多篇國內外文獻顯示，接種流感疫苗是目前減低流感衝擊最有效的方法。我國於1998年首度試辦「65歲以上高危險群老人流感疫苗接種先驅計畫」，至2003年免費接種對象新增禽畜養殖等相關工作人員。雖然政策面已降低了財務上的障礙，但依衛生署疾病管制局統計2007年禽畜業相關人員流感疫苗接種率是50.4%，其中花蓮縣僅達31.2%。本研究希望能瞭解影響此族群接種疫苗的相關因素，以提供相關單位規劃接種流感疫苗推廣方案之參考，讓此政策的實施能達到最大效益。

本研究以花蓮縣2007年防疫及禽畜養殖相關工作人員名冊為對象，抽取人口稠密之花蓮市、吉安鄉與壽豐鄉實際接觸禽畜養殖、活體屠宰兼販賣之工作人員共202人為研究樣本，為避免訪員問法不一致所造成之偏差，本研究由研究者以面談方式完成所有結構式問卷調查。在統計方面，以百分比、次數分配分析樣本特性，獨立T檢定、單因子變異數分析樣本差異性，皮爾森相關性檢定健康信念、自我效能、社會支持等自變項與依變項接種行為之相關，並利用複迴歸探討各變項對此族群流感疫苗接種行為的預測力。

研究結果顯示花蓮地區禽畜養殖業者過去五年不曾接種流感疫苗者佔35.3％，每年皆有接種者僅佔7.4％。而影響禽畜養殖業者流感疫苗接種行為的因素為教育程度(F=3.965，p=.005)、運動習慣(F=9.183，p=.000)、自覺健康狀態 (F=3.537，p=.017)、有高危險疾病(t=-4.925，p=.000)等；而性別、年齡、婚姻狀態、家庭月總收入、吸菸、喝酒習慣及感冒頻率等因素則無統計上顯著差異。

健康信念變項中除了自覺嚴重性外(r=.159，p=.065)，自覺罹患性(r=.261， p=.002)、自覺利益(r=.529，p=.000)顯著與禽畜養殖業者流感疫苗接種行為正相關，自覺親醫障礙(r=.440，p=.000)、自覺效益障礙(r=.343，p=.000)等顯著與禽畜養殖業者流感疫苗接種行為負相關，其中自覺利益、自覺親醫障礙、自覺效益障礙等能有效預測禽畜養殖業者流感疫苗接種行為。

另迴歸分析結果顯示，自我效能是預測禽畜養殖業者流感疫苗接種行為之首
要預測變項，研究對象在沒有人提醒及沒有收到接種通知等情境下，流感疫苗接種自我效能較低；社會支持中親友支持(r=.676，p=.000)及團體支持(r=.245，p=.000)皆與流感疫苗接種行為顯著相關，但前者的相關程度較高，顯示支持禽畜養殖業者流感疫苗接種的主要來源是家人及同事，其次才是農政、醫政等輔導團體。

本研究建議可以善用農政單位的輔導管道，加強非高齡且無罹患高危險疾病之禽畜養殖業登記雇主對接種流感疫苗的利益性及效益性宣導。衛政單位除了寄發明信片，亦可擬定減少禽畜養殖業者接種疫苗障礙方案，例如設立特別時段（如假日或夜間）門診，集中且快速地完成疫苗接種，以降低其親醫障礙。

Quite a few papers show that influenza vaccinations have thus far become the most effective way to reduce the impact of influenza. In 1998, Taiwan initiated a pioneer project to provide free of charge Influenza Vaccinations for the high risk group of elderly persons over 65 years of age, and in 2003, extended the scope to include vaccinations to poultry and livestock workers. Though the policy had eliminated any financial barriers, the rate of vaccination among poultry and livestock workers was only 50.4%, based on data from the Center for Disease Control, R.O.C. statistics report for 2007. Among Taiwan’s counties, Hualien’s rate is lower than average at 31.2%. In this study, we sought to discover the relevant factors affecting the rate of influenza vaccinations among poultry and livestock workers in Hualien County. We expect this study will provide to the Bureau of Health data which facilitates influenza vaccinations and maximizes the policy benefit.

The candidates in this study came from the Bureau of Health’s 2007 list of poultry and livestock workers in Hualien County. The research data was generated by all the 202 listed poultry and livestock workers from Hualien City, Chi-an, and Shoufong townships. To avoid bias from the inconsistency of interviewers’ questioning style, the author personally interviewed each candidate with a structured questionnaire. These data were analyzed using descriptive statistics, t-test, one way ANOVA, Pearson’s correlation, and multiple regression analysis.

