影響北部三所醫院醫護人員個人健康紀錄使用意願之因素

The Factors Affecting Usage Intentions of Personal Health Record by Physicians and Nurses in Three Hospitals of Northern Taiwan

陳亭羽(Ting-Yu Chen)

指導教授 ： 溫信財

臺北醫學大學/公共衛生暨營養學院/醫務管理學研究所/碩士(2010年)

摘要

背景與目的：個人健康紀錄(Personal Health Record, PHR)是一個可以協助醫護人員執行醫療照護的工具，它不僅可提供正確、及時之資訊，以維護與管理個人健康，且能因此節省整體醫療浪費並提高醫療照護品質。然而醫師及護理人員對於PHR之態度及使用意願，將會影響此系統是否能夠有效發揮功效。因此，本研究應用科技接受模型(Technology Acceptance Model, TAM)等理論，由影響醫護人員的認知及態度之因素來探討其使用意願，期望從理論模型之建構作為醫療機構未來推動PHR之參考。
方法：本研究為橫斷性研究，以自填性結構問卷為研究工具，採立意取樣方式，以台北縣市三所醫院醫護人員為研究對象。問卷內容在經過效度及信度檢定後進行測試。調查期間爲99年4月19日至99年5月21日，問卷之回收結果，醫師部份，發出470份，有效問卷204份，回收率為43.40%；護理人員部份，發出1060份，有效問卷468份，問卷回收率為44.15%。問卷資料經整理後，分別使用SPSS12.0及AMOS18.0統計套裝軟體，進行描述性及結構方程模式(Structural Equation Modeling, SEM)統計分析。
結果：本研究以驗證性因素分析，並刪除變項修正以取得最佳解釋模型後，醫師部份，修正模式之卡方值為386.854、卡方值/自由度為1.653。GFI為0.864、AGFI為0.826、RMSEA為0.057，其值表示在整體模式有合理的配適度。而諸多影響醫師PHR使用意願之因素中，最顯著的為「知覺有用性」（整體效果=0.449, p<0.001)，另醫師的使用態度可解釋使用意願39.4%之變異，而相關研究變項可解釋使用態度56.3%的變異，其中知覺有用性、資料安全及主觀規範對使用態度有正向之顯著影響;而護理人員部份，修正模式之卡方值為647.356、卡方值/自由度為2.304。GFI為0.902、AGFI 為0.877、RMSEA為0.053，且RMSEA值接近0.05，表示在整體模式有合理的配適度。而影響護理人員PHR使用意願之因素中，則是以「主觀規範」為關鍵因素(整體效果=0.216, p＜0.05)，護理人員之使用態度可解釋使用意願89.2%之變異，而相關研究變項可解釋使用態度82.6%的變異，其中知覺有用性、知覺易用性、電腦自我效能及主觀規範對使用態度有正向之顯著影響。
結論：醫護人員對於個人健康紀錄之使用意願，經由本研究模型之建構，醫師資料與TAM理論部分相符，護理人員則完全符合。大部分之醫護人員均願意使用個人健康紀錄且持正向之態度，且使用態度對使用意願有正向之顯著影響。因此未來醫療機構在PHR設計上，應注重產生醫療照護之實質效益進而提升其有用性，並制訂相關的推行政策以提高使用意願。

關鍵字

個人健康紀錄(Personal Health Record, PHR) ； 科技接受模式(Technology Acceptance Model, TAM) ； 醫護人員 ； 使用意願

並列摘要

Background and Objectives: Personal Health Record (PHR) is a tool for clinicians to provide care effectively and save medical cost by accurate and timely health information. However, whether the PHR system could be successful implemented depends on physicians and nurses’ attitude and behavior intention. This study will explore the factors affecting clinicians’ intentions of PHR which is based on Technology Acceptance Model (TAM) and related theories. The theoretical model we built could also be referred to hospital PHR implementation.
Methods: It was a cross-sectional study and conducted by structured questionnaire. We used judgmental sampling that subjects were physicians and nurses in three hospitals of northern Taiwan. After verifying validity and reliability, questionnaires were collected in the period of April 19 to June 21, 2010. A total of 204 valid questionnaires were collected from physicians (response rate: 43.40%) and 468 from nurses (44.15%). SPSS12.0 and Structural Equation Modeling (SEM) statistics software were used to analyze data and verify the hypotheses.
Result: The confirmatory factor analysis (CFA) was used to revise the factor structure and get the optimized model. The revised model of χ2, χ2/df , GFI, AGFI and RMSEA for physicians were 386.854, 1.653, 0.864, 0.826 and 0.057 respectively, which showed the theoretical model fitted the observed data well. Perceived usefulness played the most significant factor for physicians’ attitude (total effect=0.449, p<0.001). Physicians’ attitude explained 39.4% variances of their PHR behavior intention. The results also showed that perceived usefulness, security, and subjective norm influenced physicians’ attitude positively. Similarly, the theoretical model for nurses fitted the observed data well, the revised model of χ2, χ2/df , GFI, AGFI and RMSEA were 647.356, 2.304, 0.902, 0.877 and 0.053 respectively. Subjective norm played the most significant factor for nurses (total effect=0.216, p<0.05). Nurses’ attitude explained 89.2% of their PHR intention. The results also showed that perceived useful, ease of use, computer self-efficacy and subjective norm influenced nurses’ attitude positively.
Conclusions: The models constructed by our study fitted the TAM and found that physicians and nurses had the positive intention and attitude of PHR. Moreover, clinicians’ attitude influenced their behavior intention significantly (p<0.001). Therefore, the design of PHR should be focused on usefulness, and policies of healthcare organizations should offer incentives to promote the acceptance of PHR.

並列關鍵字

Personal Health Record (PHR) ； Technology Acceptance Model (TAM) ； Physicians and Nurses ； Behavior Intention

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