指数=0.93，近似误差均方根=0.06)；组合信度=0.85，平均方差提取量=0.52，Cronbach α系数为0.81，重测信度为0.79，提示量表信、效度良好。
1.2.3　社交网络构建
采用多模态策略构建学生社交网络：自评部分以限定提名方式收集学业合作(3人)、日常互动(5人)与信息传播对象(2人)；客观行为观察由10名经过一致性校准的观察员执行3轮非连续课堂记录，记录内容经OpenCV工具库模糊化处理以保护隐私。问卷与观察数据融合采用熵值法设定权重(问卷∶观察=0.6∶0.4)，生成加权无向邻接矩阵。为后续建模，使用时序指数随机图模型分析结构演化趋势，并据结构嵌入度设定核心节点筛选标准[13]：(1)中介中心性(betweenness centrality，Cb)≥0.3；(2)特征向量中心性(eigenvector centrality，Ce)≥P90；(3)担任学生干部≥1年；(4)在课堂或信息互动中被提及≥2次。最终依据上述标准筛选出50名同伴节点，用于后续干预实施。
1.2.4　干预流程
1.2.4干预流程依据能力—机会—动机—行为模型理论[14]，2025年5月9—29日，设计“5-5-5”轻量化干预：共5轮，每轮5 d，同伴领袖每日通过微信/QQ群推送5次微信息(知识点、互动话题或视频)，并记录反馈与扩散。干预流程：(1)心理能力建设，引入联合国艾滋病规划署动画[15]与互动问答提升认知；(2)反思性动机激发，运用“思考-配对-分享”[16]组织讨论与代表发言；(3)物理机会创设，发放附二维码“荧光卡”，扫码进入互动页面，系统自动追踪扩散路径与层级。参与者在任意一轮中完成全部每日信息接收与反馈，即视为“接受1次干预”。
1.3　统计学分析
纳入完成基线评估且接受至少1次干预者，统计分析使用SPSS 26.0与R 4.2.1软件。正态性检验采用Shapiro-Wilk法，符合正态的计量数据两组间比较采用配对样本t检验，非正态用Wilcoxon符号秩检验；分类变量比较采用χ2检验并报告Cramer's V。干预效应以Cohen's d衡量，Cohen's d值范围0.20~ < 0.50为小效应，0.50~ < 0.80为中等效应，≥0.8为高效应[17]。网络分析基于1.3节所构建的加权无向邻接矩阵，使用TERGM建模演化趋势[18]；信息扩散以Logistic函数拟合累计覆盖人数[19]，参数通过非线性最小二乘法估计，拟合优度以R2表示。为控制医学组占比偏低所致偏倚，构建岭回归模型[20](λ经十折交叉验证确定)，纳入标准化的结构中心性、医学背景及其交互项，以检验专业二分类的统计合理性，据此开展Logistic回归分析其对KAP改善的预测机制。检验水准α=0.05。
2　结果
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2.1　岭回归分析与分组变量确定
基于367份样本构建岭回归模型，纳入医学背景、结构优势节点及其交互项作为自变量。引入岭回归(λ=1.74，经十折交叉验证确定)控制医学组比例偏倚，并对所有变量进行标准化处理。结果显示，结构优势(OR=3.00，95%CI=1.71~5.27)、医学背景(OR=1.10，95%CI=1.04~1.16)及其交互项(OR=4.21，95%CI=1.89~9.38)均为KAP改善的正向预测因子(P值均 < 0.01)。据此，后续干预成效分析以“是否为医学专业”作为主分组变量，强调结构与专业的耦合效应。
2.2　被试学生基线艾滋病防治KAP水平
艾滋病防治KAP基线水平整体较高，其中中高水平占93.2%，低水平占6.8%。不同性别、专业与月消费水平学生KAP水平分布差异均有统计学意义(P值均 < 0.01)；女性高KAP比例为58.6%，高于男性的37.1%(Cramer's V=0.25)；医学组高KAP占比达87.2%，非医学组仅为29.2%(Cramer's V=0.42)；高月消费水平组亦优于低月消费水平组(Cramer's V=0.28)。见表1。
干预前，节点Cb与被提名次数和KAP水平相关性均无统计学意义(r值分别为0.08，0.06，P值均>0.05)，提示结构传播潜力尚未被激活，需依赖干预过程引导其实现行为转化。为保障网络数据的客观性，10名观察员经一致性校准，评分一致性良好(ICC=0.81)[21]。融合问卷与行为观测生成的社交网络结构经QAP检验有统计学意义(P < 0.01)，说明其连接模式非随机，具备开展结构传播分析的基础。此外，进一步比较显示，医学专业同伴的Cb(0.51±0.09)高于非医学组(0.34±0.12)(t=3.18，P < 0.01)，提示其在干预传播网络中占据更强的结构通达位置，具备天然的传播枢纽潜力。
2.3　大学生艾滋病防治KAP干预效能检验
干预后，学生KAP总得分由(65.86±6.58)分提升至(71.27±4.90)分(t=-12.84，P < 0.01)，Cohen's d=0.94(95%CI=0.76~1.06)，为中高强度干预效果。干预前知识、态度、行为得分分别为(23.22±3.32)(22.83±3.12)(19.81±3.11)分，干预后分别为(25.13±2.78)(24.89±2.85)(21.25±2.59)分，差异均有统计学意义(t值分别为-8.82，-9.35，-6.88，P值均 < 0.01)。3个维度中，态度改善最优，改善率为9.0%；知识提升8.2%，行为提升7.3%。73.3%(269名)的学生得分提升超过5分，15.5%(57名)超过10分；根据配对分析结果显示，医学组KAP总分由(67.3±6.1)分提升至(73.5±4.7)分，非医学组由(65.2±6.8)分提升至(70.6±4.9)分，组间改善幅度差异有统计学意义(t=2.13，P=0.03)。
干预传播历经潜伏(第1~2轮)、快速扩散(第3轮)、饱和(第4~5轮)3个阶段。第3轮传播速率达峰值(每天8.71人)，81.3%新增覆盖由核心节点推动，累计覆盖率达73.8%。Logistic回归模型拟合结果显示，传播过程呈典型的S型累积趋势(R2=0.96)，符合分阶段扩散的动力学特征。见图1。