The results of this study revealed that 35.3% of Hualien’s poultry and livestock workers had not been vaccinated against influenza in the past five years, and only an average of 7.4％ of Hualien’s poultry and livestock workers are vaccinated each year. The primary factors affecting influenza vaccination rates for poultry and livestock workers were: education level (F=3.965，p=.005), regular exercise (F=9.183，p=.000), self-rated health (F=3.537，p=.017), and high-risk disease(t=-4.925，p=.000), among others. On the other hand, gender, age, marital status, monthly household income, and the frequency of smoking, drinking and common cold showed no statistically significant impact.

In the independent variables of health belief, perceived severity(r=.159，p=.065), perceived susceptibility (r=.261，p=.002), perceived benefits (r=.529，p=.000) had significantly positive correlations with influenza vaccination rates, whereas perceived medical facility barriers (r=.440，p=.000), perceived effective barriers (r=.343，p=.000) had significantly negative correlations with influenza vaccination. Moreover, perceived benefits, perceived medical facility barriers and perceived effective barriers can effectively predict the influenza vaccination rate for poultry and livestock workers.

The results of multiple regression analysis revealed that self-efficacy is the major independent variable in predicting influenza vaccination rates for poultry and livestock workers. Within the category of social supports, the relatives’ support (r=.676，p=.000) had a higher correlation than that of group support (r=.245，p=.000) in predicting influenza vaccination rates. It shows that the major channel of support for receiving influenza vaccinations among poultry and livestock workers comes from family or colleagues, and the secondary channels were the agricultural and health authorities.

As a recommendation, one should make use of the agricultural authority’s channel in promoting the benefit of influenza vaccinations to the employers of registered poultry and livestock workers. However, in addition to sending postcard reminders, As a means to reduce the time barriers and to facilitate use of such medical services, health authorities could set up a designated timeframe (such as holidays or evenings) at local clinics, so that poultry and livestock workers could receive their vaccinations quickly and intensively.

誌謝………………………………………………………………………………… I
中文摘要………………………………………………………………………… II
英文摘要……………………………………………………………………………IV
目錄…………………………………………………………………………………VI
圖表目錄……………………………………………………………………… VIII
第一章 緒論
第一節 研究背景與動機…………………………………………………… 1
第二節 研究之重要性……………………………………………………… 4
第三節 研究目的、問題與假設…………………………………………… 6
第四節 名詞界定…………………………………………………………… 7
第二章 文獻探討
第一節 簡介流行性感冒與其預防及治療………………………………… 9
第二節 國內外流行性感冒疫苗接種政策及實施效益…………………… 13
第三節 影響流感疫苗接種行為之相關因素……………………………… 20
第四節 健康行為理論應用………………………………………………… 28
第五節 小結………………………………………………………………… 33
第三章 研究設計與方法
第一節 研究架構…………………………………………………………… 34
第二節 研究材料與方法…………………………………………………… 36
第三節 資料處理與統計分析方法………………………………………… 46
第四章 研究結果
第一節 社會人口學、健康行為及健康狀態之描述性分析……………… 50
第二節 研究對象之年齡、健康信念、自我效能、社會支持
及流感疫苗接種行為之描述性分析……………………………… 55
第三節 研究對象之社會人口學、健康行為及健康狀態
對流感疫苗接種行為之差異性分析……………………………… 70
第四節 健康信念、自我效能、社會支持與流感疫苗接種行為
之相關性分析……………………………………………………… 77
第五節 健康信念、自我效能、社會支持與流感疫苗接種行為
之預測力分析……………………………………………………… 79
第五章 討論
第一節 禽畜養殖業者流感疫苗接種行為………………………………… 84
第二節 研究對象社會人口學、健康行為、健康狀態
與流感疫苗接種行為之差異性…………………………………… 85
第三節 健康信念、自我效能、社會支持與流感疫苗接種行為之關係… 89
第六章 結論與建議
第一節 結論………………………………………………………………… 91
第二節 限制與建議………………………………………………………… 92
參考文獻…………………………………………………………………………… 93
附錄
附錄一：問卷專家效度審查名單…………………………………………… 98
附錄二：預試問卷…………………………………………………………… 99
附錄三：正式問卷……………………………………………………………105

中文部份：

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國家衛生研究院電子報 第33期 2004-02-24
http://enews.nhri.org.tw/


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