應用健康信念模式探討21-29歲臨床護理人員接受人類乳突病毒疫苗與子宮頸抹片檢查之相關因素:以北部兩所醫院為例

Using Health Belief Model to Evaluate Related Factors for Taking Human Papillomavirus Vaccine and Pap Smear Test among Clinical Nurses Aged 21-29: from Two Hospitals in Northern Taiwan

蔡宜芳(I-Fang Tsai)

指導教授 ： 季瑋珠

國立臺灣大學/公共衛生學院/流行病學與預防醫學研究所/碩士(2017年)

https://doi.org/10.6342/NTU201700764

摘要

研究背景: 子宮頸癌為全球女性第四大常見癌症，目前預防子宮頸癌發生的預防方法包含初級預防(人類乳突病毒疫苗)以及次級預防(子宮頸抹片檢查)。健康信念模式已被廣泛應用於探討執行健康行為之相關因素，關於探討施打人類乳突病毒疫苗的研究對象大多數以學生族群為主，而在子宮頸抹片檢查方面則是主要以30歲以上婦女作為研究對象，且較少研究將此兩項健康行為合併做探討。再者，臨床護理人員在推廣健康行為及預防醫學上扮演著重要的角色，但在台灣很少研究去針對此族群做探討。

研究目的: 透過完整的健康信念模式來預測影響21-29歲臨床女性護理人員接受人類乳突病毒疫苗及子宮頸抹片檢查之重要因素。

研究方法: 此研究為橫斷式研究，而透過自擬的結構式問卷進行訪問，此問卷效度經由專家效度評估，信度則是運用內容一致性(Cronbach’s α)。於2016.09-2017.01期間在台北兩所醫院收集205名21-29歲女性臨床護理人員進行結果分析，分析方法則運用探索性因素分析、描述性分析、多元迴歸分析及逐步邏輯式回歸。

研究結果: 在205名研究對象中，42.4%曾施打過人類乳突病毒疫苗，而認知程度、自覺行動障礙、自我效能及行動線索等變項在曾施打過疫苗者與未施打者兩組之間的得分有顯著差異(5.5 vs. 5.0, p-value=0.009; 7.6 vs. 13.5, p-value <.0001; 11.9 vs. 8.3, p<0.0001; 3.1 vs. 2.4, p-value=0.003)。經由逐步邏輯式迴歸分析結果顯示自覺行動障礙、自我效能及有無子宮頸癌家族病史(β=-0.22, Wald X2=20.24, p-value<.0001; β=0.28, Wald X2=20.5, p-value<.0001; β=1.52, Wald X2=4.56, p-value= 0.03)為施打疫苗之顯著預測因子。
而在子宮頸抹片檢查方面，僅有26.3%曾執行過檢查，而認知程度、自覺行動障礙、自我效能及行動線索等變項在曾執行過檢查與未執行過兩組之間得分有顯著差異(5.7 vs. 5.0, p-value= 0.006; 7.6 vs. 13.5, p= 0.0004; 9.9 vs. 8.4, p-value= 0.005; 3.4 vs. 2.8, p-value= 0.006)；經由逐步邏輯式迴歸分析結果顯示認知程度、自覺行動障礙、行動線索與婦產、血液腫瘤專科性護理師(β=0.25, Wald X2=4.06, p-value=0.04; β=-0.11, Wald X2=10.64, p-value=0.001; β=0.28, Wald X2=5.44, p-value=0.02; β=0.82, Wald X2=4.84, p-value=0.03)為執行子宮檢抹片檢查之顯著預測因子。

結論: 本研究顯示子宮頸癌疾病認知程度、自覺行動障礙、自我效能、行動線索皆影響年輕臨床護理人員有無執行預防子宮頸癌之健康行為，在臨床在職教育需加強護理人員對於子宮頸癌之預防方式。更重要的是醫院行政管理者必須提供護理人員更多的支持環境與主動的關懷，讓護理人員在忙碌的工作環境中能有更多的空間能關注自身健康。

關鍵字

年輕臨床護理人員 ； 健康信念模式 ； 人類乳突病毒疫苗 ； 子宮頸抹片檢查 ； 子宮頸癌認知程度

並列摘要

Background: Cervical cancer is the fourth common cancer in women and HPV vaccination and Pap smear screening played important roles in primary prevention and secondary prevention of cervical cancer. Health Belief Model has been used extensively to study beliefs and health behaviors of vaccination and Pap smear testing. Many previous studies focused on students in HPV vaccination and females who aged over 30 years in Pap smear testing. Besides, nursing staffs play an important role in promoting health behavior about prevention of disease, but few studies focused on this group in Taiwan.

Aim: To assess the predictability of taking HPV vaccine and Pap smear testing by socio-demographic variables, awareness and health belief among young nurses.

Methods: We designed the structured questionnaire tested the validity by experts and analyzed the internal consistency (Cronbach’s α) to assess the reliability. Between 2016.09-2017.01 we collected 205 nurses from two hospitals in northern Taiwan. This data was analyzed by exploratory factor analysis, descriptive statistics, stepwise multiple linear regression and stepwise multiple logistic regression.

Results: Among the 205 subjects, the vaccination rate was about 42.4%. The significant associated factors included awareness, perceived barriers, action cues and self-efficacy (5.5 vs. 5.0, p-value=0.009; 7.6 vs. 13.5, p-value <.0001; 11.9 vs. 8.3, p<0.0001; 3.1 vs. 2.4, p-value=0.003). Moreover, the significant predictors included perceived barriers, self-efficacy and family history of cervical cancer (β=-0.22, Wald X2=20.24, p-value<.0001; β=0.28, Wald X2=20.5, p-value<.0001; β=1.52, Wald X2=4.56, p-value= 0.03)
The rate of Pap smear testing was about 26.4%. The significant associated factors included awareness, perceived barriers, action cues and self-efficacy (5.7 vs. 5.0, p-value= 0.006; 7.6 vs. 13.5, p= 0.0004; 9.9 vs. 8.4, p-value= 0.005; 3.4 vs. 2.8, p-value= 0.006). Moreover, the significant predictors included awareness, perceived barriers, action cues and specialty nurses (β=0.25, Wald X2=4.06, p-value=0.04; β=-0.11, Wald X2=10.64, p-value=0.001; β=0.28, Wald X2=5.44, p-value=0.02; β=0.82, Wald X2=4.84, p-value=0.03).

Conclusions: The awareness of cervical cancer, perceived barriers, self-efficacy and action cues influence the subjects taking the prevention of cervical cancer. Therefore, providing on-job education of cervical cancer, and a supportive environment are the key factors to young nurses in the preventions of cervical cancer.

並列關鍵字

Young Clinical Nurses ； Health belief model ； Human Papilloma Virus Vaccination ； Papanicolaou Smear Testing ； Awareness of Cervical Cancer

參考文獻

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