臺灣博碩士論文加值系統

台灣地區之大腸癌發生率及死亡率逐年有急遽上升的趨勢，目前大腸癌位居
癌症死因中之第三位，對國人健康已造成嚴重威脅，而目前台灣之大腸癌篩檢率
偏低，國民健康局統計顯示大腸癌在第零期與第一期發現的比率不到二成，與美
國大腸癌之發生情形相比，早期發現比率偏低。然而，若大腸癌能夠早期發現早
期治療，存活率可達九成以上，而定期大腸癌篩檢便是防治大腸癌的第一步，又
由於暸解中老年人篩檢意願之影響因素是提升大腸癌篩檢率的重要關鍵。本研究
主要目的乃是探討影響參與社區篩檢之40 歲以上中老年人接受大腸癌篩檢及進
一步侵入性大腸鏡檢查意願的相關態度及健康信念認知因素。
本研究為橫斷式相關性研究，是以北、高兩市各社區篩檢之40 歲以上中老
年人為研究對象，以結構式問卷由民國九十六年八月至九十七年五月進行資料收
集，共回收462 份有效問卷，其中有做過篩檢者279 位，未做過篩檢者183 位。
資料分析以描述性統計分析及Chi-square、Independent T-test、Logistic
regression、Path analysis 等推論性統計分析方法，主要運用健康信念模式內
之自覺威脅性、行動利益、行動障礙、行動線索、健康動機及自我效能等健康信
念認知相關因素，以及害怕、擔心篩檢工具之準確性及安全性、樂觀面對病情真
相等態度相關因素，探討出影響社區民眾接受大腸癌篩檢意願之因素。
研究結果顯示：(一)健康信念相關因素中之自覺威脅性認知、行動障礙認
知、行動線索等變項對進一步大腸鏡檢查意願具有預測能力。而其中糞便潛血篩
檢意願除了上述三項之外，亦受健康動機因素之影響。(二)態度相關因素中之害
怕面對病情真相、擔心篩檢工具之準確性及安全性等檢查態度皆分別影響糞便潛
血篩檢及大腸鏡檢查意願。(三)受檢族群健康狀態中之排便狀況僅會影響其接受
糞便潛血篩檢意願，而健康行為僅會影響其接受進一步大腸鏡檢查之意願。(四)
僅有糞便潛血篩檢意願會受到年齡、社交活動、篩檢經驗的影響，而大腸鏡檢查
意願則與人口屬性較無相關。另外，徑路分析中發現：(一)樂觀態度會影響行動
線索，且健康行為會影響健康動機，進而間接影響糞便潛血篩檢意願；(二)自覺
排便症狀會影響自覺威脅性認知，進而間接影響大腸鏡檢查意願；(三)對大腸癌
及大腸癌篩檢的相關知識瞭解程度亦與糞便潛血篩檢及大腸鏡檢查意願具有間
接影響。
本研究貢獻主要是藉由了解社區受檢族群接受大腸癌篩檢意願之影響因
素，以提供衛生單位在擬定大腸癌健康照護計畫之參考依據，研究在實務上的應
用如下：(1)衛生相關單位除了訂定大腸癌篩檢目標並建議可依研究結果針對特
定族群加強健康信念宣導；(2)藉著社區與醫療之有效結合，透過醫病關係將對
篩檢率的提升有所幫助；(3)提倡防治教育以促進民眾對大腸癌及篩檢的瞭解，
且降低此疾病之威脅性，達到提昇國民健康、節制癌症醫療費用之目標。

In Taiwan, colorectal cancer incidence rate and mortality rate had been increased remarkably. Colorectal cancer was the third leading cause of death in all cancers in Taiwan, which had cause serious threaten on the health condition of people. The CRC
screening rate is relatively low in Taiwan, from the statistic information in Bureau of Health Promotion shows that less than 20 % of colorectal cancer cases were detected on stage 0 and stage Ι in Taiwan. The early detection rate was relatively low as comparing with colorectal cancer in the United States. However, if colorectal cancer is vital for the optimal treatment to obtain a correct diagnosis promptly, the long-term
survival rate can reach as high as 90% for the early staged CRC.
As we know, regular screening examination for colorectal cancer was the first step to treat colorectal cancer.
The key point for promoting the colorectal cancer screening rate was to realize the factors which affecting the willingness of receiving the screening examination among older adults.
Due to that, this study is aimed to identify the attitude toward screening and health-belief recognition among older adults above 40 years old within the community screening program, in order to realize factors influence the older adults’ willingness of the colorectal cancer screening and Colonoscopy.
The study design was a cross-sectional co-relational community-based survey.
The data collection period was from August 2007 to May 2008. Data were collected from older adults which above 40 years old in Taipei and Kaohsiung. There were 462 samples which included 279 samples were having an experience of CRC screening before, and 183 samples were never had such screening before. The data was analyzed with descriptive statistics and inferred statistics such as Chi-square, Independent
T-Test, Logistic regression analysis, Path analysis. The Logistic regression analysis was used to determine the related factors which might affecting the willingness of CRC screening among the older adults in community, including the factors applying from Health Belief Model such as Perceived threat, Perceived benefits of taking actions, Perceived barriers of taking actions, Cues to actions, Self-Efficacy, Health Motivation. Also addressed the factors related to attitudes such as fear about cancer,
worry about accurate or safety of screening method, optimistic.
The results of the study were as following. (1)In health belief related sectors, Perceived threat, Barriers, Cues to actions were significant with both the willingness
of receiving Colonoscopy and FOBT screening. Except for those three factors that mentioned above, Health motivation would influence the willingness of FOBT
screening, instead of Colonoscopy. (2) In attitude related sectors, fear about cancer, worry about accurate or safety of screening method were significant with both the willingness of receiving Colonoscopy and FOBT screening. (3) In health status sectors,bowel symptoms were significant with the willingness of receiving FOBT screening.
Health behavior would only significant with the willingness of receiving Colonoscopy.
(4) Age, social activity, screening experience would affect the willingness of receiving FOBT screening. On the other hand, the willingness of receiving Colonoscopy was no significant with demographic characteristic. Besides, the results of the path analysis
were shown as below.
(1)Optimistic would affect Cues to actions factor, and health behavior may affect Health motivation factor, under such relation, optimistic and health behavior would indirect affect the willingness of receiving FOBT.(2)Bowel symptoms would affect Perceived threat which may indirect affect the willingness of
receiving Colonoscopy.
(3)The knowledge of CRC and CRC screening would also indirect affect the willingness of receiving FOBT and Colonoscopy.
The major attribution of this study was to realize the factors influence the willingness of accepting CRC screening, which could provide for health promotion
policy makers to develop suitable policy for CRC health protect planning.
The study may be implicated in the following aspects：(1) Not only settle the goals of screening,
and also suggest policy makers to promote the awareness and health belief toward colon cancer to target groups which the study result had shown. (2)With the union of the community and medical, physician counseling may enhance the CRC screening rate, especially Colonoscopy. (3)Fulfill the knowledge of detect colon cancer and CRC screening among older adults, make themselves know how to decrease the threat of the disease, in order to achieve the goal of improving their health and saving the
expense of the injure.

