探討護理人員對流感及其疫苗的知識、態度、行為之相關性及其影響因子

Exploring the association of knowledge, attitude, and behaviors regarding seasonal influenza and vaccination and the factors of vaccination behavior among nurses

劉雅芝(Ya-Chih Liu)

指導教授 ： 李雅玲

國立臺灣大學/醫學院/護理學研究所/碩士(2013年)

https://doi.org/10.6342/NTU.2013.10980

摘要

流行性感冒是公共衛生防疫重要目標，預防最佳辦法是接種疫苗。目前國內民眾接種率未達目標，而醫護人員是病患在做醫療決定時最常諮詢的對象，欲探討護理人員對流感及其疫苗的知識、態度、行為。
本研究為橫斷式描述性相關性研究設計，以分層隨機抽樣方式抽出樣本，研究對象為門診與病房護理人員，以及臨床試驗中心的研究護理師。以Zhang等(2012)所發展的護理師接種流感疫苗調查問卷(the King’s Nurses’ Influenza Vaccination Questionnaire, KNIVQ)為訪談工具，經專家審議後得整體CVI .65 -.83，研究內容得Cronbach’s alpha .70。
研究總共收案263位護理人員，結果發現，護理人員對流感及其疫苗之知識答對率為73%。對流感的危險性感受態度整體平均得分3.10 ± 0.42，控制信念態度以內在控制信念居多(4.30 ± 0.60)。過去有接種者佔72.2%，曾推薦病人接種者佔56.7%，未來預計接種者佔60.8%，未來預計會建議病人占62.7%。
將研究對象中的臨床護理人員與研究護理師執行次群體分析，臨床護理人員接種行為顯著高於研究護理師，過去接種(χ2= 34.02, p = .00)、未來接種(χ2 = 14.77, p = .00)；推薦行為則未達統計上顯著差異。以羅吉斯迴歸分析行為的影響因素發現，護理人員對流感及其疫苗「知識」、「流感危險性感受」與「強而有力他人控制信念」可預測未來接種行為(OR = 1.28, p = .00, 95% CI = 1.12-1.46)、(OR = 1.08, p = .04, 95% CI = 1.00-1.17)、(OR = 1.08, p = .02, 95% CI = 1.01-1.15)以及推薦行為(OR = 1.19, p = .01, 95% CI = 1.04 - 1.35)、(OR = 1.17, p = .00, 95% C I= 1.07-1.27)、(OR = 1.11, p = .00, 95% CI = 1.04 -1.19)。
接種疫苗行為是複雜的，本研究顯示提高知識及強而有力他人影響的態度可增加流感疫苗的接種行為以及推薦行為，建議護理領導者可加強應用研討會來增強護理人員對流感及其疫苗的相關知識，進而影響其自信的提昇以推展流感疫苗的接種及推薦給他人，確保接種率的提升。

關鍵字

護理人員 ； 流感 ； 疫苗 ； 知識 ； 態度 ； 行為 ； 研究護理師

並列摘要

The prevention of seasonal influenza is a major goal of public health. The best way of prevention is taking influenza vaccine. However the rate of influenza vaccination in public people is lower than expectation. Health care providers are the persons who can persuade people to engage in influenza vaccination when they have correct knowledge, positive attitude and convincing behaviors in influenza and vaccination. The goal of current study is to explore the correlation of knowledge, attitude, and vaccination behaviors and the factors of vaccination behaviors in nurses.
A cross-sectional and correctional design was conducted for the study. Stratified random sampling was used to recruit participants. The nurses in the outpatient department, inpatient wards, and clinical research units in a medical center in northern Taiwan were the target subjects. The structured questionnaire of the King’s Nurses’ Influenza Vaccination Questionnaire, KNIVQ, was the tool to collect data. Cronbach’s alpha coefficient calculated for the internal consistency of the scale is .70. The CVI of the study is .65-.83.
A total of 263 nurses have been recruited for the analysis of the study. It is found that 73% of participants have answered the knowledge questions about influenza vaccination correctly. The average of risk perception attitude regarding influenza vaccination is 3.10 ± 0.42 based on a five-point scale. The self-control health belief (4.30 ± 0.60) is their major attitude towards influenza vaccination. 72.2% of participants report that they have received influenza vaccine before. 56.7% of them have recommended people to receive influenza vaccine before. The percentage of the participants themselves would like to receive and recommend people to receive influenza vaccine in the future is 60.8% vs 62.7% respectively.
Based on subgroup analysis, there is significant difference of influenza vaccination behavior between bedside nurses and clinical research nurses in the past (χ2 = 34.02, p = .00) and the willingness of receiving influenza vaccination in the future (χ2 = 14.77, p = .00), but no significant difference in recommendation behavior. Logistic regression analysis revealed that three variables of knowledge, risk perception and powerful others health locus of control towards influenza and influenza vaccination are the both predicting factors of future vaccination behavior, OR=1.28, p=.00, 95% CI=1.12-1.46; OR=1.08, p=.04, 95% CI=1.00-1.17; OR=1.08, p=.02, 95% CI=1.01-1.15, respectively, and future recommendation behavior, OR=1.19, p=.01, 95% CI =1.04 - 1.35; OR=1.17, p=.00, 95% CI=1.07-1.27; OR=1.11, p=.00, 95% CI = 1.04 -1.19, respectively.
It is complex to understand the influenza vaccination behavior. Current study found that nurses who have higher knowledge score are more likely to have higher influenza vaccination and recommendation behaviors. It is suggested that nursing leaders may organize more influenza and influenza vaccination related programs for clinical nurses in order to increase their confidence, vaccination and recommendation behaviors.

並列關鍵字

nurse ； influenza ； vaccination ； knowledge ； attitude ； behavior ； clinical research nurse

參考文獻

Ben-Ari, A. (1996). Israeli professionals' knowledge and attitudes towards AIDS. Social Work in Health Care, 22(4), 35-52. doi: 10.1300/J010v22n04_03

中文部分

王任賢 (2009)．疫苗發展之過去、現在興未來．感染控制雜誌，19(6), 370-374。

王蓉君、李明亮、莊再成 (2006)．新型流感疫苗之臨床試驗．Acta Paediatrica Taiwanica, 47(s)，18-22。

行政院衛生署疾病管制局 (2008)．季節性流感防治工作指引．臺北市:衛生署http://www.cdc.gov.tw/infectionreportinfo.aspx?treeid=075874dc882a5bfd&nowtreeid=8dba723ff186fac0&tid=9398F7A4E003C44A.