運用健康信念模式探討臺灣成人若以丙型干擾素釋放試驗檢測潛伏結核感染結果為陽性時之就醫意圖

Healthcare Seeking Intention If Diagnosed with LTBI Using IGRA among Adults in Taiwan: An Exploration Based on the Health Belief Model

何宜帆(I-Fan Ho)

指導教授 ： 黃俊豪

國立臺灣大學/公共衛生學院/公共衛生碩士學位學程/碩士(2020年)

https://doi.org/10.6342/NTU202002760

摘要

背景：結核病是威脅全球人口健康之重要公共衛生議題，世界衛生組織估計，全球約四分之一人口具潛伏結核感染 (latent tuberculosis infection, LTBI)，若無適當診斷及治療，存在持續發展為結核病之風險及散播病菌之可能。針對LTBI感染者給予藥物治療，為「2035終結結核」之重要輔助策略，臺灣衛生主管機關自2008年起持續推行LTBI防疫政策，例如：將結核病接觸者篩檢，由13歲以下，擴大至全年齡層接觸者、引入新型篩檢工具丙型干擾素釋放試驗 (interferon-γ release assay, IGRA) 以及短程治療處方，期望有效預防結核病發生。然而2019年LTBI陽性者接受治療之比例，未達世界衛生組織建議。
目的：有鑑於此，本研究欲以行為科學理論為基礎，系統性地探究臺灣成人若IGRA檢驗為陽性時，影響其就醫意圖 (healthcare seeking intention, HSI) 之相關因素，作為未來結核防疫政策制定之參考，故採用健康信念模式 (Health Belief Model, HBM) 為架構，探討影響臺灣成人IGRA HSI之相關因素。
方法：本研究於2020年2月至同年3月間，透過網路匿名問卷，針對臺灣北、中、南、東四區20歲以上成人進行招募，共計1,501位研究參與者納入最終統計分析。問卷依據HBM五大構念（自覺罹患性、自覺嚴重度、自覺利益、自覺障礙及行動線索）設計而成，透過探索性因素分析萃取出六個潛在因素，運用多變項羅吉斯迴歸，以性別分層，進一步探討影響臺灣成人IGRA HSI之相關因子。
結果：成年男性具以下特質時，其具高IGRA HSI之勝算比顯著增加：具相對高度自覺整體利益 (AOR=4.14)、具相對高度自覺罹患性 (AOR=3.10)、具相對高度自覺嚴重度（他人健康層面）(AOR=1.73)，以及具相對中度 (AOR=1.88) 或相對高度 (AOR=3.83) 自覺利益；成年男性具以下特質時，其具高IGRA HSI之勝算比顯著減少：具相對中度 (AOR=0.60) 或相對高度 (AOR=0.61) 自覺整體障礙、具相對中度 (AOR=0.60) 或相對高度 (AOR=0.50) 自覺嚴重度（社會心理層面）。另一方面，成年女性具以下特質時，其具高IGRA HSI之勝算比顯著增加：具相對中度 (AOR=1.72) 或相對高度 (AOR=3.97) 自覺整體利益、具相對高度自覺罹患性 (AOR=2.08)，以及具相對中度 (AOR=2.00) 或相對高度 (AOR=1.59) 自覺利益。
結論：本研究運用HBM為架構，以性別做為分層之依據，調查臺灣成人IGRA HSI及其影響因子，結果發現影響男女IGRA HSI之主要因素為自覺整體利益。基於本研究結果，未來應加強宣導接受LTBI治療之益處，針對男性，強調接受治療不僅有益於自身健康，更具有利他之特性；針對女性，提供適當經濟誘因作為提升IGRA HSI之辦法。過往與結核病相關之研究，鮮少以性別進行分層，本研究發現，影響男女IGRA HSI之因素確有不同，期望研究結果有助於改變臺灣民眾健康信念，進而提升其就醫意圖，以順利達成「2035終結結核」之目標。

關鍵字

終結結核 ； 結核病 ； 潛伏結核感染 ； 丙型干擾素釋放試驗 ； 健康信念模式 ； 臺灣成人 ； 就醫意圖

並列摘要

Background: Tuberculosis (TB) is an important public health issue that threatens the global population health. The World Health Organization (WHO) estimates that about a quarter of the world’s population is affected by latent tuberculosis infection (LTBI). Without proper diagnosis and treatment, there is an increased risk of progression to TB and transmission. Offering medical treatment to people with LTBI is an important strategy for ending TB by 2035. Taiwan’s health authorities have implemented LTBI prevention policies since 2008—e.g., extending LTBI contact tracing from age thirteen or younger to all age groups, introducing a new screening tool, namely, interferon-γ release assay (IGRA), and short-term treatment prescriptions, hoping to prevent TB more effectively. However, the treatment coverage of LTBI in 2019 did not reach the level recommended by WHO.
Objectives: Given this, the current study aimed to systematically explore the relevant factors that affect the healthcare seeking intention (HSI) of Taiwanese adults if the IGRA test was positive on the basis of behavioral science theory, so as to provide empirical evidence to inform future TB prevention policies. Based on the Health Belief Model (HBM), this study explored factors associated with IGRA HSI among Taiwan adults.
Methods: An anonymous online survey was used to collect data from adults aged 20 or older living in the northern, central, southern, and eastern regions of Taiwan, between February and March 2020. A total of 1,501 participants were included in the final statistical analysis. The questionnaire was designed according to the five main constructs of the HBM (i.e., perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and cues to action). Six latent factors were extracted through exploratory factor analysis (EFA). Multivariate logistic regression and sex stratification were used to explore the factors associated with IGRA HSI among Taiwan adults.
Results: Among male adults, those who perceived: (1) high overall benefits (AOR=4.14), (2) high susceptibility (AOR=3.10), (3) high severity (related to others’ health) (AOR=1.73), and (4) intermediate (AOR=1.88) or high (AOR=3.83) benefits, were significantly more likely to have high IGRA HSI. By contrast, men who perceived: (1) intermediate (AOR=0.60) or high (AOR=0.61) overall barriers, and (2) intermediate (AOR=0.60) or high (AOR=0.50) severity (related to psychosocial health), were significantly less likely to have high IGRA HSI. On the other hand, among female adults, those who perceived: (1) intermediate (AOR=1.72) or high (AOR=3.97) overall benefits, (2) high susceptibility (AOR=2.08), and (3) intermediate (AOR=2.00) or high (AOR=1.59) benefits, were significantly more likely to have high IGRA HSI.
Conclusions: Using HBM as the theoretical framework, this study stratified the analysis by gender and found perceived overall benefits to be the most important factor for IGRA HSI for both genders. In view of our findings, it is advisable to strengthen the beliefs about the benefits of receiving LTBI treatment in the future. For men, we could emphasize that receiving treatment is not only beneficial to their own health but also altruistic in that it could help prevent further transmission. For women, we could increase IGRA HSI by providing financial incentives. Relatively fewer previous TB studies have stratified their analysis by gender. This study found that the factors associated with IGRA HSI varied by gender. It is hoped that this study could help to change the health beliefs of Taiwan adults, thereby increasing their IGRA HSI and achieving the goal to “End TB by 2035”.

並列關鍵字

END TB ； Tuberculosis (TB) ； Latent tuberculosis infection (LTBI) ； Interferon-γ release assay (IGRA) ； Health Believe Model (HBM) ； Taiwan adults ； Healthcare seeking intention (HSI)

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