台灣地區影響婦女接受子宮頸抹片醫療服務之研究

A Study Exploring the Factors Influencing Women Receiving Papanicolaou Smears in Taiwan

許嘉琳(HSU-CHIA-LIN)

指導教授 ： 吳明勳 ； 張明正

亞洲大學/健康學院/健康管理研究所/碩士(2008年)

摘要

中文摘要
子宮頸癌自民國71 年起，為我國女性高發生率、高死亡率之癌症，也是最適合實施篩檢的癌症。我國婦女接受子宮頸抹片篩檢比例偏低，因此探討其相關因素有助於提昇篩檢率。本研究使用ANDERSEN醫療服務利用行為模式為研究架構，資料來源係取自行政院衛生署國民健康局的「民國九十一年台灣地區國民健康促進知識、態度與行為調查資料庫」來進行資料分析，目的在了解台灣地區婦女接受子宮頸抹片檢查的預防保健服務之相關因素，與分析接受過子宮頸抹片檢查的婦女進行人口統計學變項對服務品質滿意度的影響，並了解未接受子宮頸抹片檢查的預防保健服務之成因。利用統計軟體SPSS15.0進行描述性統計、卡方檢定、階層式邏輯斯迴歸、因素分析、信度分析、變異數分析、多重比較等統計方法分析，根據統計資料分析结果：
經卡方檢定後，將傾向、能用、需要因素中具有顯著相關變項與是否接受抹片檢查，放入邏輯斯迴歸預測模型中，本研究結果發現：傾向因素中的六個變項：年齡、婚姻狀況、教育程度、家庭結構、宗教信仰、是否知道健保提供免費抹片檢查對受檢與否具有預測力；能用因素中的四個變項：平均月收入、地區別、過去一年內是否接到電話或信函通知、收到通知的受檢地點是否方便對受檢與否具有預測力；需要因素中的一個變項：收到通知的受檢時間是否合適對受檢與否具有預測力；本研究所建立的階層邏輯斯迴歸模型的整體預測正確率為74.1﹪。在受檢者對抹片檢查的服務滿意度方面，本研究共衡量了檢查是否費時、檢查環境舒適度、檢查器具的清潔、檢查過程的舒服感、醫護人員態度以及檢查之隱私性等六個題目，此六個題項經過因素分析發現可歸類為同一面向(dimension)，且信效度良好，服務滿意度各題的平均滿意度皆介於3.5-4.5分之間，六個項目的平均滿意度為4.03分（總分範圍為1-5分）得分最高為檢查是否費時平均分數4.30，其次為醫護人員態度平均分數4.22；人口學變項中：教育程度、籍貫、工作行業別、宗教信仰、知道健保提供免費抹片檢查、地區別、過去一年內接過電話或信函通知、收到通知的地點是否方便、收到通知的受檢時間是否合適、自覺健康狀況對受檢者的服務滿意度具有顯著差異。在未接受子宮頸抹片檢查原因方面，根據本研究結果顯示未做子宮頸抹片檢查者原因有自覺身體健康、不喜歡做內診或害羞、其他、太忙了沒時間等等，針對選擇「其他」這一題項進一步分析，以未婚或沒有性行為者為主，其次為已無子宮、老了不用做為未接受檢查之原因。根據研究結果就影響婦女接受子宮頸抹片檢查的因素，研擬抹片篩檢率提升策略，以提供相關衛生單位推動抹片篩檢參考
關鍵字：子宮頸抹片、篩檢

關鍵字

子宮頸抹片 ； 篩檢

並列摘要

Abstract
Cervical cancer occurs very frequently in Taiwan, and it is also a cancer with a high death rate, thus making it most suitable for screening and prevention. Since the overall Taiwanese women’s reception of cervical smear screen is comparatively lower than other countries, this study tries to investigate the factors that will help to enhance the screen rate. This research used Andersen’s medical service utilization behavioral mode as a research framework, and the data were from the “Database of the investigation of the promotional knowledge, attitudes and behaviors of citizen’s health in Taiwan in 2002 published by the Health Bureau of Executive Yuan for analysis, The main objectives are to understand the factors that influence the utilization of the preventive and health service of cervical smear screen for the women in Taiwan, analyze demographically the variables related to the degree of satisfaction for the Taiwanese women who have utilized the cervical smear screening, and to understand the reasons for the people who did not utilize the preventive and health service of cervical smear screen. The results from statistic data analysis using the statistic software SPSS15.0 for descriptive statistics, chi-square evaluation, laddered logistic regression, factors analysis, credibility analysis, variables analysis, and multiple comparison are as follows:
I. An analysis of the prominently related variables with whether or not to receive cervical smear screen of tendency factors, enabling factors and needs factors by using the logistic regression model was performed.: 6 variables of tendency factors with predictive value as to whether a woman receive cervical smear screen or not include age, marital status (having a spouse or single ), educational level, family structure, religion, and the knowledge of free smear examination offered by mandatory citizen health insurance; 4 variables with enabling factors with predictive value include average monthly income, district, whether receiving telephone or letter notices in the past year, and the degree of convenience of the examination location. One variable of needs factors with predictive value: is the suitability of the examination time notified. The accuracy rate of laddered logistic regression model built by this research was 74.1%.
II. For the service satisfaction by the examinees of the smear screen, this research measured 6 aspects, namely, time needed for the examination, the comfortableness of the examination environment, the cleanness of the examining tools, the comfortableness of the examination process, the attitude of the medical personnel, and the privacy of the examination. After analysis of the 6 aspects which were grouped as the same dimension and good credibility, all the satisfaction scores were between 3.5 to 4.5, with the average satisfaction score of the 6 areas being 4.03 (the range of score is from 1 to 5).The highest score received, 4.30, was in the area of the time needed for examination, while the next highest score received, 4.22, was in the area of the attitude of the medical personnel. Some of the he demographic variables include: educational level, native place, group of jobs, religions, knowledge of cost free cervical smear covered by mandatory citizen health insurance, district, whether the patients received telephone or letter notices in the past year, the convenience of the examination location notified, the suitability of the examination time notified, and the health condition perceived by oneself, and circumstances of the examination notified. An analysis of these demographic variables showed that many were all related significantly with the examinees’ satisfaction level with the service provided.
III. The study has shown that the reasons not to receive cervical smear examination include the self-perception of a healthy physical condition, being afraid of internal examination or shyness,, being busy and other factors. Other reasons for patients not to accept cervical screening include unmarried women or those without sexual behaviors, not having an uterus or the examination being unnecessary for old people. Key words: Cervical Smear, Screen

並列關鍵字

Cervical Smear ； Screen

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