臺灣博碩士論文加值系統

背景：糞便潛血檢查基隆市社區闔家歡健康篩檢中結直腸癌的篩檢工具，糞便潛血檢查陽性者應接受內視鏡檢查才算完成「完整診斷評估」。由於民眾的健康行為與其健康信念有關，而部份研究發現健康識讀與健康行為有關，因此本研究試圖探討民眾的健康信念、健康識讀與進行完整診斷評估的行為之關連性。
目的：針對不同的健康識讀程度之糞便潛血檢查陽性民眾，探討接受完整診斷評估與其健康信念之關係。
方法：以2006年至社區參加基隆市社區闔家歡健康篩檢的所有糞便潛血檢查陽性民眾為研究對象（共610名），以研究者自行發展之結構式問卷進行電話訪問。排除資料不完整者，餘318名進行分析，以健康識讀分層進行邏輯斯回歸，依變項為接受完整診斷評估的行為，重要自變項為健康信念及行動線索。
結果：以健康識讀分層並調整重要變項後，健康識讀足夠者拒絕進行CDE的民眾與醫療環境有關的障礙分數（2.88±0.70）高於有進行CDE者與醫療環境有關的障礙分數（2.43±0.74）；健康識讀不足者對FOBT(+)的嚴重度高1分，有進行CDE的比例多2.07倍，不記得有人協助預約專診的人有進行CDE的比例為記得者的0.08倍。
結論：本研究發現進行CDE的相關因素因健康識讀程度而異，建議應先瞭解FOBT(+)民眾之健康識讀再分別提供不同的CDE衛教資訊。

Background: Fecal occult blood test (FOBT) is one of screening service in the Keelung Community-based Integrated Screening (KCIS). People with positive FOBT result have to receive endoscope as complete diagnostic evalation (CDE). Health behavior is related to people’s health beliefs. Studies find that health behavior is correlated with their health literacy. This study tries to explore the relationship between health beliefs, health literacy, and the behavior of adherence CDE.
Purpose: To analysis the relationships between adherence CDE and health beliefs among different health literacy in people with positive FOBT.
Methods: All of the positive FOBT participants (n=610) from KCIS in 2006 are study subjects. Using structured questionnaire which is developed by researchers to interview subjects by phone. Excluding subjects with incomplete data, 318 persons were included in analysis. Predictors of adherence CED were identified in logistic regression with stratified by health literacy. The dependent variable is the behavior of adhearece CDE, and the independent variables are health beliefs and cues to action.
Results: In the adequate health literacy people, adherence CDE have higher perceived barrier regarding to the environment of hospital. In the inadequate health literacy people, adherence CDE have lower perceived severity regarding to positive FOBT and higher rate of the memory of appointment for CDE.
Conclusion: The factors of adherence CDE are different between adequate and inadequate health literacy people. Understanding people’s health literacy to offer appropriate health education to people with positive FOBT is needed.

