臺灣博碩士論文加值系統

研究背景: 子宮頸癌為全球女性第四大常見癌症，目前預防子宮頸癌發生的預防方法包含初級預防(人類乳突病毒疫苗)以及次級預防(子宮頸抹片檢查)。健康信念模式已被廣泛應用於探討執行健康行為之相關因素，關於探討施打人類乳突病毒疫苗的研究對象大多數以學生族群為主，而在子宮頸抹片檢查方面則是主要以30歲以上婦女作為研究對象，且較少研究將此兩項健康行為合併做探討。再者，臨床護理人員在推廣健康行為及預防醫學上扮演著重要的角色，但在台灣很少研究去針對此族群做探討。

研究目的: 透過完整的健康信念模式來預測影響21-29歲臨床女性護理人員接受人類乳突病毒疫苗及子宮頸抹片檢查之重要因素。

研究方法: 此研究為橫斷式研究，而透過自擬的結構式問卷進行訪問，此問卷效度經由專家效度評估，信度則是運用內容一致性(Cronbach’s α)。於2016.09-2017.01期間在台北兩所醫院收集205名21-29歲女性臨床護理人員進行結果分析，分析方法則運用探索性因素分析、描述性分析、多元迴歸分析及逐步邏輯式回歸。

研究結果: 在205名研究對象中，42.4%曾施打過人類乳突病毒疫苗，而認知程度、自覺行動障礙、自我效能及行動線索等變項在曾施打過疫苗者與未施打者兩組之間的得分有顯著差異(5.5 vs. 5.0, p-value=0.009; 7.6 vs. 13.5, p-value <.0001; 11.9 vs. 8.3, p<0.0001; 3.1 vs. 2.4, p-value=0.003)。經由逐步邏輯式迴歸分析結果顯示自覺行動障礙、自我效能及有無子宮頸癌家族病史(β=-0.22, Wald X2=20.24, p-value<.0001; β=0.28, Wald X2=20.5, p-value<.0001; β=1.52, Wald X2=4.56, p-value= 0.03)為施打疫苗之顯著預測因子。
而在子宮頸抹片檢查方面，僅有26.3%曾執行過檢查，而認知程度、自覺行動障礙、自我效能及行動線索等變項在曾執行過檢查與未執行過兩組之間得分有顯著差異(5.7 vs. 5.0, p-value= 0.006; 7.6 vs. 13.5, p= 0.0004; 9.9 vs. 8.4, p-value= 0.005; 3.4 vs. 2.8, p-value= 0.006)；經由逐步邏輯式迴歸分析結果顯示認知程度、自覺行動障礙、行動線索與婦產、血液腫瘤專科性護理師(β=0.25, Wald X2=4.06, p-value=0.04; β=-0.11, Wald X2=10.64, p-value=0.001; β=0.28, Wald X2=5.44, p-value=0.02; β=0.82, Wald X2=4.84, p-value=0.03)為執行子宮檢抹片檢查之顯著預測因子。

結論: 本研究顯示子宮頸癌疾病認知程度、自覺行動障礙、自我效能、行動線索皆影響年輕臨床護理人員有無執行預防子宮頸癌之健康行為，在臨床在職教育需加強護理人員對於子宮頸癌之預防方式。更重要的是醫院行政管理者必須提供護理人員更多的支持環境與主動的關懷，讓護理人員在忙碌的工作環境中能有更多的空間能關注自身健康。

Background: Cervical cancer is the fourth common cancer in women and HPV vaccination and Pap smear screening played important roles in primary prevention and secondary prevention of cervical cancer. Health Belief Model has been used extensively to study beliefs and health behaviors of vaccination and Pap smear testing. Many previous studies focused on students in HPV vaccination and females who aged over 30 years in Pap smear testing. Besides, nursing staffs play an important role in promoting health behavior about prevention of disease, but few studies focused on this group in Taiwan.

Aim: To assess the predictability of taking HPV vaccine and Pap smear testing by socio-demographic variables, awareness and health belief among young nurses.

Methods: We designed the structured questionnaire tested the validity by experts and analyzed the internal consistency (Cronbach’s α) to assess the reliability. Between 2016.09-2017.01 we collected 205 nurses from two hospitals in northern Taiwan. This data was analyzed by exploratory factor analysis, descriptive statistics, stepwise multiple linear regression and stepwise multiple logistic regression.

Results: Among the 205 subjects, the vaccination rate was about 42.4%. The significant associated factors included awareness, perceived barriers, action cues and self-efficacy (5.5 vs. 5.0, p-value=0.009; 7.6 vs. 13.5, p-value <.0001; 11.9 vs. 8.3, p<0.0001; 3.1 vs. 2.4, p-value=0.003). Moreover, the significant predictors included perceived barriers, self-efficacy and family history of cervical cancer (β=-0.22, Wald X2=20.24, p-value<.0001; β=0.28, Wald X2=20.5, p-value<.0001; β=1.52, Wald X2=4.56, p-value= 0.03)
The rate of Pap smear testing was about 26.4%. The significant associated factors included awareness, perceived barriers, action cues and self-efficacy (5.7 vs. 5.0, p-value= 0.006; 7.6 vs. 13.5, p= 0.0004; 9.9 vs. 8.4, p-value= 0.005; 3.4 vs. 2.8, p-value= 0.006). Moreover, the significant predictors included awareness, perceived barriers, action cues and specialty nurses (β=0.25, Wald X2=4.06, p-value=0.04; β=-0.11, Wald X2=10.64, p-value=0.001; β=0.28, Wald X2=5.44, p-value=0.02; β=0.82, Wald X2=4.84, p-value=0.03).