网络结构随传播同步演化，模块度由0.39升至0.47(ΔQ=0.09，P < 0.01)，平均度中心性由2.10增至3.40(t=5.62，P < 0.01)，显示网络由松散趋于凝聚，信息流转效率显著增强。核心节点的触达效率为普通节点2.89倍(95%CI=1.94~4.31)，具有明显乘数效应。以“KAP是否显著改善”(0=未显著改善，1=显著改善)为因变量进行Logistic回归分析，结果显示，结构优势提高了KAP改善概率(OR=3.00)，其与医学背景的交互项具有显著增强效应(OR=4.21)(P值均 < 0.01)。见表2。模型无明显共线性(VIF < 1.05)，拟合良好(McFadden R2=0.45，Hosmer-Lemeshow P=0.59)，具较强解释力。
3　讨论
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本研究聚焦高校人群HIV防治的关键传播机制，系统验证了同伴领袖的网络结构位置与专业背景对干预成效的协同作用。通过将结构化干预策略嵌入学生日常社交网络，构建并实证检验了由高可信度信源驱动的去中心化传播模型，有效提升了目标人群的KAP水平，并揭示出传播路径、认知通道与结构属性相互耦合的多层次机制，为优化高校健康教育体系提供了理论与实践双重支撑。
干预效果呈现出阶段性路径：态度优先、主观规范提升、行为意图激活，与计划行为理论描述的“认知—态度—行为”的结构一致[22]。近期实证研究亦显示[23]，通过强化态度和主观规范，可有效提高健康行为意图与实际行为采纳率。本研究所采用的网络干预机制，显著激活了计划行为理论模型中“主观规范”路径的影响力，通过增强群体规范感知，提升了社会驱动型行为意图的生成[24]，为理解社交网络中健康行为改变的心理机制提供了经验支持。
医学专业背景的同伴领袖在传播网络中占据显著的结构中心位置，表现出更强的通达性与影响力。这一结构优势不仅体现了中介中心性在信息扩散中的枢纽作用，也从“信任中介”的角度印证了社会认知理论中的模仿学习机制[25]。具备专业知识背景的关键节点更易被视为可信参照，其解释权与示范性可增强信息认同度，促进采纳与行为转化，与既有关于健康信息信源匹配性的研究结论一致[26]。
社交网络在干预期间的结构演化亦呈现出系统性跃迁特征。网络聚合度、连接紧密度及传播速率均在干预中期达到高峰，信息扩散轨迹呈现S型增长，符合创新扩散理论中“临界阈值激活”的动力学机制[27]。提示信息传播并非持续匀速，而是在网络结构聚合至临界点后发生加速转变。因此，干预策略应注重关键节点的识别与激活，以推动传播跨越扩散阈值。
尽管如此，结构可达性本身并不直接转化为行为改善。非医学背景学生虽在网络中广泛分布，但其KAP改善程度显著滞后于医学组，提示信息来源的背景属性、内容适配性与话语权对行为转化具有决定性影响，结果与近年来健康赋权研究中“信源—感知—采纳”路径的关键节点一致[28]。
此外，性别维度亦呈现出结构性偏倚。尽管女性的KAP水平总体优于男性，但核心传播节点中男性占比较高，呈现出“男性为信息主导者，女性为行为响应者”的结构错位格局。该现象可能导致女性群体的信息可达性下降，削弱干预的覆盖广度与公平性。已有干预研究指出[29]，忽视社交网络中的性别结构不对称，可能固化信息流通中的权力差异，进而影响干预效应。因此，后续传播设计应引入性别包容机制，以减缓结构性不均衡所带来的负面效应。
基于上述机制发现，建议高校艾滋病防控干预实现以下三重范式转型：(1)传播路径由“教师灌输”转向“同伴嵌入”，依托结构优势节点构建去中心化传播模型；(2)干预内容由知识导向拓展为“情境建模—态度塑造—行为引导”的复合式表达；(3)评估机制由静态量表过渡为动态网络行为追踪，纳入结构指标与行为反馈双重视角。建立分层传播骨干体系，提升校园健康教育的精准性与可持续性。未来研究可进一步探索线上社交平台与线下平台的融合传播路径，构建跨平台传播闭环，推动青年群体公共卫生干预的结构性与行为性协同演化。
基金
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  • 天津市性病艾滋病防治协会《2025年青年学生青春健康项目》(TJXAX202501);教育部人文社会科学基金青年项目(19YJC840030)
文献
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2025年第46卷第10期
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doi: 10.16835/j.cnki.1000-9817.2025300
  • 接收时间：2025-06-24
  • 首发时间：2026-11-06
  • 出版时间：2025-10-25
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  • 收稿日期：2025-06-24
  • 修回日期：2025-08-07
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天津市性病艾滋病防治协会《2025年青年学生青春健康项目》(TJXAX202501);教育部人文社会科学基金青年项目(19YJC840030)
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    1南开大学医院妇产科, 天津 300191
    2南开大学医院预防科
    3南开大学医院眼耳鼻喉科

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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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