應用健康信念模式探討影響台中市南屯區老年人利用衛生所社區健康篩檢服務相關因素

The factors of utilizing the health screening service of community health center for the Elderly in Nantun District of Taichung City --Application of Health Belief Model--

曾慧娟(HUI-CHUAN TSENG)

指導教授 ： 何清松

亞洲大學/健康學院/長期照護研究所/碩士(2007年)

摘要

由於人口老化及人口結構的改變，高齡化的相關社會議題，漸漸受到大家的關注及重視。老化隨之而來的社會問題，帶來有關老年人醫療費用高漲、慢性病、身體功能退化等，成為家庭、社會、國家沉重的負擔與極大的衝擊。而在我國現行的衛生政策之中，為了加強對老年人的健康照顧，將中老年病與癌症防治視為我國公共衛生現行的重要議題；其中，『健康篩檢』則是達到預防保健成效之先機。
我國行政院衛生署分別自1985年及2005年訂定中老年病防治計畫與國家癌症防治五年計畫，全面推廣中老年病防治工作，而由各鄉鎮之醫療保健服務中心---衛生所，提供主動且深入社區的健康篩檢服務。本研究採用健康信念模式，探討影響社區老年人利用衛生所社區健康篩檢服務的利用情形，並分析影響其利用社區健康篩檢服務的相關因素，藉以提出建議，供未來衛生主管機關在老年人健康促進相關計畫中的參酌。
本研究以台中市南屯區65歲以上之社區老年人348名為研究對象，使用結構式問卷，調查社區老年人利用衛生所社區健康篩檢服務及其相關影響因素。資料分析方法採用邏輯式迴歸模式針對社區老年人是否接受衛生所社區健康篩檢服務與人口學基本特性、對健康篩檢相關信念（慢性病和癌症的罹病性與嚴重性認知）、健康篩檢行動線索、健康篩檢之利益性及障礙性認知及其採取健康篩檢行為等自變項進行分析，以瞭解社區老年人利用衛生所社區健康篩檢服務的相關因素。

研究結果顯示：
（一）社區老年人在衛生所健康篩檢服務利用率為26.1%。
（二）人口學基本特性中的性別（P<0.05）、自己和同年齡的親友相比後自己的健康狀況（P<0.05）與社區老年人是否接受衛生所健康篩檢服務有相關。
（三）行動線索中，愈知道健康篩檢項目（P<0.000）、健康篩檢利益性減去障礙性得分愈高（P<0.000）與是否接受衛生所健康篩檢服務間有顯著之差異。
（四）在邏輯式迴歸分析中，指出：行動線索與是否接受衛生所健康篩檢服務（β=0.391，P< 0.05）呈現正相關；亦即愈清楚衛生所提供的健康篩檢項目者，愈會來參與衛生所健康篩檢服務；健康篩檢利益性減去障礙性得分與是否接受衛生所健康篩檢服務（β=43.157，P< 0.000）呈現正相關；即認為衛生所健康篩檢服務利益性得分愈高，比較會來參與衛生所健康篩檢服務，以上這些變項的預測情形達統計上的顯著水準。

根據研究結果提出以下之建議：
（一） 瞭解社區老年人不使用衛生所健康篩檢服務的原因。
許多不會使用衛生所健康篩檢服務的原因是「已習慣在醫療院所做健康篩檢」、「衛生所的健康篩檢項目太少」、「衛生所的健康篩檢後沒有追蹤服務」、「衛生所的健康篩檢服務後沒有醫療門診」。社區老年人希望衛生所加強中老年保健及健康檢查，期待衛生所朝向慢性疾病醫療照護項目發展。
（二） 提昇社區老年人對衛生所預防保健服務的認知程度。
應行銷衛生機關的功能與角色，包裝並宣傳衛生所提供的預防保健服務項目，以改變民眾價值觀，主動尋求衛生保健服務。
（三） 以多元化管道宣導衛生所健康篩檢服務的目的及內容與重要性。
藉由宣傳單張印製、加強地方領袖對健康篩檢內容的認識及了解、成立宣導及志工小組，以電話通知的方法，提昇老年人對衛生所健康篩檢利用率。

關鍵字

健康信念模式 ； 衛生所 ； 健康篩檢

並列摘要

Due to increased number of aging population and population structure changes, people are concerned about aging-related problems that put great burdens and make enormous impacts on the family, society, and nation. The problems include increased medical expense, chronic diseases, and degeneration of the elderly. The prevention of chronic diseases and cancers for the middle-aged and the elderly are taken as an important issue in our nation’s contemporary public health policy of enhancing healthcare for the elderly. Among the measures, "health screening" is a priority in achieving the goal of disease prevention and healthcare.

Bureau of Health Promotion made a plan to prevent chronic diseases for the middle-aged and the elderly and a five-year national plan to prevent cancers, in 1985 and 2005 respectively. These plans aim at promoting overall disease prevention for the middle-aged and the elderly. Community health center – medical center for healthcare services in towns and townships - provide initiative health screening services for each community. This research uses the Health Belief Model to explore influence on community health screening services for the elderly. Besides, related factors of the influence are also discussed. Suggestions provide reference for future related plans of Bureau of Health Promotion.

The subjects of the study are the elderly in the Nantun District of Taichung City aged 65 or above, 348 citizens in total. A questionnaire with closed questions is used to investigate the elderly use of community health services provided by community health center and related factors influencing the use. The method of data analysis Logistic Regression Model is used to analyze the elderly use of health screening services, basic demography characteristics, beliefs for health screening (perceived susceptibility and severity of chronic diseases and cancers), cues to health screening actions, and perceived benefits and barriers of health screening. In addition, the independent variable of health screening behavior is used to analyze the factors of the elderly use of health screening services provided by community health center.

The findings of the study include:
(1) 26.1 percent of the elderly in community used the health screening services provided by community health center.
(2) The gender (P<0.05) of basic demography characteristics and the health state (P<0.05) of the elderly compared to that of the relatives and friends of the same age correlate with the elderly use of health screening services by community health center.
(3) In cues to actions, the knowledge of health screening items (P<0.000), the difference between perceived benefits and barriers (P<0.000) correlate with the use of health screening services provided by community health center.
(4) The analysis by Logistic Regression Model indicates cues to action have positive correlations with the use of health screening services (β=0.391, P<0.05) provided by community health center. In other words, the clearer the understanding of health screening items, the more the use of health screening services. The difference between perceived benefits and barriers has positive correlation with the use of health screening services (β=43.157, P<0.000). That is, the more perceived benefits of health screening services provided by community health center, the more use of the services. The predictions of these variables attain statistically significant levels.

According to the findings, the following suggestions are proposed:
(1) Understanding reasons for the elderly not using health screening services provided by community health center.
The reasons for many people not using health screening services is “being used to having health screening services in hospitals”, “health screening items in community health center were few”, “no follow-up after health screening”, “no outpatient services after health screening provided by community health center”. The elderly in community hope community health center can enhance healthcare and health screening services for the middle-aged and the elderly. They expect community health center to develop medical care items for chronic diseases.
(2) Increasing the elderly perceptions of preventive healthcare services provided by community health center.
The function and role of community health center should be marketed. The package and propaganda of preventive healthcare services provided by community health center will change people’s values and make them seek for health care services.
(3) Using multiple channels to propagate the purpose, content, and importance of health screening services in community health center.
The use of health screening services can be promoted by printing flyers, enhancing local leaders’ understanding of health screening content, and establishing propaganda and volunteer groups making phone calls.

並列關鍵字

Health Belief Model ； community health center ； health screening

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