運用健康信念模式探討透析患者接種流感疫苗行為之研究

目的：我國末期腎臟病發生率及盛行率高居世界第一，透析患者耗用大量的醫療健保資源，而感染又容易造成透析患者住院率及死亡率上升。研究顯示接種疫苗可以有效預防流行性感冒，故研究旨在運用健康信念模式探討透析患者接種流行性感冒疫苗的現況及其相關性。方法：採用結構式問卷進行立意抽樣調查，問卷經信度、效度檢定，整體問卷的內部一致性係數(Cronbach’s α)達0.888，並通過IRB審查。以臺中市區各透析醫療院所接受透析治療超過三個月之透析患者為研究對象，共回收486份有效問卷，問卷有效回收率為81%。結果：本研究對象流感疫苗的訊息來源以醫護人員最多（88.3%），2017年流感疫苗接種率為80.9%，健康信念中以自覺嚴重性的平均得分最高（3.85±0.65）。接種流感疫苗行為與自覺罹患性、自覺行動利益性及行動線索有顯著正相關(r=0.207~0373，p<0.01)；自覺接種流感疫苗障礙性則對接種流感疫苗行為達顯著低度負相關(r=-0.181，p<0.01)。自覺罹患性(β=0.23，p<0.001)、自覺嚴重性(β=-0.25，p<0.001)、自覺行動利益性(β=0.13，p=0.015)、自覺行動障礙性(β=-0.19，p<0.001)與行動線索(β=0.33，p<0.001)，可顯著預測研究對象接種流感疫苗的行為。結論：自覺罹患性愈高、自覺行動利益性愈高與行動線索愈多之透析患者，其接種流感疫苗行為亦愈高；自覺嚴重性與自覺行動障礙性愈高者，接種流感疫苗行為則愈低。本研究結果希望能提供政府規劃流感疫苗注射之參考，加強推廣民眾接種流行性感冒疫苗的認識及接受性，以提升流感疫苗接種率。

關鍵字

健康信念模式；透析患者；流行性感冒；流感疫苗的接種

並列摘要

Objectives: The incidence and prevalence rates of end-stage renal disease of Taiwan are the highest around the world. These dialysis patients consumed lots of healthcare insurance resources and caused the rates of hospitalization and mortality increased by infection. Many Studies have shown that influenza was prevented effectively by vaccination. Therefore, this research was carried out to investigate the behavior and correlation factors of influenza vaccination in dialysis patients based on health belief model. Methods: This research was performed via structured questionnaire with purposive sampling method. The questionnaire was verified through reliability and validity tests. The internal consistency coefficient (Cronbach’s α) of the questionnaire was reached 0.888. This research was reviewed and approved by the IRB. The selected subjects were who received dialysis more than three months in Taichung city. A total of 486 valid questionnaires were retrieved from the patients with a valid response rate of 81%. Results: It was found that the most frequency acquired news of the influenza vaccination were medical staffs (88.3%) in this study. The influenza vaccination rate was 80.9% in 2017. The highest average score of health belief model was perceived severity (3.85±0.65). There were positive correlations among influenza vaccination behavior, perceived susceptibility, perceived benefits of action, and cues to action (r=0.207~0373, p<0.01). There were negative correlations between influenza vaccination behavior and perceived barriers of action (r=-0.181, p<0.01). The perceived susceptibility (β=0.23, p<0.001), perceived severity (β=-0.25, p<0.001), perceived benefits of action (β=0.13, p=0.015), perceived barriers of action (β=-0.19, p<0.001) and cues to action (β=0.33, p<0.001) were significantly predicted the behavior of influenza vaccination. Conclusions: The higher perceived susceptibility, the higher perceived benefits of action, and the higher cues to action tend to had the higher behavior of influenza vaccination. However, the dialysis patients who has higher perceived severity and higher perceived barriers of action had lower behavior of influenza vaccination. The results of this study provide the government some useful suggestion to organize the influenza vaccination plans to promote awareness and acceptance of influenza vaccination in the citizens.