運用計劃行為理論探討國中生之保險套使用意圖及隨機分派衛教介入成效

Condom Use Intention and Effectiveness of a Randomized Health Education Intervention among Junior High-School Students: An Exploration Using the Theory of Planned Behavior

邰思瑀(Szu-Yu Tai)

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(2018年)

https://doi.org/10.6342/NTU201803858

摘要

背景：臺灣近幾年之國中生性行為盛行率呈現上升趨勢，且進入高中職階段後倍增，另，HIV與淋病等性傳染病之個案亦明顯年輕化，顯示青少年之安全性行為觀念仍待加強，然目前相關研究之對象多為大學生或高中職學生，少有針對國中生進行探討，且多聚焦在性行為與保險套之使用現況，較缺乏以行為科學理論為基礎，系統性探討影響國中生使用保險套之相關因素，以提供安全性行為衛教之實證依據。

目標：本研究運用計劃行為理論 (Theory of Planned Behavior, TPB) 為基礎，設計並執行國中生性教育課程，期能提高學生未來在發生性行為時使用保險套之意圖，並檢視計劃行為理論三大構念與國中生保險套使用意圖之關聯性。

方法：立意取樣臺北市之公立國中二所，以隨機分派實驗研究法，分成實驗組 (467人) 與對照組 (358人) ，分別進行連續四週、每週一次各45分鐘之以TPB為基礎之衛教介入與一般衛教介入課程，並於介入前、介入後一週及二個月後，進行保險套使用意圖與相關因素之匿名問卷資料收集。

結果：多變項線性自迴歸分析結果顯示，實驗組於延宕後測時之保險套使用意圖 (β=.07)，顯著較對照組佳，證實本介入對保險套使用意圖之提升具有成效，且實驗組之介入效果係透過TPB構念改變之中介作用影響，而衛教介入能有效提升實驗組之TPB構念的正向改變，進而增加保險套之使用意圖。此外，TPB構念可有效預測國中生未來保險套使用意圖，其中行為態度 (β=.36) 扮演最關鍵之預測因子，主觀規範 (β=.16) 與自覺行為控制 (β=.18) 亦有顯著影響。當性別分層之後，發現驅動女性與男性使用保險套之因子具性別差異：女性在意保險套可以避孕 (β=.10)，男性則認為使用保險套可表現真愛 (β=.12)，而自覺健康教育老師之主觀規範，對保險套使用意圖之影響亦具性別差異 (男β=.18；女β=-.14)，另，關於保險套的使用技能，知道如何使用保險套之男性 (β=.11)，有較高保險套使用之意圖，然對女生而言，在學校曾經學過如何使用保險套 (β=.12) 具有顯著之意義。

結論：未來在進行保險套相關宣導時，應以TPB為理論基礎設計衛教介入內容，且課程應加強學生之正向態度，並於課堂上落實保險套使用之教學。此外針對性別需發展不同之適性衛教課程，以提升介入之成效。

關鍵詞：計劃行為理論、國中生、保險套使用意圖、隨機分派實驗、衛教介入

關鍵字

計劃行為理論 ； 國中生 ； 保險套使用意圖 ； 隨機分派實驗 ； 衛教介入

並列摘要

Background: The prevalence of sexual behavior among junior high school students in Taiwan is increasing and has grown substantially among senior and vocational high school students. Moreover, the age of patients with sexually transmitted diseases, such as HIV/AIDS and gonorrhea, has decreased, suggesting that teenagers’ knowledge of safe sex is lacking. However, prior research has largely focused on college or senior and vocational high school students rather than junior high school students. Further, previous studies have mainly investigated the prevalence of their sexual behavior and condom use. Relatively few have based their studies on behavioral science theories and systematically explored the factors that influenced junior high school students’ condom use so as to provide an empirical basis for sex education.

Objectives: Based on the Theory of Planned Behavior (TPB), this study designed and implemented a sex education program that aimed to increase junior high school students’ intention to use condoms during sex. The relationships between the main constructs of the TPB and the students’ condom use intention were also examined.

Methods: Two public junior high schools in Taipei City were selected through purposive sampling and randomly assigned to the experimental group (n = 467) and control group (n = 358). A TPB-based health education intervention and general health education intervention were implemented separately on the two groups once per week for 4 consecutive weeks, with 45 minutes per session. Moreover, data were collected using anonymous questionnaires to assess the students’ condom use intention and the influencing factors at baseline, 1 week after, and 2 months after the interventions.

Results: The multivariate linear autoregression revealed that, after adjusting for students’ condom use intention at baseline and their background characteristics, the experimental groups’ condom use intention (β = .07) was significantly higher than that of the control group at 2-month posttest, demonstrating that this intervention was effective in promoting condom use. Further, the effect of the intervention on condom use intention was mediated through the positive changes of the TPB constructs. The health education intervention in the experimental group more effectively facilitated the positive changes of the TPB constructs, thereby increasing the students’ condom use intention more so than in the control group. Moreover, the students’ condom use intention could be significantly predicted by the levels of their TPB construct measures, whereby their attitude toward the behavior (β = .36) was the most crucial predictor, and subjective norms (β = .16) and perceived behavioral control (β = .18) also exhibited significant influences. The data were further stratified by gender, revealing gender differences in the factors driving condom use intention. Girls emphasized the contraceptive function of condoms (β = .10), whereas boys considered condom use a manifestation of true love (β = .12). The effect of the students’ perceived support from their health education teacher for their condom use was also different between boys and girls (β = .18 and −.14, respectively). Regarding condom use skills, boys who reported that they knew how to use condoms had higher condom use intention (β = .11). By contrast, girls who reported that they had learned how to use condoms through school education had higher condom use intention (β = .12).

Conclusions: Future condom promotion campaigns should consider employing the TPB as the theoretical basis for the development and implementation of their health education interventions to improve students’ positive attitudes toward condom use. Further, students should be provided with hands-on experience in school regarding condom use. Also, health education courses for different genders should be developed to cater for their respective needs and to improve the intervention effectiveness.

Keywords: Theory of Planned Behavior; junior high school students; condom use intention; randomized controlled trial; health education intervention

並列關鍵字

Theory of Planned Behavior ； junior high school students ； condom use intention ； randomized controlled trial ； health education intervention

參考文獻

Ajzen. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50, 179-211.

Ajzen. (2006). Constructing a theory of planned behavior questionnaire. Available at people.

Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50(2), 179-211. doi:doi:10.1016/0749-5978(91)90020-T

Ajzen, I. (2002). Perceived Behavioral Control, Self-Efficacy, Locus of Control, and the Theory of Planned Behavior. Journal of Applied Social Psychology, 32(4), 665-683. doi:DOI: 10.1111/j.1559-1816.2002.tb00236.x

Armitage, C. J., & Conner, M. (2001). Efficacy of the Theory of Planned Behaviour: a meta-analytic review. Br J Soc Psychol, 40(Pt 4), 471-499.