運用計劃行為理論探討臺北市某美沙冬門診男性藥物成癮者之共用針頭行為意圖

A Study of Sharing Needle Behavior Intention of Male Drug Addicts in a Methadone Clinic in Taipei Based on the Theory of Planned Behavior

袁美珍(Mei-Jen Yuan)

指導教授 ： 張媚

國立臺灣大學/醫學院/護理學研究所/碩士(2008年)

https://doi.org/10.6342/NTU.2008.00071

摘要

摘要
本研究主要目的為運用Ajzen（1985）的計劃行為理論（the Theory of Planned Behavior）來預測並解釋男性靜脈注射藥癮者共用針頭之行為意圖，並於一個月後追蹤自我報告的共用針頭實際行為。研究對象為臺北市某美沙冬門診接受美沙冬維持療法之男性靜脈注射藥癮個案。研究工具擬定為先進行15位對象之開放式訪談，由訪談內容找出共用針頭之顯著信念，再據以建構結構式正式問卷。由研究者採一對一訪談方式收集問卷資料，共收集146份問卷。研究結果如下：
一、研究對象認為自己於問卷施測後一個月內，很有可能或有可能共用針頭者為22.6％，很不可能或不可能共用針頭者為77.4％。
二、研究對象之態度、主觀規範、自覺行為控制三個變項皆與共用針頭行為意圖有顯著相關。態度、主觀規範、自覺行為控制三個變項可解釋研究對象共用針頭意圖75.3％的變異量，自覺行為控制為最主要的預測變項。
三、最近10次用藥行為的共用針頭現況，能在計劃行為模式內變項（態度、主觀規範、自覺行為控制）之外，顯著增加3％的共用針頭行為意圖的解釋變異量。
四、研究對象共用針頭的態度、主觀規範、自覺行為控制與其構成信念間皆呈顯著正相關，與計劃行為理論相符。
五、 以共用針頭行為意圖之平均值為切點，將研究對象分為高/低意圖組，兩組在行為信念與結果評價上有顯著差異，高意圖組認為共用針頭能「快速打到藥、馬上解癮」與「表達信任對方」的可能性顯著較低意圖組高，且高意圖組對該行為之結果評價比低意圖組好。
六、高/低意圖組在規範信念與依從動機上有顯著差異，雖然兩組均自覺重要參考對象認為研究對象不應該與他人共用針頭，低意圖組感受到「家人」、「藥頭」、「配偶/男女朋友」對其共用針頭的不贊同程度比高意圖組強烈，而低意圖組對於依從「家人」與「藥頭」的願意程度比高意圖組高。
七、高/低意圖組在控制信念與自覺力量上有顯著差異，高意圖組顯著比低意圖組更常發生「要打藥時，附近沒有藥局可以買到針」、「要打藥時，藥局已經關了，買不到針」、「要打藥時，身上沒有錢可以買針」、「拿到藥時，已經很啼了，等不及去買針」、「要打藥時，發現自己準備的針已經壞了」、「別人把針筒裡還沒打完的藥給您打」、「要打藥時，懶得去買針」與「要打藥時，因為怕被警察抓，不敢去買針」等八項促進共用針頭的狀況，且認為在該狀況下發生共用針頭的容易程度也比低意圖組高；低意圖組顯著比高意圖組更常發生「要打藥時，身上有自己專用或全新的針」，低意圖組在該狀況下發生共用針頭的困難程度較高意圖組高。
八、研究對象共用針頭的行為意圖與一個月後實際共用行為之間存在有顯著正相關，r值為0.874，可見共用針頭行為意圖對實際行為有相當高的預測力。
結論：計劃行為理論能預測男性藥物成癮者共用針頭行為意圖，自覺行為控制為最主要的預測變項，而共用針頭現況可於模式內變項以外增加對意圖的解釋力。77.4％的研究對象認為自己在未來一個月不可能共用針頭，且共用針頭意圖與實際共用行為有顯著正相關，具相當高的預測力。建議：（1）持續推廣減害計畫；（2）強化個案管理護理品質；（3）善用藥癮者緊密的社會網絡。

