以健康信念模式為基礎之流行性感冒衛教介入：台灣北部高中生之隨機分派實驗

An Influenza Health Education Intervention Using the Health Belief Model: A Randomized Controlled Trial among Senior High-School Students in Northern Taiwan

李柏毅(Po-Yi Lee)

指導教授 ： 黃俊豪

國立臺灣大學/公共衛生學院/健康政策與管理研究所/碩士(2015年)

https://doi.org/10.6342/NTU.2015.00637

摘要

目標：過往之流感研究中，較少以行為科學理論為基礎進行之隨機分派實驗，故較缺乏實證資料以評估流感衛教介入之成效。本研究以健康信念模式 (Health Belief Model, HBM) 為基礎，設計、執行衛教介入，評估其對洗手、戴口罩行為與意圖之成效，並檢視何健康信念改變可預測健康行為與意圖之提升及其影響程度。
方法：針對台灣北部高中生，以隨機分派實驗研究法，分成實驗組 (329人) 與對照組 (325人)，分別進行以HBM為基礎之衛教介入與一般衛教介入，並於介入前及三個月後，分別進行流感相關之HBM健康信念、洗手與戴口罩行為及意圖之問卷資料收集。
結果：使用多變項線性自迴歸模式，控制前測洗手行為、意圖及背景特質後，發現實驗組於介入三個月後之洗手行為 (β=.098) 與意圖 (β=.140)，均較對照組顯著較佳，證實本介入對洗手行為與意圖之提升具顯著成效。於控制HBM健康信念在介入前後之改變後，前述之組別效果消失，顯示實驗組之介入效果係透過HBM改變之中介作用影響。HBM健康信念之改變中，自我效能之增強為洗手、戴口罩行為 (β=.541, .559) 與意圖 (β=.418, .437) 之顯著提升最強之預測因子；自覺利益性增強對洗手行為 (β=.107) 之提升有顯著影響，對戴口罩行為則無；自覺罹患性、嚴重性、利益性之增強均可顯著預測洗手 (β=.153, .181, .139) 與戴口罩 (β=.117, .168, .141) 行為意圖之提升。
結論：本衛教介入對三個月後之洗手行為與意圖有顯著提升作用，係透過HBM健康信念改變之中介影響所致。不同之健康行為改變受不同健康信念所驅動，自覺利益性之增強，可顯著提升洗手行為與意圖及戴口罩行為意圖，顯示未來流感衛教針對洗手與戴口罩行為，應強調其預防效果以增進自覺利益性，而自我效能之增強，對提升洗手與戴口罩行為與意圖皆具最強之影響力，故衛教應以提升自我效能為首要考量，應能發揮最大成效。

關鍵字

流行性感冒 ； 衛教介入 ； 洗手 ； 戴口罩 ； 隨機分派實驗 ； 健康信念模式 ； 高中生

並列摘要

Objectives: In previous influenza research, few randomized controlled trials based on behavior science theory have been conducted. Hence, there is a scarcity of empirical data for the evaluation of the effectiveness of influenza health education interventions. Based on the Health Belief Model (HBM), this health education intervention trial was designed and implemented to assess its effectiveness on hand washing and face mask wearing behaviors. This study also aimed to examine which changes in health beliefs could predict increases in these influenza-related health behaviors and behavioral intentions, and to what extent.
Methods: A randomized controlled trial was conducted among senior high-school students in northern Taiwan, with HBM-based health education intervention delivered to 329 participants in the experimental group and regular health education intervention delivered to 327 in the control group. Pretest and follow-up posttest data regarding influenza-related HBM health beliefs, hand washing and face mask wearing behaviors, and behavioral intentions were collected before the intervention and 3 months after the intervention, respectively, using self-administed questionnaires.
Results: Multivariate linear autoregression analysis was conducted, controlling for hand washing behavior, intention, and background characteristics at pretest. Participants in the experimental group were found to have significantly higher scores than those in the control group in their hand washing behavior (β=.098) and intention (β=.140) at 3-month follow-up, indicating that the HBM-based intervention was effective in increasing hand washing behavior and intention. However, no significant differences were found between the two groups, after controlling for the changes in HBM health beliefs between pretest and follow-up posttest, suggesting that the significant intervention effects in the experimental group were mediated through changes in HBM health beliefs.
Of all the changes in HBM health beliefs, increased self-efficacy was the strongest predictor of hand washing and face mask wearing behaviors (β=.541 and .559, respectively), as well as behavioral intentions (β=.418 and .437, respectively). Elevated levels of perceived benefits significantly increased hand washing behavior (β=.107), but had no significant effect on face mask wearing behavior. Finally, increased perceived susceptibility, severity, and benefits significantly predicted increased behavioral intention of washing hands (β=.153, .181, and .139, respectively) and wearing face masks (β=.117, .168, and .141, respectively).
Conclusions: The HBM-based health education intervention significantly increased hand washing behavior and intention, more than the regular health education intervention, at 3-month follow-up. Such intervention effects were mediated through changes in HBM health beliefs. Changes in different health behaviors were driven by changes in different health beliefs. Increased perceived benefits led to significantly increased hand washing behavior, intention, and face mask wearing intention, suggesting that future interventions should emphasize the preventive effects of hand washing and face mask wearing against influenza infection. Above all, increased self-efficacy was the strongest predictor of these influenza-related preventive behaviors. Therefore, future health education interventions should focus on increasing self-efficacy for optimal program effectiveness.

並列關鍵字

influenza ； health education intervention ； hand washing ； face mask wearing ； randomized controlled trial ； Health Belief Model ； senior high-school students

參考文獻

行政院衛生署疾病管制局（2009d）。預防H1N1新流感，請你跟我這樣做。

Aiello, A. E., Murray, G. F., Perez, V., Coulborn, R. M., Davis, B. M., Uddin, M., . . . Monto, A. S. (2010). Mask use, hand hygiene, and seasonal influenza-like illness among young adults: a randomized intervention trial. J Infect Dis, 201(4), 491-498. doi: 10.1086/650396

Aledort, J. E., Lurie, N., Wasserman, J., & Bozzette, S. A. (2007). Non-pharmaceutical public health interventions for pandemic influenza: an evaluation of the evidence base. BMC Public Health, 7, 208. doi: 10.1186/1471-2458-7-208

Bish, A., & Michie, S. (2010). Demographic and attitudinal determinants of protective behaviours during a pandemic: a review. Br J Health Psychol, 15(Pt 4), 797-824. doi: 10.1348/135910710x485826

Burns, S. M. (2009). H1N1 influenza is here. J Hosp Infect, 73(3), 200-202. doi: 10.1016/j.jhin.2009.07.012