影響醫院病患個人健康紀錄使用意願之因素

The Factors Affecting Intentions of Patient to Use Personal Health Record in Hospital

廖珮雯(Pei-Wen Liau)

指導教授 ： 溫信財

臺北醫學大學/公共衛生暨營養學院/醫務管理學研究所/碩士(2011年)

https://doi.org/10.6831/TMU.2011.00144

摘要

研究背景與目的：個人健康紀錄（Personal Health Record, PHR）是一個可以協助病患作健康決策的工具，它不僅可以提供病患所需的相關資訊，也可以降低病患與照護者間溝通的障礙，更能維護、管理自身的健康。美國、歐洲等先進國家，已經逐漸重視個人健康紀錄所帶來的實際效應；微軟（Microsoft Health Vault）與Google（Google Health）也提供個人健康資訊紀錄的全新網路服務，並與美國醫療院所連結，提供使用者專屬個人健康資訊紀錄與健康資訊提供。然而病患對於個人健康紀錄之態度及使用意願，將影響此系統之效益。故本研究欲瞭解並探討影響病患個人健康紀錄之認知與使用意願之相關因素，以及比較不同科別對個人健康紀錄使用意願的差異。
方法：本研究受試樣本為北部某醫學中心之家醫科、小兒科及婦產科三類病患。研究工具為結構式問卷。調查期間為99年12月22日至100年3月23日，回收有效問卷為：家醫科237份、小兒科231份及婦產科229份，總計697份。問卷資料經整理後，分別使用SPSS13.0與AMOS17.0統計套裝軟體，進行描述性及結構方程模式（Structural Equation Modeling, SEM）統計分析。
結果：本研究取得SEM最佳解釋模型，模式之卡方值/自由度為2.836、GFI為0.923、AGFI為0.902、RMSEA為0.051，表示整體模式有合理的適配度。在諸多影響病患PHR使用意願之因素中，最顯著的為「使用態度」（總效用 = 0.705），且本研究相關變項可解釋使用意願72.4%之變異，其中知覺有用性及使用態度對使用意願有正向之顯著影響。而其他自變項間之相關統計發現，知覺易用性對知覺有用性有顯著正向影響，知覺易用性可解釋知覺有用性42.2%的變異，且知覺有用性及知覺易用性對使用態度有顯著之正向影響，此兩變項可解釋使用態度42.2%之變異。另外，在多群組分析發現，家醫科、小兒科、婦產科三組的參數配對是有差異的。
結論：對影響病患個人健康紀錄使用意願之因素，本研究建構了合理適配度的模型，所得結果亦符合科技接受模式（TAM）理論，因此，醫院可針對個人健康紀錄之有用性與易用性進行知識推廣，以增加病患使用意願，由於大部分病患對個人健康紀錄均持正向態度且願意使用，此結果可視為未來推動個人健康紀錄發展的契機。

關鍵字

個人健康紀錄；科技接受模式；健康知能；數位落差；構方程模式；多群組分析

並列摘要

Background and Objectives: Personal Health Record（PHR）provided not only the related information for patient need as well as reduced patients-caregivers barriers
of communication, it also can maintain and manage the data of their own health. Therefore, PHR is a useful tool helps patients make their own health decision. The United States, Europe and many developed countries, have emphasized more and more on the benefits brought by the PHR. For example, Microsoft Health Vault and Google Health have provided a new personal health information network services which linked with U.S. hospitals to provide patients’unique personal health information. However, we believe that whether the PHR system could be successful implemented depends on patients’attitude and behavior intention. This study based on Technology Acceptance Model will explore the factors affecting patients’intentions of PHR. In addition, we will also compare patients’behavior intention of PHR in three different divisions of hospital.
Methods: It was a cross-sectional study and conducted by structured questionnaire. The subjects are comprised of Pediatrics, Family medicine and Obstetrics and Gynecology patients from a northern Taiwan hospital which volunteered to participate in this project. After verifying validity and reliability of questionnaire, data were collected from December 22, 2010 to March 23, 2011. A total of 697 valid questionnaires which were collected 237, 231 and 229 questionnaires from Pediatrics, Family medicine and Obstetrics and Gynecology divisions respectively. The SPSS 13.0 and AMOS 17.0 statistics software were used to analyze data and verify the hypothesis.
Results: This study has applied SEM and got the optimized model that χ2/df, GFI, AGFI and RMSEA were 2.836, 0.923, 0.902 and 0.051 respectively, which fitted the theoretical model well. Our results showed 72.4% variances of patients’ PHR behavior intention was explained by all of 7 independent variables and the most significant factor was patients’ attitude（total effect = 0.705）. Furthermore, perceived usefulness（PU）and perceived ease of use（PEU）influenced attitude positively and explained 42.2% of its variances. Also, PEU has positive influenced on PU and explained 42.2% of its variances, too. Finally, the optimized model of family medicine, pediatrics, obstetrics and gynecology patients were built by multi-group analysis, and some pairs of parameters among three departments were significant different.
Conclusions: This study has constructed a model which had a reasonable goodness of fit for affecting the acceptance of PHR. Our results also corresponded to Technology Acceptance Model（TAM）, so hospitals can promote the usefulness and ease of use of PHR to raise patients’willingness. Since most patients have positive attitude and willingness to use PHR, it would be a good opportunity for us to develop and implement PHR in the near future.

並列關鍵字

Personal Health Record（PHR）；Technology Acceptance Model（TAM）；Health Literacy；Digital Divide；Structural Equation Modeling（SEM）；Multi-Group Analysis

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