圖目錄
圖1-1.1 十大癌症死因之變化------------------------------------------1
圖2-3-1. 預防性健康行為健康信念模式(Health Belief Model)----------30
圖3-1-1. 研究架構圖-----------------------------------------------45
圖3-6-1. 研究流程圖-----------------------------------------------62
圖4-2-1. 研究對象之年齡分佈圓餅圖---------------------------------68
圖4-5-1. 研究對象之飲食習慣分佈圓餅圖1-以高脂肪和肉類為主食------95
圖4-5-2. 研究對象之飲食習慣分佈圓餅圖2-平日吃蔬菜的習慣----------96
圖4-6-1. 徑路分析------------------------------------------------109
圖4-6-2. 徑路分析------------------------------------------------110
表目錄
表1-1-1. 民國95 年台灣地區老人十大死因統計表-----------------------1
表2-1-1. 各等親之大腸癌家族史罹患大腸癌之風險---------------------11
表2-1-2. 民國94 年十大癌症死亡率(每10 萬人口)---------------------13
圖2-1-1. 歷年結腸直腸癌死亡概況趨勢圖-----------------------------13
表2-1-3. 民國94 年之性別大腸直腸癌死亡率--------------------------14
圖2-1-2. 民國94 年台灣地區大腸癌發生年齡及性別之分佈--------------14
表2-1-4. 民國94 年台灣大腸癌申報發生人數按地區別分類--------------15
表2-1-5. 各種篩檢方式之優缺點-------------------------------------17
表2-1-6. 國內與國外之篩檢方式建議比較表---------------------------21
表2-1-7. 民國90 至94 年間男性及女性結腸直腸癌之存活率現況---------22
表2-4-1. 人口學變項因素與糞便潛血篩檢行為意願之相關研究整理-------32
表2-4-2. 人口學變項因素與大腸內視鏡檢查行為意願之相關研究整理-----33
表2-4-3. 各健康信念因素與大腸癌篩檢行為意願之相關性研究整理-------37
表2-4-4. 國內外運用健康信念模式探討其與大腸癌篩檢行為意願相關文獻整
理-----------------------------------------------------------------39
表2-5-1. 國外探討知識、態度與大腸癌篩檢行為間的相關文獻整理-------43
表2-5-2. 影響民眾願意及不願意參與大腸癌篩檢之相關因素-------------44
表3-3-1. 問卷內容專家效度平均得分表-------------------------------51
表3-3-2. 健康信念變項之內部一致性信度檢定分析表-------------------52
表3-4-1. 研究變項之操作型定義-------------------------------------53
表4-1-1. 研究個案之大腸癌篩檢醫療利用情形分佈---------------------63
表4-2-1. 研究個案之人口屬性分佈-----------------------------------65
表4-2-2. 研究個案之人口屬性對大腸癌篩檢意願之雙變項分析-----------70
表4-3-1. 健康信念相關變項之得分分佈<五分法之變項>-----------------72
表4-3-2. 健康信念相關變項之得分分佈<五分法之變項>(續.)------------74
表4-3-3. 健康信念相關變項之得分分佈<二分法之變項>(續.)------------74
表4-3-4. 健康信念相關總分變項分佈---------------------------------76
表4-3-6. 自覺威脅性變項與大腸鏡檢查意願之雙變項分析-<卡方檢定>----79
表4-3-7. 行動利益變項與糞便潛血篩檢意願之雙變項分析-<卡方檢定>----80
表4-3-8. 行動利益變項與大腸鏡檢查意願之雙變項分析-<卡方檢定>------80
表4-3-9. 行動障礙變項與糞便潛血篩檢意願之雙變項分析-<卡方檢定>----81
表4-3-10. 行動障礙變項與大腸鏡檢查意願之雙變項分析-<卡方檢定>-----81
表4-3-11. 自我效能變項與糞便潛血篩檢意願之雙變項分析-<卡方檢定>---83
表4-3-12. 自我效能變項與大腸鏡檢查意願之雙變項分析-<卡方檢定>-----83
表4-3-13. 行動線索變項與糞便潛血篩檢意願之雙變項分析-<卡方檢定>---83
表4-3-14. 行動線索變項與大腸鏡檢查意願之雙變項分析-<卡方檢定>-----84
表4-3-15. 健康信念變項與大腸癌篩檢意願之雙變項分析-<卡方檢定>-----85
表4-3-16. 健康信念變項與糞便潛血篩檢意願之雙變項分析-<T-test>-----87
表4-3-17. 健康信念變項與大腸鏡檢查意願之雙變項分析-<T test>-------87
表4-4-1. 研究個案對大腸癌篩檢態度分佈-----------------------------88
表4-4-2. 檢查態度對大腸癌篩檢意願之雙變項分析-<T-test & X2 test>--91
表4-4-3. 檢查態度對糞便潛血篩檢意願之雙變項分析-<X2 test>---------92
表4-4-4. 檢查態度對大腸鏡檢查意願之雙變項分析-<X2 test>-----------92
表4-5-1. 研究個案之健康行為分佈-----------------------------------94
表4-5-2. 研究個案之健康狀態分佈-----------------------------------97
表4-5-3. 健康行為及健康狀態變項對大腸癌篩檢意願之雙變項分析-------99
表4-6-1.邏輯斯迴歸分析-FOBT--------------------------------------104
表4-6-2. 邏輯斯迴歸分析-COL--------------------------------------107
表4-7-1. 研究假設之驗證對照表------------------------------------115

