臺灣博碩士論文加值系統

摘要
子宮頸抹片的使用率以及子宮頸癌的罹患率，已經成為衡量一個國家醫療水準良窳的評鑑指標，而目前台灣婦女之子宮頸抹片檢查率仍偏低，為了提高抹片受檢率，本研究希望能找出影響台灣婦女是否接受子宮頸抹片檢查之原因，並針對有做過子宮頸抹片之婦女分析其滿意度，以期提供政府相關單位以及醫療提供者改善之道，達到全國婦女「定期」接受子宮頸抹片檢查之目標。

本研究乃參考Andersen第四階段醫療服務利用模式後，提出一概念性之理論架構；研究資料取自於行政院衛生署國民健康局之「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，有效樣本共12,998筆；本研究以邏輯斯迴歸以及逐步迴歸來進行資料分析，研究結果顯示如下：(1).傾向因素(除了教育程度)、能用因素、需要因素(除了健康狀況)與加強因素皆與「是否接受抹片檢查」有顯著相關。(2).大學教育程度、健康信念、健康行為與提醒弁鉬P子宮頸抹片滿意度有顯著相關。

本研究最後分別對政府相關單位以及醫院(與健檢中心)根據研究結果提出相關建議，以期讓我國的健康照護品質能與世界潮流同步，達成促進全民健康的目標。

The utility rate of the Pap smear and the rate of cervical cancer have been an index to examine the medical treatment standard of a country. However, the frequency of Pap smears for Taiwan women is still below standard. The purpose of this research is to find out why they decide to either take the Pap smear or not, and to analyze the satisfaction of those who have been tested. We hope this research resuls could offer the government and health care authority an approach to encourage Taiwan women to have the Pap smear check-up regularly.

This research provides a conceptual theory construction after referring to Andersen’s 4th Health Service Utilization Model. The data of this research comes from the secondary data taken from a National Health Interview Survey (NHIS) in Taiwan that was done in 2002. This survey incorporated a multi-stage stratified systematic sampling scheme and 12,998 samples were valid in this research. The data analysis was based on Logistic Regression and Stepwise Regression. The results are: 1. Predisposing component (except educational level), Enabling component, Need component (except healthy condition), and Enhancement component have a relationship with the women’s decision of “taking the Pap smear or not”. 2. Tertiary education level, health belief, health behaviors and reminding function have a relationship with the satisfaction of the Pap smear.

This research provides a correlative proposal to the government, hospitals and health center. Hopefully our quality of health care could meet the world high standard, and also accomplish the purpose of promoting the health of people in Taiwan.

目錄

摘要 ……………………………………………………………………… i
Abstract ………………………………………………………………… ii
目錄 ……………………………………………………………………… iii
圖目錄 …………………………………………………………………… iv
表目錄 …………………………………………………………………… V

第壹章 緒論 ……………………………………………………………………… 1

第一節 研究背景及動機 …………………………………………………………… 1
第二節 研究目的 …………………………………………………………………… 6
第三節 研究流程 …………………………………………………………………… 7

第貳章 文獻探討 ………………………………………………………………… 8

第一節 醫療服務利用行為模式 ………………………………………………… 10
第二節 子宮頸抹片相關文獻探討 ………………………………………………… 17
第三節 病患滿意度相關文獻探討 ………………………………………………… 30

第参章 理論模型及架構 ………………………………………………………… 41

第一節 研究架構 …………………………………………………………………… 41
第二節 研究假設 …………………………………………………………………… 43

第肆章 資料分析與結果 ………………………………………………………… 48

第一節 研究資料 …………………………………………………………………… 48
第二節 研究樣本之分析結果 ……………………………………………………… 57
第三節 台灣女性使用子宮頸抹片檢查之影響因素分析 ………………………… 62
第四節台灣女性使用子宮頸抹片檢查之滿意度分析 ………………………… 67
第五節 小結 ………………………………………………………………………… 70

第伍章 討論與建議 …………………………………………………………………… 71

第一節 討論 ………………………………………………………………………… 71
第二節 建議 ………………………………………………………………………… 77

參考文獻 ……………………………………………………………………………… 82
附錄一：各項變數編碼說明及統計表 ……………………………………………… 89
附錄二：民國九十一年國民健康促進知識、態度與行為調查部分問卷…………… 101

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中文部份


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2. 李宜蓉 (2003) 「台中地區醫院門診病患對醫療服務品質及全民健康保險實施滿意度之研究」。國立中興大學企業管理研究所碩士論文。

3. 李藝珈 (2007) 「全民健康保險子宮頸癌醫療給付改善方案對醫療院所子宮頸抹片篩檢率之影響」。國立陽明大學衛生福利研究所碩士論文。

4. 周子菁 (2004) 「婦女預防保健醫療利用分析與影響因素之探討-國民健康訪問調查資料分析」。中國醫藥大學醫務管理研究所碩士論文。

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6. 周貴女 (2005) 「婦女子宮頸癌篩檢行為意向與相關因素之探討--護理人員與製造業女性員工之比較」。高雄醫學大學醫護學研究所碩士論文。

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16. 陳松吟 (2003) 「全民健康保險子宮頸癌抹片篩檢使用型態六年之追蹤研究」。國立陽明大學衛生福利研究所碩士論文。

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18. 陸陲H (2001) 「血液透析病患選擇醫療機構要素及對現行血液透析機構滿意度之研究－以台南市三家不同類型私立醫療機構為例」。長榮管理學院經營管理研究所碩士論文。

19. 陳慈怡 (2003) 「全民健康保險實施前後影響子宮頸抹片篩檢之因素及成果」。國立台北護理學院醫護管理研究所碩士論文。

20. 莊演文 (2003) 「醫院服務品質與住院病患家屬滿意度之關聯性研究-以嘉義某區域教學醫院為例」。南華大學管理研究所碩士論文。

21. 彭百志 (2003) 「南投縣原住民婦女子宮頸抹片陽性個案與檳榔菸酒之相關研究」。高雄醫學大學口腔衛生科學研究所在職專班碩士論文。

22. 傅鍾仁、張錫惠(2002) 「我國醫療服務品質滿意度之實證研究」臺 灣 管 理 學 刊 第1 卷第2 期

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25. 蔡秀慈 (2003) 「子宮頸抹片利用次數與醫療資源使用之探討─以高屏地區87-90年第一類投保對象之30歲以上婦女為例」。高雄醫學大學公共衛生學研究所在職專班碩士論文。

26. 蔡明芸 (2006) 「影響婦女接受子宮頸抹片檢查相關因素之探討－以花蓮地區篩檢站婦女為例」。慈濟大學醫學研究所碩士論文。