致謝 i
摘要 iii
Abstract iv

第一章　前言 1
第一節 名詞解釋 1
（一） 結直腸癌（colorectal cancer, 簡稱CRC） 1
（二） 糞便潛血檢查（fecal occult blood test, 簡稱FOBT） 2
（三） 完整診斷評估（complete diagnostic evaluation, 簡稱CDE） 2
（四） 基隆市社區闔家歡健康篩檢（Keelung Community-based Integrated Screening, 簡稱KCIS） 2
（五） 健康信念模式（Health Belief Model, 簡稱HBM） 2
（六） 健康識讀（health literacy） 3
第二節 研究動機 3
第三節 研究目的 3
第二章　文獻探討 4
第一節 CRC篩檢方式的介紹 4
一、 對CRC篩檢的建議 4
二、 CRC篩檢工具的介紹 4
三、 小結 5
第二節 CDE對篩檢效益的影響及進行CDE的相關因素 5
一、 CDE對篩檢效益的影響 5
二、 進行CDE的相關因素 6
三、 小結 6
第三節 HBM在癌症相關研究上的應用 7
一、 HBM應用在癌症相關的研究 8
二、 應用HBM的CRC相關研究 8
三、 使用HBM量表之癌症相關研究 8
四、 小結 9
第四節 健康識讀與健康行為的相關研究及其測量方式 9
一、 健康識讀的定義 9
二、 健康識讀與健康行為的相關研究 10
三、 健康識讀的測量方式 12
四、 小結 14
第三章　研究方法 15
第一節 研究背景 15
第二節 研究架構 15
第三節 資料蒐集 17
第四節 研究工具 18
第五節 變項定義 18
一、 進行CDE的行為 19
二、 自覺疾病嚴重度 19
三、 自覺行動利益與障礙 19
四、 行動線索 21
五、 健康識讀 22
六、 社會人口學變項 22
七、 健康行為及疾病史 23
第六節 統計方法 23
第四章　結果 25
第一節 分析對象的個人變項之描述 25
第二節 分析對象填答問卷的結果之描述 25
第三節 與分析對象進行CDE有關之健康信念的相關因素 28
第四節 不同健康識讀之分析對象進行CDE的相關因素 32
第五章　討論 37
第一節 健康識讀的區辨方式與結果 37
一、 區辨研究對象健康識讀的方式 37
二、 不同健康識讀之分析對象的社會人口學特徵之差異 38
第二節 以HBM發現民眾進行CDE的相關因素 38
一、 FOBT(+)民眾的健康信念與進行CDE的行為之關係 39
二、 FOBT(+)民眾獲得的行動線索與進行CDE的行為之關係 39
第三節 健康識讀與疾病史及行動線索間的交互作用 40
第四節 研究限制 41
（一） 排除拒訪及未完整填答者所造成的偏差 41
（二） 回應的偏差（response bias） 42
（三） 回憶的偏差（recall bias） 42
（四） 時序性的判斷 42
第六章　結論 43
第七章　建議 43
第一節 對未來研究者的建議 43
（一） 將健康識讀加入健康信念模式中探討健康行為 43
（二） 發展適用於本國人的健康識讀量表 43
（三） 以面對面訪問的方式研究衛教單張對民眾造成的影響 43
（四） 以追蹤（perspective）的研究設計 44
第二節 對健康照護服務者的建議 44
（一） 醫護人員應更加關懷就診民眾 44
（二） 針對健康識讀的民眾做適當的衛教宣導 44
（三） 以質性研究尋找民眾所需的衛教內容 44
〈參考文獻〉 45

圖目錄
〈圖一〉健康信念模式架構圖（來源：Glanz et al, 2002, p. 52） 7
〈圖二〉基隆市民參加KCIS之流程圖 16
〈圖三〉研究架構圖 16

表目錄
〈表一〉研究對象中，完成訪問者與未完成訪問者進行完整診斷評估（CDE）的行為之比較（n=610） 18
〈表二〉以因素分析粹取「96年社區闔家歡健康篩檢FOBT陽性個案轉介服務滿意度調查問卷」自覺行動利益/障礙題目之分類結果 20
〈表三〉刪除「怕檢查會痛、不舒服」後以因素分析粹取自覺行動利益/障礙題目之分類結果 21
〈表四〉完成訪問的研究對象中，填答問卷的狀況與進行完整診斷評估（CDE）的行為之比較（n=355） 24
〈表五〉分析對象之個人變項與進行完整診斷評估（CDE）的行為之比較（n=318） 26
〈表六〉分析對象之健康信念、行動線索及健康識讀與進行完整診斷評估（CDE）的行為之比較（n=318） 27
〈表七〉分析對象之個人變項和與進行完整診斷評估（CDE）有關之健康信念的比較（n=318） 29
〈表八〉分析對象之行動線索和與進行完整診斷評估（CDE）有關之健康信念的比較（n=318） 30
〈表九〉以logistic regression分析與進行完整診斷評估（CDE）有關之健康信念的相關因素結果（n=318） 31
〈表十〉分析對象之社會人口學特徵及健康信念與進行完整診斷評估（CDE）的行為之比較（n=318） 33
〈表十一〉分析對象之健康識讀與疾病史及行動線索對進行完整診斷評估（CDE）的行為之交互作用（n=318） 34
〈表十二〉以健康識讀分層，分析對象之健康信念與進行完整診斷評估（CDE）的行為之比較（n=318） 35
〈表十三〉健康識讀不足的分析對象，以logistic regression分析與進行完整診斷評估（CDE）有關之健康信念的相關因素結果（n=177） 36

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