目錄
致謝------------------------------------------------------I
摘要-----------------------------------------------------II
Abstract------------------------------------------------III
圖目錄----------------------------------------------------V
表目錄----------------------------------------------------V
第一章 緒論
第一節 研究背景---------------------------------------1
第二節 研究動機及其重要性-----------------------------3
第三節 研究目的---------------------------------------5
第四節 研究問題陳述-----------------------------------5
第五節 研究名詞解釋-----------------------------------6
第六節 研究重要性-------------------------------------8
第二章 文獻探討
第一節 大腸癌簡介及其預防與相關篩檢政策
一、 大腸解剖與生理構造--------------------------9
二、 大腸癌之簡介相關文獻-----------------------10
三、 大腸癌在台灣地區流行近況-------------------12
四、 大腸癌相關篩檢工具內容及效能---------------15
五、 大腸癌相關篩檢政策-------------------------18
六、 大腸癌之預防性健康篩檢服務實施情況---------22
第二節 影響大腸癌篩檢意願之相關文獻
一、 影響預防性健康行為意願之相關因素-----------23
二、 影響大腸癌篩檢意願之相關因素---------------24
第三節 健康信念模式之介紹----------------------------27
第四節 大腸癌篩檢意願與HBM 模式之相關影響因素--------31
第五節 大腸癌篩檢意願與知識、態度間之相關研究--------42
第三章 研究方法
第一節 研究架構與假設--------------------------------45
第二節 研究設計--------------------------------------46
第三節 研究工具--------------------------------------47
第四節 研究變項之操作型定義--------------------------53
第五節 資料收集與分析方法----------------------------60
第六節 研究流程--------------------------------------62
第四章 研究結果
第一節 研究個案之大腸癌篩檢行為及意願分佈描述--------63
第二節 研究個案之人口屬性對大腸癌篩檢意願之相關分析--64
第三節 健康信念相關因素對大腸癌篩檢意願之相關分析----72
第四節 篩檢態度對大腸癌篩檢意願之相關分析------------88
第五節 健康行為及狀態對大腸癌篩檢意願之相關分析------93
第六節 影響大腸癌篩檢意願相關變項之迴歸及徑路分析---102
第七節 研究假設之驗證-------------------------------111
第五章 討論
第一節 健康信念相關因素對大腸癌篩檢意願之影響-------116
第二節 檢查態度相關因素對大腸癌篩檢意願之影響-------118
第三節 受檢族群健康行為及狀態對大腸癌篩檢意願之影響-119
第四節 受檢族群人口屬性對大腸癌篩檢意願之影響-------119
第五節 影響大腸癌篩檢意願之相關因素探討-------------120
第六節 探討影響大腸癌篩檢意願之變項間之關係---------121
第六章 結論與建議
第一節 結論-----------------------------------------122
第二節 研究限制-------------------------------------124
第三節 應用與建議-----------------------------------124

參考書目
西文部分--------------------------------------------126
中文部分--------------------------------------------136
碩博士論文部分--------------------------------------138
網路文獻--------------------------------------------138

附錄
一、大腸解剖生理圖----------------------------------140
二、研究問卷----------------------------------------141
三、效度評定之專家名單------------------------------145
四、邏輯斯迴歸分析----------------------------------146
五、徑路分析----------------------------------------151

西文部分
Becker MH.(1974). The Health Belief Model and Personal Health Behavior. Health Education Monographs, 4, 1-8.

Becker MH, Rosenstock IM.(1984). Compliance with medical advice. In: Stetptoe A,Methews A, editors. Health Care and Health behavior. Academic press：New York,175-208.

Berkowitz, Z., Hawkins, N. A., Peipins, L. A., White, M. C., & Nadel, M. R. (2008). Beliefs, risk perceptions, and gaps in knowledge as barriers to colorectal cancer
screening in older adults. Journal of the American Geriatrics Society, 56(2), 307-314.

Blanchard, C. G., Ruckdeschel, J. C., Cohen, R. E., Shaw, E., McSharry, J., & Horton,J. (1981). Attitudes toward cancer: I. the impact of a comprehensive oncology course on second-year medical students. Cancer, 47(11), 2756-2762.

