万州区3~36个月发育预警征阳性儿童早期干预模式对比研究——家庭结合医疗机构干预模式最优的循证分析

Comparative Study on Early Intervention Models for Children Aged 3~36 Months with Positive Developmental Warning Signs in Wanzhou District—Evidence for the Optimality of Family-Healthcare Institution Combined Intervention

摘要: 本研究旨在对比万州区3~36个月发育预警征阳性儿童中“家庭干预”“医疗机构干预”“家庭结合医疗机构干预”三种模式的效果，明确最优干预模式。共纳入178例儿童(家庭干预组33例、医疗机构组80例、结合组65例)，干预12个月，采用盖塞尔发育量表(GESELL)于基线、3/6/9/12个月评估认知、语言、社交及运动发育，通过描述性统计、方差分析及回归分析数据。结果显示：(1) 结合组GESELL评分提升最显著(认知 + 18.2、语言 + 15.6、社交 + 16.3、运动 + 14.7)，医疗机构组次之(认知 + 12.5、语言 + 10.8、社交 + 11.2、运动 + 9.9)，家庭组最差(认知 + 7.3、语言 + 6.1、社交 + 6.5、运动 + 5.8)；(2) 结合组家长依从性最高(89%)、脱落率最低(8%)，家庭组依从性最低(52%)、脱落率最高(30%)；(3) 家庭因素(家长教育、时间、知识)与模式特征(专业性、灵活性)是干预效果的关键影响因素。结论：家庭结合医疗机构干预模式效果最优，纯医疗机构干预次之，纯家庭干预最差。本研究为发育预警征阳性儿童早期干预策略优化提供循证依据。

Abstract: This study aims to compare the effects of three early intervention models—family intervention, healthcare institution intervention, and family-healthcare institution combined intervention—on children aged 3~36 months with positive developmental warning signs in Wanzhou District, and to identify the optimal model. A total of 178 children (33 in family intervention, 80 in healthcare institution intervention, 65 in combined intervention) were enrolled and followed up for 12 months. The Gesell Developmental Schedules (GESELL) was used to assess cognitive, language, social, and motor development at baseline, 3 months, 6 months, 9 months, and 12 months. Data were analyzed using descriptive statistics, analysis of variance (ANOVA), and regression analysis. Results showed that: (1) The combined intervention group had the highest improvement in GESELL scores (cognitive: +18.2, language: +15.6, social: +16.3, motor: +14.7), followed by the healthcare institution group (cognitive: +12.5, language: +10.8, social: +11.2, motor: +9.9), and the family group had the least improvement (cognitive: +7.3, language: +6.1, social: +6.5, motor: +5.8). (2) The combined model had the highest parent compliance rate (89%) and the lowest dropout rate (8%), while the family model had the lowest compliance (52%) and highest dropout rate (30%). (3) Family factors (parent education, time, knowledge) and model characteristics (professionalism, flexibility) were key factors influencing intervention effects. Conclusion: The family-healthcare institution combined intervention model is the most effective, followed by the healthcare institution model, and the family model is the least effective. This study provides evidence for optimizing early intervention strategies for children with developmental warning signs.