研究目的：花蓮地區結核病從青少年開始的發生率位居台灣第一位，為提昇國中生防治結核病的能力，本研究探討原住民分佈區域國中生的結核病知識與態度現況，並深入分析探討其相關因素。
研究方法：本研究為橫斷式研究，以花蓮縣2007年結核病發生率前三高的鄉鎮，秀林鄉、萬榮鄉及卓溪鄉的國中，分別為秀林、萬榮及三民國中於2009年在學之全體學生606人為對象進行調查。收集之有效樣本共計468份，回收率為81.02%。
研究結果：本研究對象的結核病主要訊息來源管道為電視、學校校護及學校上課；來源對象以老師及衛生所護士為主；約有六成的學生覺得沒有得到充分的結核病資訊。結核病知識的答對率為24.3%，答對率最高的題目是結核病的檢查方法；最低的題目是DOTS計畫及結核病疫苗。與知識相關具統計顯著意義的主要因素有，資訊來源管道為「宣傳資料」（η2=.061）、「不知道」結核病（η2=.066）、資訊接收來源多寡（η2=.075）、資訊來源對象「衛生所護士」（η2=.066）、「沒聽任何人提起過」結核病（η2=.063）及聽過結核病相關標語（ω2=.094）。受訪者之結核病的態度，79.1%會擔心自己被傳染結核病，74.6%的學生同意結核病是嚴重的疾病，只有37.8%的學生認為自己得到結核病的機會很大。結核病偏見的部分：不幸得病會害怕他人知道、覺得得到結核病會不好意思讓別人知道以及認為得到結核病是一件丟臉的事情的比例分別為55.5%、45.5%及26.8%。結核病防治意圖方面，同意「若不幸得到結核病會積極遵從醫師的指示服藥」、「若同住親友不幸得到結核病，會主動協助尋找相關知識」、「如果同住親友得過結核病，你生病就醫時會告知醫師接觸史」、「如果你知道結核病防治的方法，會主動向親友宣傳」及如果你不幸得到結核病會告訴他人，並尋求協助」的比例為86.1%、78.4%、69.4%、67.9％及65.0%。最常被認為不幸得到結核病的非疾病歸因是衛生習慣不好。學校別、鄉鎮別與「結核病偏見」有中度相關；自己是否得過結核病與「結核病容易感染程度」有中度相關，「健康習慣的好壞」及「是否希望獲得更多結核病資訊」分別跟「結核病防治意圖」有中度相關。結核病知識及結核病防治意圖有相關性。
對於結核病防治有正確的知識、良好的態度以及提高對結核病的警覺性才能有效降低人際間的傳播。因此本研究建議學校及衛生單位可以針對山地鄉的學生加強結核病的衛教宣導，讓政府「結核十年減半」的計畫落實，在衛教內容方面，希望可以更生動活潑，定期舉辦課程研討，加強衛教內容的深度。讓山地鄉的學生們擁有正確的結核病知識與態度，進而擔任健康種子，將正確的資訊帶入家庭及社區。