Bostick, R. M., Sprafka, J. M., Virnig, B. A., & Potter, J. D. (1993). Knowledge,attitudes, and personal practices regarding prevention and early detection of cancer.
Preventive Medicine, 22(1), 65-85.

Brawarsky, P., Brooks, D. R., Mucci, L. A., & Wood, P. A. (2004). Effect of physician recommendation and patient adherence on rates of colorectal cancer testing.
Cancer Detection and Prevention, 28(4), 260-268.

Brown, M. L., Potosky, A. L., Thompson, G. B., & Kessler, L. G. (1990). The knowledge and use of screening tests for colorectal and prostate cancer: Data from the 1987 national health interview survey. Preventive Medicine, 19(5), 562-574.

Bleiker E.M.A., Menko F.H., Taal B.G., Kluijt I., Wever L.D.V., Gerritsma M.A.,Vasen H.F.A.& Aaronson N.K.(2005). Screening behavior of individuals at high risk
for colorectal cancer. Gastroenterology,128, 280-287.
Champion, V. L. (1984).

Instrument development for health belief model constructs. Advances in Nursing Science, 6(3), 73-85.

Carpenter, V., & Colwell, B. (1995). Cancer knowledge, self-efficacy, and cancer screening behaviors among mexican-american women. Journal of Cancer Education : The Official Journal of the American Association for Cancer Education, 10(4),

217-222.

Codori, A. M., Petersen, G. M., Miglioretti, D. L., & Boyd, P. (2001). Health beliefs and endoscopic screening for colorectal cancer: Potential for cancer prevention.
Preventive Medicine, 33, 128-136.

Colombo L., Corti G., Magri F., Marocchi A., Brambilla P., Crespi C., Manieri L.,Ghezzi S., Giannone D., Merlino L.&Mocarelli P.(1997). Results of a pilot study of endoscopic screening of first degree relatives of colorectal cancer patients in Italy. Journal of Epidemiology and Community Health,51, 453-458.
Cooper, G.S., Fortinsky, R.H., Hapke R., Landefeld C.S.(1997). Primary care physician recommendations for colorectal cancer screening. Archives of Internal
Medicine,157, 1946-1950.

Cooper, G.S., Fortinsky, R.H., Hapke, R., Landefeld, C.S.(1998). Factors associated with the use of flexible sigmoidoscopy as a screening test for the detection of
colorectal carcinoma by primary care physicians. Cancer, 82, 1476-1481.

Cronan, T. A., Devos-Comby, L., Villalta, I., & Gallagher, R. (2008). Ethnic differences in colorectal cancer screening. Journal of Psychosocial Oncology, 26(2),63-86.

Dellefield, M. E. (1988). Informational needs and approaches for early cancer detection in the elderly. Seminars in Oncology Nursing, 4(3), 156-168.
DeWys, W. (1976). Editorial: Changing attitudes towards cancer. Journal of Chronic
Diseases, 29(9), 545-548.

Eddy, D. M., Nugent, F. W., Eddy, J. F., Coller, J., Gilbertsen, V., Gottlieb, L. S., et al. (1987). Screening for colorectal cancer in a high-risk population. Results of a mathematical model. Gastroenterology, 92(3), 682-692.

Evashwick, C., Rowe, G., Diehr, P., & Branch, L. (1984). Factors explaining the use of health care services by the elderly. Health Services Research, 19(3), 357-382.

Feinleib M.(1996). New directions for community intervention studies[editorial]. American Journal of Public Health, 86, 1696-1698.

Gili, M., Roca, M., Ferrer, V., Obrador, A., & Cabeza, E. (2006). Psychosocial factors associated with the adherence to a colorectal cancer screening program. Cancer Detection and Prevention, 30(4), 354-360.

Gipsh, K., Sullivan, J. M., & Dietz, E. O. (2004). Health belief assessment regarding screening colonoscopy. Gastroenterology Nursing : The Official Journal of the
Society of Gastroenterology Nurses and Associates, 27(6), 262-267.

Gochman DS.(1988). Health behavior-emerging research perspectives. Plenum Press：New York.

Green, L. W., & Kreuter, M. W.(1990). Health promotion as a public health strategy for the 1990s. Annual Review of Public Health, 11, 319-334.

Green, P. M., & Kelly, B. A. (2004). Colorectal cancer knowledge, perceptions, and behaviors in african americans. Cancer Nursing, 27(3), 206-15.
Greenwald, B. (2006).

Promoting community awareness of the need for colorectal cancer screening: A pilot study. Cancer Nursing, 29(2), 134-141.

Greiner, K. A., Born, W., Nollen, N., & Ahluwalia, J. S. (2005). Knowledge and perceptions of colorectal cancer screening among urban african americans. Journal of General Internal Medicine : Official Journal of the Society for Research and Education in Primary Care Internal Medicine, 20(11), 977-983.

Gupta K.(1990). Screening and health maintenance. In: Eldeman CL, Mandle CL, editors. Health Promotion. Mosby ST. Louis.

Hadley D.W., Jenkins J.F., Dimond E., de Carvalho M., Kirsch I. & Palmer C.G.S.(2004). Colon cancer screening practices after genetic counseling and testing for hereditary nonpolyposis colorectal cancer. Journal of Clinical Oncology,22,39-44.

Harewood, G. C., Wiersema, M. J., & Melton, L. J.,3rd. (2002). A prospective,controlled assessment of factors influencing acceptance of screening colonoscopy.The American Journal of Gastroenterology, 97(12), 3186-3194.