Conclusions: The awareness of cervical cancer, perceived barriers, self-efficacy and action cues influence the subjects taking the prevention of cervical cancer. Therefore, providing on-job education of cervical cancer, and a supportive environment are the key factors to young nurses in the preventions of cervical cancer.

口試委員審定書 I
誌謝 II
中文摘要 III
Abstract IV
Table of Contents V
List of Figures IX
List of Tables X
Chapter 1. Introduction 1
1.Background 1
2.Research Aims 3
3.Research Hypothesis 3
Chapter 2. Literature review 4
1.Association between Human papillomavirus (HPV) and cervical cancer 4
1.1 Epidemiology of HPV infection and cervical cancer 4
1.2 Basics of HPV virology 5
1.3 Risk factors of HPV infection and development of cervical cancer 6
1.4 Natural history of HPV infection and cervical intraepithelial neoplasia (CIN) 7
1.5 Stages of cervical cancer 9
2.Introduction of HPV vaccine 10
2.1 Quadrivalent HPV vaccine (qHPV vaccine) 10
2.2 Bivalent HPV vaccine 12
2.3 9-valent HPV vaccine 13
2.4 Current Status of HPV vaccination in Taiwan 15
3.Papanicolaou smear testing (Pap smear testing) 16
3.1 Introduction of Pap smear 16
3.2 Guidelines of Pap smear screening 17
3.3 Current status of Pap smear testing in Taiwan and screening rates in aged 21-30 women 18
4.Health Belief Model (HBM) 19
5.Associated factors of taking HPV vaccine and Pap smear testing in young women 20
5.1 Associated factors of taking HPV vaccine 20
5.2 Associated factors of taking Pap smear testing 21
6.Nurses’ role in the prevention of cervical cancer and associated factors of taking HPV vaccine and Pap smear testing 22
6.1 Nurses’ role in the prevention of cervical cancer 22
6.2 Associated factors of taking HPV vaccination among nurses 22
6.3 Associated factors of taking Pap smear testing among nurses 23
7.Research Gaps 24
Chapter 3. Subjects and Methods 53
1.Research process and framework 53
2.Interpretation of terminology 53
3.Method of data collection 55
3.1 Subjects 55
3.2 Estimation of sample size 55
3.3 Research tool 55
4.Procedure of data collection 58
5.Data analysis 58
Chapter 4. Results 66
1.Reliability and context validity of the question 66
1.1 Reliability 66
1.2 Construct validity 66
2.Descriptive statistics of socio-demographic variables and status of HPV vaccination and Pap smear testing among 205 subjects 67
2.1 Socio-demographic variables 67
2.2 Statuses of HPV vaccination and Pap smear testing 67
3.Distribution of awareness and domains of health belief among 205 subjects 67
3.1 Awareness of HPV infection and cervical cancer 67
3.2 Perceived susceptibility 68
3.3 Perceived severity 68
3.4 Perceived benefits of HPV vaccination and Pap smear testing 69
3.5 Perceived barriers to HPV vaccination and Pap smear testing 69
3.6 Action cues of taking HPV vaccine and taking Pap smear testing 70
3.7 Self-efficacy of taking HPV vaccine and Pap smear testing 70
4.Association among socio-demographic variables, awareness level, health belief, and statuses of HPV vaccination and Pap smear testing among 205 nurses 71
4.1 Association between socio-demographic variables and statuses of taking HPV vaccination and Pap smear testing 71
4.2 Association between socio-demographic variables and awareness level 72
4.3 Association between socio-demographic variables and health beliefs 72
4.4 Association about awareness level, health beliefs and statuses of HPV vaccination and Pap smear testing 73
5.Comparison of specialty nurses and general nurses about awareness level, health beliefs and statuses of HPV vaccination and Pap smear testing 74
6.Predictors of awareness of HPV infection and cervical cancer among 205 nurses 74
7.Predictors of taking HPV vaccine and Pap smear testing among 205 nurses 74
7.1 Predictors of taking HPV vaccine 74
7.2 Predictors of taking Pap smear testing 75
8.Sensitivity Analysis 75
8.1 Reliability and construct validity of questionnaire after deleting non-convergent items 75
8.2 Effects of predictors of taking HPV vaccine after deleting non-convergent items in the health belief 76
8.3 Effects of predictors of taking Pap smear testing after deleting non-convergent items in the health belief 77
Chapter 5. Discussion 97
1.Major findings of this study 97
1.1 HPV vaccination 97
1.2 Pap smear testing 97
2.Socio-demographic variables and awareness 98
3.Association among socio-demographic variables, HPV vaccination and Pap smear testing--98
3.1 HPV vaccination 98
3.2 Pap smear testing 99
4.Association among awareness, HPV vaccination and Pap smear testing 100
4.1 HPV vaccination 100
4.2 Pap smear testing 101
4.3 Summary 101
5.Association among health belief variables, HPV vaccination and Pap smear testing 102
5.1 HPV vaccination 102
5.2 Pap smear testing 103
6.Association among action cues, HPV vaccination and Pap smear testing 104
6.1 HPV vaccination 104
6.2 Pap smear testing 105
7.The non-convergent and misclassified items of the questionnaire 106
8.Sensitivity analysis 107
9.Sample size 107
10.Strengths 108
11.Limitations 108
12.Conclusions 108
13.Recommendations 109
Reference 110
Appendix 117
1.Questionnaire of expert validity 117
2.Official Questionnaire 126
3.Detailed results 134
4.List of experts 163
5.Clinical Research Approval 164
6.Consent Form 170

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