孕婦選擇生產場所相關因素研究－以台中地區數家醫療機構為例

懷孕生產是女人一生中的大事，儘管多數人認為生產不是生病，生產場所以安全、方便為原則，但是孕婦選擇生產場所的決策行為，卻是多元而複雜的。為瞭解孕婦選擇生產場所之影響因素，本研究以計劃行為理論為研究架構，以自擬結構式問卷為工具，在台中地區立意選取有提供接生的醫療機構之婦產科門診，面訪363位孕婦，並在受訪孕婦預產期一個月後，以電訪等方式追蹤其生產場所，追蹤率88%。研究發現：孕婦選擇生產場所除與年齡、教育程度、居住地、胎次有關外，孕婦最重視醫師專業與技術、科別完整／危機處理能力、儀器先進齊全、環境整潔舒適、醫師態度親切。最不重視醫師性別、附設坐月子中心、產後贈送禮物、認識醫護人員、親友推薦。在基層診所產檢的孕婦就醫滿意度最高，但最終回產檢場所完成生產的比率卻最低(58.9%)。在驗證計劃行為理論部份發現：「就醫態度」、「主觀規範」、「知覺行為控制」均可有效解釋孕婦的生產場所「意向」解釋力46.1%，但生產場所「意向」對最終選擇「行為」卻沒有影響力。至於「知覺行為控制」不僅能問接地影響行為，也可以不經由行為意向，直接影響行為。研究建議：建立孕婦正確的就醫信念和創造滿意的就醫屬性，是產前衛生教育和醫療機構經營管理可努力的方向。

關鍵字

生產場所；計劃行為理論；態度；意向；婦產科

並列摘要

Pregnancy and delivery are significant events in womens' lives. For a pregnant woman's, choosing a safe and convenient place for delivery is essential, but the process of making this decision is complicated and multi-dimensional. Thus, this study examined the factors considered by pregnant women in choosing delivery places. Based on the Theory of Planned Behavior (TPB), the study first interviewed 363 pregnant women at 15 medical institutions in Taichung area, and then conducted telephone interviews a month following their expected date of confinement, to identify the delivery places they had ultimately selected. The results showed that delivery place is significantly related to age, education, urbanlization, and paraity. Furthermore, import hospital-related considerations including physicians' expertise and attitudes, complete departments, capability of dealing with emergent cases, advanced medical instruments, comfortable and clean environment are very important for the subjects. Meanwhile, the less important considerations including doctor gender, mother-baby care center, free gift, acquaintance of medical technicians, recommendation from friends. The subjects were generally satisfied with the prenatal care services provided at Obstetrics and Gynecology clinics, but not many of them returned to these clinics for delivery. The results of testing the TPB showed that: ”attitude”, ”subjective norm”, and ”perceived behavior control” could explain subject ”behavioral intensions” regarding the delivery places. However, subject ”behavioral intensions” did not correlate with their ”behaviors”. Notably, ”perceived behavior control” influenced ”behaviors” both directly and indirectly. This study recommended that: (1) prenatal health education is necessary to help pregnant women develop sound ideas regarding optimal medical treatment, and (2) medical institutions should seek to provide medical treatment that is satisfactory to their patients.