Harris M.A. & Byles J.E.(1997). A survey of screening compliance among first degree relatives of people with colon cancer in New South Wales. Journal of Medical Screening,4, 29-34.

Holt, W. S.,Jr. (1991). Factors affecting compliance with screening sigmoidoscopy.The Journal of Family Practice, 32(6), 585-589.

Homa, K., Brzosko, M., Safranow, K., & Marlicz, K. (2005). Acceptance of screening colonoscopy in the prevention of colorectal cancer in relation to some demographic factors. Polski Merkuriusz Lekarski : Organ Polskiego Towarzystwa Lekarskiego,
19(110), 179-182.

Hunter, W., Farmer, A., Mant, D., Verne, J., Northover, J., & Fitzpatrick, R. (1991). The effect of self-administered faecal occult blood tests on compliance with screening for colorectal cancer: Results of a survey of those invited. Family Practice, 8(4),
367-372.

Jacobs, L. A. (2002). Health beliefs of first-degree relatives of individuals with colorectal cancer and participation in health maintenance visits: A population-based survey. Cancer Nursing, 25(4), 251-265.

James, A. S., Campbell, M. K., & Hudson, M. A. (2002). Perceived barriers and benefits to colon cancer screening among african americans in north carolina: How does perception relate to screening behavior? Cancer Epidemiology, Biomarkers &Prevention : A Publication of the American Association for Cancer Research,Cosponsored by the American Society of Preventive Oncology, 11(6), 529-534.

Janz, N.K., & Becker, M.H. (1984). The Health Belief Model：a decade later. Health Education Quart, 11, 1-47.

Janz, N.K., Champion, V.L., Strecher, V.J.(1996). The health belief model. In: Glanz K, Lewis FM, Rimer BK, editors. Health behavior and health education.
Jossey-Bass：San Francisco, 3rd ed, 45-66.

Janz, N. K., Wren, P. A., Schottenfeld, D., & Guire, K. E. (2003). Colorectal cancer screening attitudes and behavior: A population-based study. Preventive Medicine, 37(6Pt 1), 627-634.

Jarvinen H.J., Aarnio M., Mustonen H., Aktan-Collan K., Aaltonen L.A. & Peltomaki P.(2000). Controlled 15-year trial on screening for colorectal cancer in families with
hereditary nonpolyposis colorectal cancer. Gastroenterology,118, 829-834.

Johnson K.A., Trimbath J.D., Petersen G.M., Griffin C.A. & Giardiello F.M.(2002). Impact of genetic counseling and testing on colorectal cancer screening behavior.
Genetic Testing,6, 303-306.

Kasl S.V. & Cobb S.(1966). Health behavior, illness behavior, and sick role behavior. Archivus of Environmental Health, 12(2), 246-266.

Kelly, R. B., & Shank, J. C. (1992). Adherence to screening flexible sigmoidoscopy in asymptomatic patients. Medical Care, 30(11), 1029-1042.

Kim, K., Yu, E. S., Chen, E. H., Kim, J., & Brintnall, R. A. (1998). Colorectal cancer screening. knowledge and practices among korean americans. Cancer Practice, 6(3),167-175.

Lechner, L., Vries, H., & Offermans, N.(1997). Participation in a breast cancer screening program：influence of past behavior and determinants on future screening participation. Preventive Medicine, 26(4), 473-482.

Leonard,G.(1985). The Self-care Motivation Model：Theory and Practice in Health Human Development, 55(2), 57-61.

Levin, B., Lieberman, D. A., McFarland, B., Andrews, K. S., Brooks, D., Dash, C., et al. (2008). Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: A joint guideline from the american cancer society, the US multi-society task force on colorectal cancer, and the american college of
radiology. Gastroenterology, Feb(8),1-26.

Lewis, S. F., & Jensen, N. M. (1996). Screening sigmoidoscopy. factors associated with utilization. Journal of General Internal Medicine : Official Journal of the Society for Research and Education in Primary Care Internal Medicine, 11(9), 542-544.

Ling, B. S., Moskowitz, M. A., Wachs, D., Pearson, B., & Schroy, P. C. (2001).Attitudes toward colorectal cancer screening tests. Journal of General Internal
Medicine : Official Journal of the Society for Research and Education in Primary Care Internal Medicine, 16(12), 822-830.

Lurie, N., Manning, W. G., Peterson, C., Goldberg, G. A., Phelps, C. A., & Lillard, L.(1987). Preventive care: Do we practice what we preach? American Journal of Public Health, 77(7), 801-804.

Macrae, F. A., Hill, D. J., St John, D. J., Ambikapathy, A., & Garner, J. F. (1984). Predicting colon cancer screening behavior from health beliefs. Preventive Medicine, 13(1), 115-126.

Madlensky, L., Esplen, M. J., Gallinger, S., McLaughlin, J. R., & Goel, V. (2003). Relatives of colorectal cancer patients: Factors associated with screening behavior.
American Journal of Preventive Medicine, 25(3), 187-194.

Maeland, J. G., & Aaro, L. E. (1993). Theory of behavior and preventive health care in medical practice. [Atferdsteori og forebyggende helsearbeid i praksis] Tidsskrift for Den Norske Laegeforening, 113(1), 51-55.

Mandel, J. S., Bond, J. H., Church, T. R., Snover, D. C., Bradley, G. M., Schuman, L.M., et al. (1993). Reducing mortality from colorectal cancer by screening for fecal
occult blood. minnesota colon cancer control study. The New England Journal of Medicine, 328(19), 1365-1371.

