以健康信念模式分析民眾對大腸癌篩檢再檢行為影響之研究-以中部某地區醫院

大腸癌於近幾年位居癌症十大死因第三名，多數民眾常忽視篩檢又因錯誤的認知，延誤治療而導致在診斷時已近末期癌症而死亡，喪失可藉由篩檢早期發現大腸癌早期治療甚至痊癒之機會。雖然目前篩檢率已逐年提高，但再次篩檢率與初次篩檢率有明顯的落差。許多民眾雖曾經接受篩檢，不知為何因素影響其再次篩檢的行為，導致延誤最佳治療時間，因此希望透過此研究瞭解民眾之想法改善篩檢教育宣導模式，提升民眾的再次篩檢率。本研究對象中部某地區醫院符合現今衛生福利部大腸癌糞便潛血篩檢檢查政策年齡之條件，納入條件為50-74歲兩年可做一次此篩檢者，且於2016年該醫院做過大腸癌糞便潛血篩檢檢查，個案共737名，經條件篩檢後，母群體共為719名，再將母群體分為2018年未再接受篩檢者為487人與2018年再次接受糞便篩檢者研究對象為232人;將由這兩群研究對象，以系統等距抽樣方式每兩位研究對象抽取一人，無再次篩檢為46人，有再次篩檢為76人；一共收集研究對象為122人。並事先以電話詢問是否願意接受調查，若遇不同意者再以未抽中者為替代樣本進行調查，再寄出問卷進行郵寄。運用健康信念模式探討大腸直腸癌糞便潛血再篩檢行為為研究架構，調查民眾對於大腸直腸癌糞便潛血篩檢的健康信念行為與再次接受篩檢行為的相關性。研究將採描述式統計、t檢定、卡方檢定及邏輯式回歸等分析法，將蒐集資料利用SPSS 25.0統計軟體進行資料分析。民眾大腸直腸癌糞便潛血檢查再次篩檢率為62.3%;在健康信念模式的自覺行動利益上接受再次篩檢者之得分高於未再篩檢者。影響民眾大腸直腸癌糞便潛血檢查再次篩檢之邏輯斯回歸分析發現自覺行動利益是影響民眾再篩檢的重要因素，自覺行動利益之得分每增加1分將可增加其再篩機率之2.38倍，自覺行動利益性愈高者再次接受篩檢行為愈高。本研究發現自覺行動利益者是影響民眾再篩檢之重要影響因素，由於再篩需要再花費時間成本，如果要提高民眾再次篩檢行為，除提醒罹患大腸直腸癌之風險外，更需強調篩檢的舒適、簡單、方便、安全與免費更能使民眾再次篩檢意願提高；以提升民眾定期接受篩檢比率，降低其死亡率。

關鍵字

大腸直腸癌；糞便潛血篩檢；健康信念模式；癌症篩檢

並列摘要

Colorectal cancer has been the third leading cause of cancer death in recent years. However, many people often ignore screening or delay treatment due to misbelief, and the loss of opportunity to detect and treat colorectal cancer early would lead to advanced cancer or death. Although the current screening rate has increased year by year, there is an obvious gap between the rescreening rate and the initial screening rate. Although many people have received screening, they often fail to receive the rescreening for unknown reason, resulting in the delay in optimal treatment time. This study aims to understand factors affecting people’s willingness to receive rescreening, thus improving the rescreening promotion approaches and increase the re-screening rate. The research subjects were patients meeting the current criteria for colorectal cancer FOBT of the Ministry of Health and Welfare policy. The inclusion criteria included: people aged 50-74 who is entitled to receive the FOBT screening once within 2 years; people who had received colorectal cancer FOBT screening at the study hospital in 2016. This study enrolled a total of 737 subjects. Based on the subjects meeting the criteria, the parent population included 719 subjects, which were further divided into 487 subjects who did not receive the rescreening in 2018 and 232 subjects who received the FOBT rescreening in 2018. This study then selected 1 out of every 2 subjects from these two groups using systematic sampling, and obtained 46 subjects without rescreening and 76 subjects with rescreening, totally 122 subjects. The researcher contacted the subjects via phone in advance to ask about their willingness to participate in the research. If a subject rejected the research, another subject was sampled from the pool. Afterwards, questionnaires were distributed via mail. This study used health belief model to investigate the rescreening behavior of colorectal cancer FOBT as the research framework, and probe into the correlation between subjects’ health belief behavior in colorectal cancer FOBT screening and rescreening behavior. Statistical methods, such as descriptive statistics, t-test, chi-square test, and logistic regression analysis, were used to analyze the collected data using SPSS 25.0. The rescreening rate of colorectal cancer FOBT of the subjects was 62.3%. The score of self-perceived action benefits in the health belief model of the subjects who received the rescreening was higher than that of those who did not receive it. The logistic regression analysis on the factors affecting the subjects’ willingness to receive the rescreening of colorectal cancer FOBT showed that self-perceived action benefits was an important factor. Every increase in the score of self-perceived action benefits by 1 point led to the increase in the rescreening rate by 2.38 times. The rescreening behavior of the subjects with higher self-perceived action benefits was higher. This study found that self-perceived action benefits were an important factor affecting subjects’ willingness to receive the rescreening. As rescreening consumes both time and cost, in order to increase the public’s rescreening behavior, in addition to reminding them of the risk of colorectal cancer, it is also necessary to emphasize the advantages of screening, such as comfort, simplicity, convenience, safety, and free-of-charge, so as to increase people’s willingness to receive periodic screening rate and reduce mortality. Keywords: Colorectal Cancer, Fecal Occult Blood Test Screening, Health Belief Model, Cancer Screening