關鍵字

計劃行為理論 ； 男性藥物成癮者 ； 共用針頭意圖 ； 美沙冬門診 ； 海洛因 ； 毒癮 ； 藥癮 ； 注射藥癮者

並列摘要

Abstract
This study is based on Ajzen’s（1985） the Theory of Planned Behavior and the purpose of this study is to predict and perceive the intention and behavior of needle sharing among male drug addicts. One month later we followed up the actual needle sharing behavior by using subject self-reports. The research subjects were selected from a Methadone clinic in Taipei who were male and receiving Methadone supportive treatments aggressively. Fifteen of research population were interviewed by open-ended questions and the salient beliefs were elicited. A formal structured questionnaire was then constructed according to the salient beliefs. A total of 146 respondents were interviewed face-to-face with their consent. The results shown are as follows：
1. 22.6％ study subjects thought that they would highly likely or likely to have needle sharing behavior within a month after the interview; and 77.4％ of them responded “highly unlikely” or “unlikely.”
2. The intention of needle-sharing had a significant correlated with study subjects’ attitude, subjective norm and perceived behavior control. They also explained the 75.3% of variation. However, the perceived behavior control was the main affecting variation in needle-sharing intention.
3. In addition to the internal variables of the Theory of Planned Behavior (attitude, subjective norm, and perceived behavior control), the frequency of needle sharing in last 10 times of drug injection can increase another 3% of the explanations of the variance of needle-sharing intention.
4. The attitude of respondents toward sharing needle intention was positively related to the sum of the product of behavioral beliefs multiplied by outcome evaluations （Σbi*ei). The subjective norm of respondents toward sharing needle intention was positively related to the sum of the product of normative beliefs multiplied by motivations to comply (Σnb*mc). The perceived behavioral control of respondents toward sharing needle intention was also positively related to the sum of the product of control beliefs multiplied by perceived power (Σcb*pp). These results were also consistent with the theory of planned behavior.
5. The respondents were divided into high/low intention groups by the mean score of needle-sharing intention. There were noteworthy differences in behavior beliefs and outcome evaluations between two groups. For instance, the high intention group is more likely to believe that “by sharing needles can inject drugs faster and relieve the onset of drug addiction immediately” and “they can trust other users” than the low intention group. Moreover, the high intention group had better outcome evaluations of those items.
6. There were significant differences in normative beliefs and motivations to comply between these two groups. Although both groups believed that most of their significant others thought they should not share needle with others, the low intention group perceived stronger disagreement of sharing needle behavior from family members, drug dealers and spouse/partner than high intention group. Besides, the low intention group were more willing to comply with family and family members, drug dealers, in terms of not sharing needle.
7. There were significant differences in control beliefs and perceived powers in between these two groups. The high intention group was more likely to have the following 8 situations happened: “ when needing an injection, there is no drugstore nearby to buy needles”, “when needing an injection, the drugstore is closed already, so I can’t buy a needle”, “when needing an injection, I do not have money to buy a needle”, “ when I get the drugs, craving for the drugs has become too strong so that I can't wait to buy a needle”, “when I am going to inject myself, I find my needle is not working”, “others give me the drugs which was not finished injecting yet in the syringes”, “I am too lazy to buy a needle”, or “ I am afraid of being caught by the police so that I do not dare to buy a needle”. And under above circumstances, the high intention group also believed that they are very easy to share needles with others. On the other hand, the low needle-sharing intention group would have higher frequency of “while injecting drugs , I have my own needle or a brand-new needle with me”, and they believe when they have their own needles, it is more difficult to share needles with others.
8. The needle sharing behavior intention of respondents was positively related to the actual behavior for the following month (r＝0.874), that again proved that the needle-sharing actual behavior was highly prediction by needle-sharing behavior intention of respondents.
Conclusions: The Theory of Planned Behavior provided good prediction of needle-sharing behavior intention, and the perceived behavioral control was the main affecting variance. The frequency of needle sharing in last 10 times of drug injection significantly enhanced the explanations for the variance of needle-sharing intention in addition to the main variances of the theory model. 77.4％ of respondents showed that they would not share needles with other users next month. The needle-sharing behavior intention was positively related to the needle-sharing actual behavior, and from the behavior intention, the needle-sharing actual behavior was able to be predicted highly successfully.
Recommendations:（1）Continuing to promote harm reduction program,（2）Strengthening case management and nursing quality,（3）Utilizing the unique and powerful drug addicts social net.

並列關鍵字

Theory of Planned Behavior ； Male drug addicts ； Needle-sharing behavior intention ； Methadone clinic ； Heroin ； Substance abuse ； Drug addiction ； Injection drug users

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