Manne S., Markowitz A., Winawer S., Meropol N.J., Haller D., Rakowski W., Babb J.& Jandorf L.(2002). Correlates of colorectal cancer screening compliance and stage of adoption among siblings of individuals with early onset colorectal cancer. Health Psychology, 21,3-15.

Menon, U., Champion, V. L., Larkin, G. N., Zollinger, T. W., Gerde, P. M., & Vernon,S. W. (2003). Beliefs associated with fecal occult blood test and colonoscopy use at a worksite colon cancer screening program. Journal of Occupational and
Environmental Medicine / American College of Occupational and Environmental Medicine, 45(8), 891-898.

Morrow GR, Way J, Hoagland AC, Cooper R.(1982). Patient compliance with self-directed hemoccult testing. Preventive Medicine, 30, 1029-1042.

Myers, R. E., Ross, E., Jepson, C., Wolf, T., Balshem, A., Millner, L., et al. (1994).
Modeling adherence to colorectal cancer screening. Preventive Medicine, 23(2), 142-151.

Nancy K. Janz, Ph.D.,Patricia A. Wren, Ph.D., David Schottenfeld, M.D., and Kenneth E. Guire, M.S. (2003). Colorectal cancer screening attitudes and behavior: a
population-based study. Preventive Medicine, 37(9), 627-634.

Ng, E. S., Tan, C. H., Teo, D. C., Seah, C. Y., & Phua, K. H. (2007). Knowledge and perceptions regarding colorectal cancer screening among chinese--a community-based survey in singapore. Preventive Medicine, 45(5), 332-335.

Nunnally, J.C.,&Bernstein, I.H.(1994).Psychometric theory(3rd editor). New York：McGraw-Hill.
Opelka FG, Timmcke AE, Gathright JB Jr, et al.(1992). Diminutive colonic polyps: An indication for colonoscopy. Disease Colon Rectum,35,178-181.

Pender N.J.(1975). A conceptual model for preventive health behavior. Nursing Outlook, 23(6), 385-390.

Peppone, L. J., Mahoney, M. C., Cummings, K. M., Michalek, A. M., Reid, M. E.,Moysich, K. B., et al. (2008). Colorectal cancer occurs earlier in those exposed to
tobacco smoke: Implications for screening. Journal of Cancer Research and Clinical Oncology,134(7), 743-751.

Petersen G.(2002). Barriers to preventive intervention. Gastroenterology Clinical North American,31, 1061-1068.

Pignone M., Bucholtz D. & Harris R. (1999). Patient preferences for colon cancer screening. Journal of General Internal Medicine,14, 432-437.

Pignone, M., Rich, M., Teutsch, S. M., Berg, A. O., & Lohr, K. N. (2002). Screening for colorectal cancer in adults at average risk: A summary of the evidence for the U.S. preventive services task force. Annals of Internal Medicine, 137(2), 132-141.

Polit, D.F.& Hungler, B.P.(1999). Assessing data quality. In Nursing research：principle and method(6th ed.,407-436). New York：Lippincott.

Price, J. H. (1993). Perceptions of colorectal cancer in a socioeconomically disadvantaged population. Journal of Community Health, 18(6), 347-362.

Rees, G., Martin, P. R., & Macrae, F. A. (2008). Screening participation in individuals
with a family history of colorectal cancer: A review. European Journal of Cancer Care, 17(3), 221-232.

Riffle K.L., Yoho J.& Sams, J.(1989). Health promoting behavior, perceived social support, and self-reported health of Appalachian elderly. Public Health Nursing, 6(4),204-211.

Rosentock IM.(1974). Historical origins of the health belief model. Health Education Monographs, 2, 328-335.

Rosentock IM.(1988). Social Learning Theory and the Health Belief Model. Health Education Quarterly,15, 175-183.

Rosentock IM.(1990). The health belief model：Explaining health behavior through expectancies. In:Lewis FM, Rimer BK, Glanz K, editors. Health Behavior and Health Education: Theory, Research, and Practice. Jossey-Bass Publishers：San Francisco,1990, 36-92.

Schoen RE, Weissfeld JL, Kuller LH.(1995). Sigmoidoscopy use among primary care
physicians. Preventive Medicine,24, 249-254.

Selby JV, Friedman GD, Quesenberry CP Jr, Weiss NS.
(1992). A case-control study of
screening sigmoidoscopy and mortality from colorectal cancer. The New England
Journal of Medicine, 326, 653-657.

Seow A., Huang J., Straughan PT. (2000). Effects of social support, regular physician
and health-related attitudes on cervical cancer screening in an Asian population. Cancer Causes Control,11(3), 223-230.

Sheikh, R. A., Kapre, S., Calof, O. M., Ward, C., & Raina, A. (2004). Screening preferences for colorectal cancer: A patient demographic study. Southern Medical
Journal, 97(3), 224-230.

Smith, R. A., Cokkinides, V., Eyre, H. J., & American Cancer Society. (2003). American cancer society guidelines for the early detection of cancer, 2003. CA: A
Cancer Journal for Clinicians, 53(1), 27-43.

St John D.J.B., McDermott F.T., Hopper J.L., Debney E.A., Johnson W.R. & Hughes E.S.(1993). Cancer risk in relatives of patients with common colorectal cancer. Annals of International Medicine, 118, 785-790.

Strecher, V.J., Rosenstock, I.M.(1997). The Health Belief Model. In: Glanz, K., Lewis,F.M., Rimer, B.K., editors. Health behavior and health education: theory, research and practice. Jossey-Bass：San Francisco CA, 2nd ed, 41-59.

