運用健康信念模式探討C型肝炎帶原靜脈藥癮者之就醫行為－以台北市及新北市之美沙冬門診為例

A Study of Health Seeking Behavior of HCV Carriers with Injected Drug Use in three Methadone Clinics in Taipei City and New Taipei City Based on the Health Belief Model

蔡昱芸(Yu-Yun Tsai)

指導教授 ： 張媚

國立臺灣大學/醫學院/護理學研究所/碩士(2013年)

https://doi.org/10.6342/NTU.2013.00754

摘要

惡性腫瘤為台灣十大死因之首，其中肝癌為十大癌症的第二位，在民國99年有7,758人死於肝癌；而慢性肝病及肝硬化有4,912人死亡。C型肝炎是造成肝癌、慢性肝病與肝硬化的主因之一，主要透過血液體液傳染。靜脈藥癮者常因共用針具注射毒品導致C型肝炎的傳播，以至於國內外靜脈藥癮者感染C型肝炎的盛行率高達約80-90%。藥癮者因為物質濫用行為而引發許多健康問題，卻常常是不被重視的一群。
本研究主旨在於運用健康信念模式探討C型肝炎帶原之靜脈藥癮者的健康信念、就醫行為（係指個案因C型肝炎帶原而定期回診追蹤的行為及追蹤意願，本研究稱定期回診追蹤行為）與相關的影響因素。收案對象為台北市與新北市共三家醫院之美沙冬門診個案，採橫斷式研究設計，研究工具為自擬的結構式問卷，內容包括C型肝炎疾病認知量表、C型肝炎藥癮者健康信念量表、社會支持量表、就醫行為量表、物質濫用行為量表、基本特性。研究時間自民國101年10月至102年1月，共發出242份問卷，回收有效問卷232份，回收率為95.9%。
本研究結果發現，C型肝炎帶原靜脈藥癮者的人口學、社會心理學變項、結構變項、健康信念會影響定期回診追蹤行為；影響個案過去追蹤的預測因子有：診斷為C型肝炎的年齡、是否接受過C型肝炎治療、肝炎症狀種類的數量、行動障礙、行動線索；可預測未來追蹤意願的因子是行動障礙與行動線索。在實務建議上，可協助減少阻礙個案定期回診追蹤的因素（行動障礙），並增加促成或引發個案採取定期回診追蹤的訊息（行動線索）。行動障礙與家人親友社會支持、健康專業人員社會支持、疾病認知都有顯著負相關；行動線索與兩種社會支持、疾病認知都有顯著正相關。若要降低個案的行動障礙、增加行動線索，可從加強其社會支持與疾病認知著手。另外，可針對個案有肝炎症狀者、診斷為C型肝炎年齡51歲以上者，可多鼓勵並關心其定期回診追蹤的情形。
根據研究結果，遂提出幾點建議：1.持續編列經費，給予美沙冬門診之C型肝炎靜脈藥癮者定期回診追蹤的補助；2.提供充分資訊，加強個案疾病認知；3.成立病友團體給予支持；4.個案管理制度的建立；5.規劃個案定期回診追蹤之臨床路徑；6.多鼓勵有肝炎症狀者、診斷為C型肝炎的年齡51歲以上者能夠定期回診追蹤。希冀本研究的發現與建議可作為相關衛生單位制定疾病防治政策之參考。

關鍵字

C型肝炎 ； 靜脈藥癮者 ； 健康信念 ； 就醫行為 ； 定期回診追蹤 ； 社會支持

並列摘要

Malignant tumor is the head of the top ten leading causes of death in Taiwan, while hepatocelluar carcinoma (HCC) is top two of ten malignant tumors. In 2010, 7,758 people died of HCC; 4,912 died of chronic liver disease and liver cirrhosis. Hepatitis C virus (HCV) is one of the main reasons of liver-related diseases. HCV infection is transmitted by exposing to contaminated blood and unsafe sexual relationship. Injection drug users frequently spread HCV through sharing injecting equipment, which make up approximately 80-90% of this population domestically and abroad. Because of substance abuse behavior, drug users have many health problems; however, they do not usually attract much attention.
The purpose of this study is to investigate HCV carriers’ health belief, health seek behavior (it means cases’ regular follow-up behavior and willingness to do so), and related factors based on the Health Belief Model. The subjects are HCV carriers with injected drug use in three methadone clinics in Taipei City and New Taipei City. This cross-sectional study utilizes a self-developed structured questionnaire, which includes HCV Knowledge Scale, Injected Drug User Health Belief Scale, Social Support Scale, Health Seeking Behavior Scale, Substance Abuse Behavior Scale, and personal information. The data was collected from October, 2012 to January, 2013. A total of 242 people responded to the questionnaires. Among them, 232 copies were valid. The overall response rate is 95.9%.
The results of this study show that the demographic, social-psychological, structural variables and health belief may impact the subjects’ regular follow-up behavior. The predictors of regular follow-up in the past include the age when HCV was diagnosed, acceptance of treatment or not, the number of types of hepatitis symptoms, barriers to action and cues to action. Barriers and cues to action are predictors of the subjects’ willingness to conduct regular follow-up afterwards. In practice, we may not only help decrease barriers to action of this population, but also may increase their cues to action. Barriers to action reveal a significant negative correlation with family and peer social support, health provider social support and the knowledge of HCV; however, cues to action have a positive correlation with them. If we want to decrease their barriers and increase the cues to action, we have to enhance their social support and knowledge. In addition to all of the above, we should encourage regular follow-up behavior of those who have symptoms or are diagnosed with HCV at the age over 51.
According to the results, some suggestions are proposed to facilitate policy making on medical prevention. The suggestions include: we should (1) continue providing regular follow-up subsidies for HCV carriers with injected drug use in methadone clinics; (2) offer HCV carriers sufficient information to strengthen their knowledge of HCV; (3) set up patient support group; (4) establish a case management system; (5) plan cases’ clinical pathways of regular follow-up; (6) encourage those who have symptoms or are diagnosed with HCV at the age over 51 to have regular follow-up.

並列關鍵字

HCV ； injection drug user ； health belief model ； health seeking behavior ； regular follow-up ； social support

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