A Tailored Web-Based Intervention to Promote Women's Perceptions of and Intentions for Mammography

適性化網路衛教對女性接受乳房攝影的認知及意向之成效

林祝君(Zu-Chun Lin) ； 王淑芳(Shu-Fang Wang)

《The Journal of Nursing Research》 17卷4期 (2009/12) Pp. 249-260

摘要

背景　網際網路已日漸被廣為應用做為健康資訊傳遞的方式，然而現今線上健康資訊建構的方式較缺乏「適性化」及「理論導向」的應用。本研究以Prochaska的跨理論模式(Transtheoretical Model)為理論依據，建構並評量適性化網路乳房攝影衛教對女性接受乳房攝影的認知及意向。
目的　應用三組前後測設計。研究假設為「全適性化衛教組」較「適性化訊息衛教組」在乳房攝影的認知得分較高及較強烈的意向且有顯著差異。「適性化訊息衛教組」較「制式化衛教組」在乳房攝影的認知得分較高及較強烈的意向且有顯著差異。「全適性化衛教組」較「制式化衛教組」在乳房攝影的認知得分較高及較強烈的意向且有顯著差異。
方法　185位屬於意圖前期(precontemplation stage)的女性依隨機方式被分配到「全適性化衛教組」、「適性化訊息衛教組」、「制式化衛教組」。研究對象在研究前與後完成線上問卷。
結果　認知層面的假說被印證。在意向層面，「全適性化衛教組」較「制式化衛教組」在乳房攝影的正向意向有顯著差異，但「全適性化衛教組」較「適性化訊息衛教組」在乳房攝影的正向意向無顯著差異。「適性化訊息衛教組」較「制式化衛教組」在乳房攝影的正向意向亦無顯著差異。
結論與臨床應用　本研究印證了以行為理論為基礎的適性化衛教方式在改變乳房攝影認知層面的效果，雖然在意向層面的效果較不顯著。建議可運用不同的行為改變過程及技巧於不同意向階段之女性，以探究其成效，再將結果運用於推動乳房攝影。

關鍵字

適性化措施 ； 網際網路 ； 跨理論模式 ； 乳房攝影 ； 篩檢

並列摘要

Background: The Internet is rapidly becoming an accepted standard for disseminating and obtaining health information. However, health information presented on the Web frequently is neither tailored to patients' characteristics nor theoretically driven. This study used Prochaska's transtheoretical model to guide the design and evaluation of a tailored Web-based mammography educational program.
Purpose: This study used a pretest-posttest design to examine the impact of a tailored Web-based educational intervention on women's perceptions of and intentions to obtain a mammography. We hypothesized that a complete tailored intervention (CTI) would result in a significantly higher score than that of tailored message intervention (TMI) in terms of women's perceptions of mammography and intentions to receive a mammography. Both TMI and CTI have been found to have significantly higher scores in terms of women's perceptions of mammography and intentions to receive a mammography than those of the standard intervention (SI).
Methods: One hundred eighty-five women were assigned randomly to one of three groups: CTI (n=61), TMI (n=63), or SI (n=61). Online questionnaires were completed by participants at baseline and after completion of intervention.
Results: Study results supported the hypothesis of perceptions of mammography. The CTI group had significantly higher scores on intention to obtain a mammogram than those of the SI group. However, the differences between CTI and TMI groups and between TMI and SI groups were not significant.
Conclusions and Implications for Practice: Results of the study validated the importance of utilizing theory for tailored intervention design to enhance individuals' positive perceptions of health behaviors. Additional studies should consider the effect of various processes and activities on women at different stages of acceptance of the need to obtain a mammogram to further determine outcomes and apply such to mammography screening behavior.

並列關鍵字

tailored intervention ； Web-based ； transtheoretical model ； mammography ； screening

參考文獻

Allen, B.,Bazargan-Hejazi, S.(2005).Evaluating a tailored intervention to increase screening mammography in an urban area.Journal of the National Medical Association.97(10),1350-1360.

Blackman, D. J.,Masi, C. M.(2006).Racial and ethnic disparities in breast cancer mortality: Are we doing enough to address the root causes?.Journal of Clinical Oncology.24(14),2170-2178.

Bridle, C.,Riemsma, R. P.,Pattenden, J.,Sowden, A. J.,Mather, L.,Watt, I. S.(2005).Systematic review of the effectiveness of health behavior interventions based on the transtheoretical model.Psychology and Health.20(3),283-301.

Champion, V. L.,Skinner, C. S.,Menon, U.,Seshadri, R.,Aznalone, D. C.,Rawl, S. M.(2002).Comparisons of tailored mammography interventions at two months post intervention.Annals of Behavioral Medicine.24(3),211-218.

Chang, K. J.,Kuo, W. H.,Wang, M. Y.(2008).The epidemiology of breast cancer in Taiwan.Journal of Oncology Society.24(2),85-93.