Su, M. Y., Hsu, C. M., Lin, C. J., Ho, Y. P., Chiu, C. T., Chen, P. C., et al. (2008).
Endoscopic treatment of colorectal neoplasms: A simple and safe procedure to lower the incidence of colorectal cancers. Digestive Diseases and Sciences, 53(5), 1297-302.

Sun, W.Y., Basch, C.E., Wolf, R.L., Li, X.J.(2004). Factors associated with colorectal
cancer screening among Chinese-Americans. Preventive Medicine, 39(2), 323-329.

Sung, J. J., Choi, S. Y., Chan, F. K., Ching, J. Y., Lau, J. T., & Griffiths, S. (2008).
Obstacles to colorectal cancer screening in chinese: A study based on the health belief
model. The American Journal of Gastroenterology,103(4)：974-981.

Sung, J.J., Lau, J.Y., Goh, K.L., Leung, W.K.(2005). Asia Pacific Working Group on Colorectal Cancer. Increasing incidence of colorectal cancer in Asia：implications for screening. Lancet Oncol(Nov, Review),6(11), 871-876.

Tessaro, I., Mangone, C., Parkar, I., & Pawar, V. (2006). Knowledge, barriers, and predictors of colorectal cancer screening in an Appalachian church population.
Preventing Chronic Disease, 3(4), A123.

Thomas, R. J., & Clarke, V. A. (1998). Colorectal cancer: A survey of community beliefs and behaviours in victoria. The Medical Journal of Australia, 169(1), 37-40.

Thomas, W., White, C. M., Mah, J., Geisser, M. S., Church, T. R., & Mandel, J. S. (1995). Longitudinal compliance with annual screening for fecal occult blood.minnesota colon cancer control study. American Journal of Epidemiology, 142(2),176-182.

Towler BP, Irwig L, Glasziou P, Weller D, Kewenter J. (2002). Screening for colorectal cancer using the faecal occult blood test, hemoccult. Cochrane Database System Review, 2, CD001216.

Ueland, A. S., Hornung, P. A., & Greenwald, B. (2006). Colorectal cancer prevention and screening: A health belief model-based research study to increase disease awareness. Gastroenterology Nursing : The Official Journal of the Society of Gastroenterology Nurses and Associates, 29(5), 357-363.

Vernon, S. W. (1997). Participation in colorectal cancer screening: A review. Journal of the National Cancer Institute, 89(19), 1406-1422.

Wardle, J., Sutton, S., Williamson, S., Taylor, T., McCaffery, K., Cuzick, J., et al.(2000). Psychosocial influences on older adults'' interest in participating in bowel cancer screening. Preventive Medicine, 31(4), 323-334.

Wee, C. C., McCarthy, E. P., & Phillips, R. S. (2005). Factors associated with colon cancer screening: The role of patient factors and physician counseling. Preventive Medicine, 41(1), 23-29.

Weinrich, S. P., Weinrich, M. C., Boyd, M. D., Johnson, E., & Frank-Stromborg, M.(1992). Knowledge of colorectal cancer among older persons. Cancer Nursing, 15(5),322-330.

Weitzman E.R., Zapka J., Estabrook B., Goins KV. (2001). Risk and reluctance: understanding impediments to colorectal cancer screening. Preventive Medicine,32,502-513.

Weller, D. P., Owen, N., Hiller, J. E., Willson, K., & Wilson, D. (1995). Colorectal cancer and its prevention: Prevalence of beliefs, attitudes, intentions and behavior.Australian Journal of Public Health, 19(1), 19-23.

Wender, R. C. (2002). Barriers to screening for colorectal cancer. Gastrointestinal Endoscopy Clinics of North America, 12(1), 145-170.

Winawer, S. J., Fletcher, R. H., Miller, L., Godlee, F., Stolar, M. H., Mulrow, C. D.,et al. (1997). Colorectal cancer screening: Clinical guidelines and rationale.
Gastroenterology, 112(2), 594-642.

Winawer SJ, Stewart ET, Zauber AG, Bond JH, Ansel H, Waye JD, et al. (2000). A comparison of colonoscopy and double-contrast barium enema for surveillance after polypectomy. The New England Journal of Medicine, 342, 1766-1772.

Wolf, M. S., Rademaker, A., Bennett, C. L., Ferreira, M. R., Dolan, N. C., Davis, T.C., et al. (2005). Development of a brief survey on colon cancer screening knowledge and attitudes among veterans. Preventing Chronic Disease, 2(2), A11.

Zisman, A. L., Nickolov, A., Brand, R. E., Gorchow, A., & Roy, H. K. (2006). Associations between the age at diagnosis and location of colorectal cancer and the
use of alcohol and tobacco: Implications for screening. Archives of Internal Medicine,
166(6), 629-634.

