Virginia Li, PhD, MPH Professor, UCLA School of Public Health, Department of Community Health Sciences November 14, 2006

1. Bridging the Urban-Rural
Continuum to Improve
Services in Rural China
Virginia C. Li, PhD, MPH,
Professor of Community Health Sciences
UCLA 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

5. Specific Objectives
1. 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.

6. to rural health professionals and the other target
groups.
服务提供者
Website
Village Doctors/ Teachers/ Women’s Cadres
Villagers/ Students

7. Figure 2. Website Development, Implementation, and
Evaluation.
Web
Design tree diagram
Domain application obtain hardware Install software
Upload web pages Pretest & modification
BaselineSurvey
Site Selection Survey design Identify subject
Identify core areas
Identify central
messages
Develop
questionnaires
Finalize
pretest Qs
Training
interviewers
Field implementation Analysis
Survey organization Supervision
Website Development, Maintenance and Management + Interactivities

8. Figure 2. Website Development, Implementation, and
Evaluation (Cont.).
Evalu
Survey
Survey design Training interviewersOrganize survey team
Implement in fieldsAnalysisReports/papers
Implementations
Mobile monitoring team Participatory planning MeetingTrouble shooting
Plan for dissemination of website information, strategies and practices
Training
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 Areas
2. Core Messages
3. Interactive activities
4. Educating villagers

9. Figure 3. Frequency of browsing the reproductive health
website and time spent on the website per week (July
1, 2003 to January 12, 2004).
0
0. 5
1
1. 5
2
2. 5
3
3. 5
4
7. 1-
7. 14
7. 15-
7. 28
7. 29-
8. 11
8. 12-
8. 25
8. 26-
9. 8
9. 9-
9. 22
9. 23-
10. 6
10. 7-
10. 20
10. 21-
11. 3
11. 4-
11. 17
11. 18-
12. 1
12. 2-
12. 15
12. 16-
12. 29
12. 29-
1. 12
Ti me pi erod
Browsingfrequencyperweek
0. 00
10. 00
20. 00
30. 00
40. 00
50. 00
60. 00
70. 00
80. 00
90. 00
Duration
Browsing frequency
Duration

10. 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 Mean
Standard
Deviation
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

11. Table 2. Utilization of the interactive functions of the
reproductive health website (July 1, 2003 to January 12,
2004).
Indicators Mean
Standard
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

12. 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

13. 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**

14. 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
%
Change
Baseline
%
Change
Baseline
%
Change
Nanhua/
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.

15. 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 % change
Base
line
%
change
Baseline
%
change
Nanhua/
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.

16. 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.