彰化縣地區民眾之疾病預防價值觀、自我效能與大腸癌糞便潛血檢查(FOBT)篩檢行為、行為意向之關聯性：個案對照研究

Disease prevention values and self-efficacy regarding faecal occult blood test (FOBT) related to colorectal cancer screening behavior and intention – a population based case-control study in central Taiwan

黃冠蓁(Kuan-Jen Huang)

指導教授 ： 陸玓玲

中山醫學大學/健康管理學院/公共衛生學系碩士班/碩士(2016年)

摘要

目的：
在個人層次，探討疾病預防整體價值觀、自我效能、行動線索與大腸直腸癌糞便潛血檢查(FOBT)篩檢行為及未來FOBT篩檢意向之關係。在環境層次，則運用多層次分析，探討鄉鎮市之教育程度、收入狀況與FOBT篩檢行為和未來FOBT篩檢意向之關係。

材料方法：
本研究為一橫斷式個案對照研究。將彰化縣50-74歲之參與者，按其2015年之FOBT篩檢行為區分為四組：規律篩檢（對照組）、不規律篩檢、首次篩檢、從未篩檢，於2015年9月至2016年1月以家戶訪查問卷進行資料收集。測量社會人口學、個人及家族疾病數、疾病預防整體價值觀、自我效能、行動線索及未來FOBT篩檢意向等重要變項。最終回收814人，四組完訪率分別為：規律篩檢（對照組）46.00%、不規律篩檢41.92%、首次篩檢39.53%、從未篩檢36.48%。環境層次資料部分，使用104年度彰化縣政府民政處之大專畢業及以上人口比例作為鄉鎮市教育程度指標、102年度財政部之彰化縣鄉鎮市年所得中位數作為收入狀況指標。以SAS 9.4進行卡方檢定及ANOVA檢定檢視個人層次資料之基本分布狀況，後以HLM進行個人層次、環境層次之多變量、多層次分析。

研究結果：
個人層次方面，疾病預防整體價值觀部分，首次篩檢、從未篩檢者其分數較規律篩檢者低，而FOBT自我效能部分，不規律篩檢、首次篩檢、從未篩檢者其自我效能是皆較規律篩檢者差。另外，疾病預防整體價值觀越正向、FOBT自我效能越好，其未來FOBT篩檢意向亦會相對提升，而在篩檢行為部分，從未篩檢者其未來FOBT篩檢意向分數較規律篩檢者低。行動線索部分，則僅與未來FOBT篩檢意向有關聯，接收到較多元之行動線索，未來FOBT篩檢意向分數越高。環境層次方面，居住在中、高教育程度鄉鎮市者，其從未篩檢之可能性皆較居住在低教育程度鄉鎮市者高，而鄉鎮市之收入狀況則與FOBT篩檢行為無關。最後，在本研究中鄉鎮市之社會經濟地位與未來FOBT篩檢意向亦無關聯。
結論：
本研究發現個人的疾病預防價值觀與自我效能是FOBT篩檢行為及篩檢意向的重要相關因素，未來提升民眾接受FOBT之介入計畫與衛生教育應加以考量。此外亦發現鄉鎮市教育程度為FOBT篩檢行為之相關因子，收入狀況則非，可推知彰化縣推行組織行篩檢能有效克服因鄉鎮市收入不同而產生之健康不平等，但地區教育程度之差異仍然存在。

關鍵字

疾病預防價值觀 ； 自我效能 ； 行動線索 ； 糞便潛血檢查(FOBT) ； 篩檢行為 ； 篩檢意向 ； 地區教育程度 ； 地區收入狀況 ； 多層次分析

並列摘要

Objectives:
The aim of this study in individual level was to identify the relationships between independent variables [(1) disease prevention related values, (2) cues to action and (3) self-efficacy regarding Faecal Occult Blood Test (FOBT)] and outcome variables (FOBT behavior and intention to future FOBT) in a community population. As for environmental level, this study used multilevel analyses to specify the relationships between outcome variables (FOBT screening behavior and intention to future FOBT) and independent variables (Education level and income status of townships).
Methods:
A community-based case-control study was conducted by cross-sectional household survey (questionnaire). According to FOBT screening behaviors in 2015, we divided four groups as (1) regular screenees (ever-screenees and completing FOBT in 2015, as control group), (2) irregular screenees (ever-screenees but not completing FOBT, as case A), (3) first screenees (never-screenees and completing FOBT, as case B), (4) never screenees (never-screenees and not completing FOBT, as case C). Participation rates of each group were 46.00% (control group), 41.92% (case A), 39.53% (case B), 36.48% (case C), respectively. A total sample of 814 participants, those aged 50 to 74 lived in Chunghua County, was collected during September, 2015 to January, 2016.
Results:
Both individual level models were adjusted for gender, age, education, job, income, and personal disease history. For FOBT behavior: (1) disease prevention value of first and never screenees were lower than regular screenees (Odd ration (OR) =0.96 and 0.94, respectively); (2) self-efficacy in irregular, first screenees, and never screenees were lower than regular screenees (OR=0.89, 0.86 and 0.72, respectively). For intention to future FOBT: (1) those who perceived higher disease prevention value showed higher intention to future FOBT; (2) those who reported higher self-efficacy also showed higher intention to future FOBT; (3) never screenees’ self-efficacy were lower than regular screenees. Cues to actions only show significant relationship with the intention to future FOBT: those who received more cues showed higher intention to future FOBT. For environmental level results, this study discovered that those lived in a higher education level township were more likely to possess never screening behavior (compared to regular screening behavior). The income status of townships did not show significant relationship with FOBT behavior. Neither the education level nor the income status of townships has shown a significant relationship with the intention to future FOBT.
Conclusions:
In individual level, disease prevention values and self-efficacy were significantly positive associated with FOBT behavior and intention. Future intervention and health education program could consider these factors to improve FOBT behavior. In environment level, the education level of townships has found to be a factor of FOBT behavior, but not related to intention. The income status of townships, however, did not show any relation with neither FOBT behavior nor the intention to future FOBT. Our study suggests that organized screening in Chunghua County could successfully reduce the possible health inequity caused by different income status of townships.

並列關鍵字

disease prevention values ； self-efficacy ； cues to action ； faecal occult blood test (FOBT) ； screening behavior ； screening intention ； education level of region ； income status of region ； multilevel analysis

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