中文部分
王正一（1987)。大腸癌之篩檢（二）臺大醫院之經驗以糞便易查片及直接大腸鏡檢查進行大腸癌篩檢之意義。中華民國消化系醫學會雜誌，4（4)，219-226。
王秀伯(2006)。啤酒與高濃度酒精飲料增加大腸癌的機會。健康世界，242：6。
王秀伯(2006)。誰會比較早得大腸癌? 健康世界，245：6。
許志弘(2005)。西化飲食和精緻食物的代價－大腸癌。健康世界，240(12)：29~32。
許自齊(1995)。直腸息肉的患者應該接受大腸鏡檢。中華民國消化系醫學會雜誌，12(3)：238-242。
邱皓政（2006）。量化研究與統計分析-SPSS 中文視窗版資料分析範例解析。五南圖書：台北。
林姿利、郭憲文(1992)。影響老人接受健康檢查服務因素之研究－以台中市老人免費健康檢查服務為例。公共衛生雜誌，19(1)：94-111。
李文森(1991)。解剖生理學。華杏第二版：台北。
李卓倫(1987)。民眾尋求與利用健康服務的行為模式。公共衛生雜誌，14；42-60。
李卓倫、周碧瑟(1987)。以健康信念模式分析鹿谷鄉民的肝癌篩選行為。公共衛生雜誌，14：236-249。
李世代、賴美淑(1997)。全民健康保險成人預防保健服務實施之檢討－1996 年之回顧。中華家庭醫學雜誌，7(2)：94-104。
洪秀蒼(1993)。高雄市小港區未接受免費健檢老人之追蹤計劃報告。高雄市政府衛生局：高雄。
陳懋良(1979)。纖維質與大腸癌。台灣營養學會雜誌，4(1)：5。
陳曉悌、李怡娟、李汝禮（2003）。健康信念模式之理論起源與應用。Formosan J Med，7(4)：632-639。
黃千芳、賴世偉、劉秋松(2006)。大腸癌的篩檢。基層醫學，21(7)：193-196。
黃璉華(1981)。老人健康檢查行為之研究。護理雜誌，28(1)：77-88。
唐憶淨、王玉潯、張文道、張文瀚(1997)。某醫學中心自費健康檢查民眾的動機與追蹤就醫之先驅研究。中華家醫雜誌，7：43-51。
梁金銅（2004)。大腸鏡檢查。健康世界，227：93-97。
吳明隆(2006)。SPSS 統計應用學習實務：問卷分析與應用統計。知城數位科技：台北。
吳明蒼、馬遠成、劉宏文、劉文章、馬敘強、潘純(1990)。接受婚前健康檢查者對婚前健康檢查的動機與態度之探討。高雄醫學科學雜誌，6(11)：594-598。
蔡秀美(1993)。社會安全問題之探討。國立中正大學，嘉義：215-242。
廖建彰、王心怡、林端雄、謝長堯、宋鴻樟(2005)。台灣地區男性大腸癌與攝護腺癌篩檢狀況。台灣公共衛生雜誌，24(3)：209-216。
盧成皆(2001)。研究工具之信度與效度。於李選總校閱，護理研究與應用。華杏第二版，273-288：台北。
賴德興(2003)。大腸直腸癌的認識及預防。聲洋防癌之聲，104(12)：10-13。
簡茂發(2002)。信度與效度。於楊國樞、文崇一、吳聰賢、李亦園編著，社會及行為科學研究法。東華第十三版，365-396：台北。

碩博士論文部分

于家珩(2003)。影響女性乳癌篩檢因素之分析－以某區域教學醫院門診民眾為
例。中國醫藥大學. 醫務管理研究所，碩士論文，台中市。
陳姿萍(2006)。非麻醉與麻醉對大腸鏡檢疼痛程度之個案對照研究。國立陽明大
學. 衛生福利研究所，碩士論文，台北市。
黃素雲(2004)。應用健康信念模式探討台灣地區影響老年人利用健保成人預防保
健服務之相關因素研究。中國醫藥大學. 醫務管理研究所，碩士論文，台中市。
柯懿嬖(1995)。以健康信念模式分析某工作場所員工之大腸直腸癌糞便篩檢行為
研究。國立台灣師範大學. 衛生教育學系，碩士論文，台北市。
梅彪祥(2005)。全民大腸直腸癌篩檢模式評估-以模擬基層醫療與社區醫院執行
模式為例。國立台灣大學. 醫療機構管理研究所，碩士論文，台北市。

網路文獻

1. 衛生統計資訊網
http://www.doh.gov.tw/statistic/index.htm

2. 衛生署(2006)：民國95 年死因統計上冊統計表
http://www.doh.gov.tw/statistic/data/衛生統計叢書2/95/上冊/index.htm

3. 衛生署(2007)：中華民國公共衛生學會年報96 年版

4. 中華民國公共衛生學會癌症登記小組年報(2005)：94 年版
http://crs.cph.ntu.edu.tw/crs_c/annual.html

5. 行政院衛生署國民健康局(2008)：93 年及94 年癌症登記小組
http://www.bhp.doh.gov.tw/BHPnet/Portal/

6. 行政院衛生署國民健康局(2008)：法規輯要
http://www.bhp.doh.gov.tw/BHPnet/Portal/Law.aspx

7. 李樹人(2008)：體重過重、代謝異常 大腸直腸癌高危險群。http://mag.udn.com/mag/life/storypage.jsp?f_ART_ID=112773139

8. 行政院衛生署國民健康局(2008)：93-94 年癌症登記記者會簡報檔

9. 國家衛生研究院癌症研究組(1998)：大腸直腸癌診斷與治療之共識http://www.nhri.org.tw

10.李怡嬅(2007)。康健雜誌108 期。便血，是痔瘡還是大腸癌?
http://www.commonhealth.com.tw/article/index.jsp?id=4023

11.吳若女(2000)。康健雜誌19 期。你需要做大腸鏡檢查嗎?
http://www.commonhealth.com.tw/article/index.jsp?id=882

12. 台北市衛生局(2007)：黃金50－輕鬆篩檢 腸保健康
http://www.health.gov.tw/Default.aspx?tabid=36&mid=442&itemid=18538

13. 高雄市政府衛生局(2006)：95 年度施政計畫提要
http://rdec.moi.gov.tw/garden/tbldownload/128/new20-95 衛生局施政計畫

14.台灣癌症臨床研究發展基金會：哪種人是大腸癌的高危險群?http://www.tccf.org.tw/information/C_RISK.HTM