病患個人碳足跡與低碳就診行為意向之研究–以北部某區域教學醫院為例

Studies on Patients’ Carbon Footprint & Intention for Low-carbon Healthcare: A Study Case of a Regional Teaching Hospital in Northern Taiwan

陳華強(Hua-Chiang Chen)

指導教授 ： 湯玲郎

元智大學/管理學院/管理碩士在職專班/碩士(2012年)

摘要

全球暖化的環境問題需要全世界共同致力於緩和氣候變遷；隨著低碳經濟的到來，各行業開始計畫自己的低碳時代，而需要謀劃佈局的行業，自然包括本來就司職維護健康的醫療機構。因此也有必要說服人們改變其就診行為以善待我們的環境。環境行為研究中，學者們認為計畫行為理論能提供研究者預測病患個人看診就醫時，對環境的可能影響行為，進而在其行為之前有所預防與宣導。
本研究目的如下：（1） 嘗試以計畫行為理論建構病患者之低碳就診行為意向模式；（2）瞭解不同個人碳足跡總分的病患者在低碳就診行為意向模式中之差異；（3）瞭解病患基本屬性變項對低碳就診行為意向模式中的態度、主觀規範、知覺行為控制、行為意向之差異。
本研究以Ajzen提出之計畫行為理論為基礎設計問卷，並在北部某區域教學醫院，進行現地病患問卷調查，採用便利抽樣方式，總調查物件為330份，回收有效問卷287份，有效問卷回收率為87%。本研究使用描述性統計敍述病患個人之基本屬性，再以結構方程式分析（SEM）檢驗低碳就診行為意向模式之潛在變項及影響情形，並比較不同碳足跡病患在結構模式內之差異，最後以t檢定、單因數變異數分析進行不同病患的基本屬性在模式內變項之差異分析。
本研究由原始模式進行修正檢查，最後獲得修正模式之整體適配指標均可以接受，研究結果顯示：
（1）患者對低碳就診行為的態度、主觀規範、知覺行為控制會顯著正向影響低碳就診行為意向；而各信念個別顯著正向影響其態度、主觀規範、知覺行為控制；（2）不同個人碳足跡分數的患者在低碳就診行為意向模式中有顯著差異；（3）不同基本屬性的患者對低碳就診行為的態度、主觀規範、知覺行為控制有顯著差異，分析結果表明除了性別變項無差異外，其他各方面基本屬性如年齡、教育程度、就診時從事低碳就診行為之情形、參與保育團體情形、高低碳足跡者、居住地區等均有著顯著差異。
本研究建議未來低碳就診行為的政策實施與教育宣導層面，應該從個人的主要信念著手，才能促進患者從事低碳就診行為的意願。另外，個人生活碳足跡的高低，亦會使態度、主觀規範、知覺行為控制影響行為意向之程度有所不同，本研究結果顯示，可從態度、主觀規範、知覺行為控制影響低碳足跡者的行為意向，至於高碳足跡者則要從態度與主觀規範去著手。政府也可藉由推動低碳醫療事業的發展，進而提升整體效果。

關鍵字

低碳就診 ； 計畫行為理論 ； 信念 ； 態度 ； 主觀規範 ； 知覺行為控制

並列摘要

The environmental issues of global warming need the commitment of the whole world to alleviate the climate change. With the advent of low-carbon economy, various industries intiitate their strategies and plans to deal with the prospective businesses for the coming low-carbon era, and the scope of the services certainly includes hospitals and other medicare insitutions. The traditional healthcare practices may cause the increase of total carbon dioxide emissions; therefore, people should be convincd to change their healthcare behaviors and pay more concerns bout the environment.
In the studies of environmental behavior, the scholars pointed out that the theory of planned behavior may provide researchers the measurement to predict the healthcare activities and the behavior that may affect the environment; thus the patients need to be educated and guided which behavior should be avoided.
The purposes of this study focuses on (1) The theory of planned behavior is applied to construct an intention model for patients’ low-carbon healthcare behavior; (2) To find out differences of the intention models in patients’ low-carbon heathcare behaviors at the aspect of total footprints of different individuals; (3) To find out differences of intention models in variables of patients’ individual attribute towards low-carbon hearthcare behaviors at the aspect of maners, subjective norms and perceived hehavior control, and behavior intention.
In this study, questionnaires are designed based on Ajzen’s theory of planned behavior; the data collection was made at a regional teaching hospital in northern Taiwan. The survey was conducted in random sampling of patients on site. Fom a total of 330 questionnaires, 287 valid questionnaires were received; the effective response rate was 87%.
In this study, firstly, a descriptive analysis was conducted to described the individual attribute of patients; secondly, a Structural Equation Analysis (SEM) was conducted to examine potential effect of low-carbon behavior intention model on latent variable and to compare the differences of the carbon footprints in the structure of the model. Finally, we use t test analysis, and one way ANOVA analysis of individual attribute from various patients to test the significant differences.
In this study the original models were tested and adjusted. Both the revised model and the final revised model were acceptable as indicators. The findings of the study have shown (1) The attitude, subjective norms and perceived behavioral control on low-carbon healthcare behavior of patients are significantly and positively correlated with patients’ intentions of low-carbon healthcare behavior; while some of the beliefs are significantly and positively correlated with patients' attitude, subjective norms and perceived behavioral control; (2) patients’carbon footprints were divided into two categories: i.e. low-carbon footprint and high-carbon footprint. They have significant differences in the behavioral intention model of low-carbon treatment; (3) Patients’ different basic attributes toward the low-carbon hearthcare behavior, subjective norms and perceived behavioral control are significantly different. The ANOVA analysis have shown: except the variables of gender, the rest aspects of basic attributes, such as age, education level, and patients’ low-carbon heathcare behavior, participation of reservation groups, and degree of low-carbon footprints and inhabitant are significantly different.
In view of future policy on low-carbon healthcare behavior and its implementation and education, this study proposes that personal beliefs should first be dealt with before patient's willingness toward low-carbon healthcare behavior can be promoted. In addition, the level of personal carbon footprint will affect the behavioral intention in various degrees by attitude, subjective norms, and perceived behavioral control. The findings of this study show that attitude, subjective norms, and perceived behavioral control enable to affect the behavior intentions of low-carbon healthcare footprints. For high carbon footprints, we may first deal with patients’ attitude, and subjective norms. The government may also push forward the development of low carbon healthcare businesses for even better integral effectiveness.

並列關鍵字

subjective norms ； perceived behavioral control ； low-carbon healthcare ； theory of planned behavior ； belief ； attitude toward the behavior

參考文獻

1. 王國川，（1998），計劃行為理論各成份量表之設計、發展與建立，國立臺灣師範大學衛生教育研究所，師大學報：教育類，43（2），67-91。

8. 楊俊仁 (2010)，以PAS(2050)標準探討產品碳足跡評估與查證之研究，元智大學經營管理碩士在職專班碩士論文。

9. 溫玉嬌 (2010)，探討醫療機構碳足跡之研究-以血液透析治療為例，元智大學經營管理碩士在職專班碩士論文。

13. Ajzen, I., （1991）, The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50, 179-211.

15. Ajzen, I., (2002), Residual effects of past on later behavior: Habituation and reasoned action perspectives. Personality and Social Psychology Review, 6:107~122.