以健康信念模式檢視臺灣女性護理人員子宮頸抹片意圖：探討抹片經驗及性別氣質之調節作用

An Examination of Pap Smear Screening Intention among Female Nurses in Taiwan Using the Health Belief Model: Exploring the Moderating Effects of Pap Smear Screening Experience and Gender Characteristic

徐嘉羚(Chia-Ling Hsu)

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(2018年)

https://doi.org/10.6342/NTU201803989

摘要

背景：惡性腫瘤為臺灣2017年十大死因之第一位，其中子宮頸癌為女性十大癌症死因之第七位。子宮頸癌能運用子宮頸抹片早期篩檢與治療，且為國民健康署防癌重點。護理人員多為女性，但以行為改變理論探討其抹片意圖之研究較少。
目的：以健康信念模式 (Health Belief Model) 探討女性護理人員之抹片意圖，及抹片經驗與性別氣質之調節作用。
方法：以立意取樣針對某醫院女性護理人員進行問卷調查，共收回1,001份，運用階層式羅吉斯迴歸及逐步迴歸，並以抹片經驗分層，分別檢視健康信念與抹片意圖之關係，並探討性別氣質之交互作用。
結果：無抹片經驗者中，自覺罹患性高者 (AOR=1.77)，及有抹片經驗者中，自覺嚴重度高者 (AOR=2.37)，其抹片意圖較高。另發現性別氣質具調節作用：於無抹片經驗且性別氣質陽剛者，若自覺行動障礙（與個人信念相關）高時 (AOR=0.28)，其抹片意圖較低，但若自覺行動線索多時 (AOR=2.12)，其抹片意圖較高。於有抹片經驗且性別氣質陽剛者，若自覺行動障礙（與個人信念相關）高時 (AOR=0.19)，其抹片意圖較低，但若自覺行動障礙（與檢查相關）高時 (AOR=18.44)，其抹片意圖較高。
結論：自覺罹患性與自覺嚴重度，分別為無以及有抹片經驗者之未來抹片意圖的主要影響因素，而性別氣質對自覺行動障礙與行動線索可能具調節作用。此可作為醫院在針對具不同抹片經驗及性別氣質之女性護理人員，推行適性之員工健康促進計劃時之實證參考依據。

關鍵字

健康信念模式 ； 女性護理人員 ； 子宮頸抹片意圖 ； 抹片經驗 ； 性別氣質

並列摘要

Background: Cancer ranked number one among the top ten causes of death in Taiwan in 2017, and among the 10 leading causes of cancer death in women, cervical cancer ranked seventh. Cervical cancer can be detected early through Pap smear screening, thereby allowing early treatment. Hence, Pap smear screening has been the focus of cancer prevention efforts of the Health Promotion Administration in Taiwan. Nurses are mostly female, but few studies based on behavior change theory have been conducted to investigate Pap smear screening intention among female nurses in Taiwan.

Objectives: Based on the Health Belief Model, this study aimed to examine female nurses’ Pap smear screening intention and to explore the moderating effects of their Pap smear screening experience and gender characteristic.

Methods: A questionnaire survey using purposive sampling was conducted among female nurses in a hospital in Taiwan. A total of 1,001 questionnaires were collected. Hierarchical logistic regression and stepwise regression were used for analysis. To explore the potential moderating effects of Pap smear screening experience, data were stratified as such to examine the relationships between health beliefs and Pap smear screening intention, as well as their interaction effects with gender characteristic.

Results: Among those without Pap smear screening experience, high perceived susceptibility (AOR=1.77) was related to greater Pap smear intention, whereas among those with Pap smear experience, high perceived severity (AOR=2.37) was associated with greater intention. Besides, gender characteristic was found to have moderating effects. Among masculine nurses without Pap smear experience, those who had high perceived barriers related to personal beliefs (AOR=0.28) were less inclined to receive a Pap smear; however, those who had more cues to action (AOR=2.12) had higher intention. Among masculine nurses with Pap smear experience, those who had high perceived barriers related to personal beliefs (AOR=0.19) had lower intention to receive a Pap smear; however, those who had high perceived barriers related to a Pap test (AOR=18.44) had greater Pap smear intention.

Conclusions: Perceived susceptibility and perceived severity were the main factors linked to Pap smear intention among those without and with Pap smear experience, respectively. Gender characteristic might moderate the effects of perceived barriers and cues to action on Pap smear intention. These findings can serve as an empirical basis for health promotion programs in the hospitals tailored for female nurses with different Pap smear screening experiences and gender characteristic.

並列關鍵字

Health Belief Model ； Female nurses ； Pap smear screening intention ； Pap smear screening experience ； Gender characteristic

參考文獻

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American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. Retrieved from https://onlinelibrary.wiley.com/doi/full/10.3322/caac.21139

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