Objectives: The incidence of tuberculosis (TB) higher than teenage in Hualien is the highest in Taiwan. The porpose of this study was to survey the knowledge and attitude of TB prevention among students in junior high schools located in indigenous living areas in Hualien.
Methods: We performed cross-sectional survery on the junior high school students in three indigenous villages namely, Xiu-ling Village, Wan-rong Village and Zhuo-xi Village where the TB incidences are the highest among Hualien area. A structure questionnaire was used for data collection. In all, 606 questionnaires were distributed and 491 returned a response rate as 81.01%. We excluded uncomplete data and then 468 questionnaires were used for data analysis.
Results: The main source of information about TB was television, teachers and clinic nurse. Sixty percent reported that he or she did not obtain sufficient information for TB. The average correct rate for TB knowledge test was 24.29%. The questions that showed the highest correct answer was the method to diagnose TB and the lowest were the method of TB treatment plan and TB vaccination. The variables of relative factors of TB knowledge were the public source of TB information, the TB information from at least three sources, the availability of TB information, the TB information obtained from a clinic nurse, and TB slogan. Regarding the attitudes about TB, 79.1% of students reported that they worried about getting TB, 74.6% agreed that TB is a serious disease, and only 37.8% felt they have chance to getting TB. Regarding TB stigma, subjects tends to be afraid of the condition if others know they were infected with TB, to feel embarrassed if they getting TB, to feel ashamed if getting TB. The most common cause of getting TB is poor hygiene. The variables of relative factors of TB stigma were the school they studied and the villages the lived. The students who ever got TB would felt easy to get TB. The relative factors of preventive TB behavior intention were TB knowledge, health behavior and the incentive to obtain more TB information.
These results can be used for TB prevention in junior high school in indigenous living areas. We suggest to give more TB education to these students and it is a part of effectve ways on decreasing TB in ten years of our government policy. The material of TB education needs to be improved and made more interesting for students. If students receive correct TB information, they will propagate these information to their family and community.

目 次
中文摘要…………………………………………………………..........………….. Ⅱ
英文摘要.................................................................................................................... Ⅳ
目次…………………………………………………………………………............ Ⅵ
第一章 緒論…………………………………………………..…………………… 1
第一節 研究背景……………………………………………..……………… 1
第二節 研究目的…………………………………………………..………… 4
第三節 名詞解釋………………………………………………………..…… 5
第二章 文獻探討…………………………………………………………..……… 7
第一節 結核病流行病學及疾病概述…………………………………..…… 7
第二節 政府結核病十年減半政策………………………………………. … 16
第三節 校園結核病防治及結核病衛生教育現況分析……….……….….. 17
第四節 結核病的知識、態度的相關因素…………………………..……… 20
第三章 研究方法………………………………………………………………..… 33
第一節 研究架構………………………………………………… …….…… 33
第二節 研究對象………………………………………………………..…… 33
第三節 研究工具………………………………………………………..…… 34
第四節 問卷施測流程….…………………………………………………...…. 37
第五節 資料處理與分析………………………………………………..…… 38
第四章 研究結果……………………………………………………………..…… 40
第一節 樣本特質及結核病教育經驗描述……………………………….... 40
第二節 結核病知識現況與相關因素…………………………………..….. 45
第三節 結核病態度現況與相關因素…………………………………….... 48
第四節 結核病知識與態度相關分析……………………………………… 52
第五節 校護及老師的訪談…………………………………………….…. 53
第五章 討論……………………………………………………………………..… 57
第一節 結核病資訊來源及教育經驗……………………………....…...… 57
第二節 結核病知識與相關因素……………………………….………...... 58
第三節 結核病態度與相關因素…………………………….…………….. 59
第四節 結論與建議…………………………………………..……………. 62
參考文獻……………………………………………………………..………….… 63

附 件
附件一 接觸者及感染源調查 ………………………………………………… 113
附件二 結核病全民知識 …………………………………………………...…. 114
附件三 校園傳染病防治計畫_結核病聚集感染 …………………………..… 118
附件四 花蓮縣國中生對結核病之知識、態度調查問卷 ………………….... 120
附件五 專家效度名單………………………………………………………….. 136

參考文獻
Ailinger, R., Armstrong, R., Nguyen, N., & Lasus, H. (2004). Latino Immigrants' Knowledge of Tuberculosis. Public Health Nursing, 21(6), 519.
Ailinger, R., Lasus, H., & Dear, M. (2003). Americans' Knowledge and Perceived Risk of Tuberculosis. Public Health Nursing, 20(3), 211-215.
Becker, M., Drachman, R., & Kirscht, J. (1974). A new approach to explaining sick-role behavior in low-income populations. American Public Health Association, 64, 205-216.
Brassard, P., Anderson, K., Menzies, D., Schwartzman, K., & Macdonald, M. (2008). Knowledge and perceptions of tuberculosis among a sample of urban aboriginal people. Journal of community health, 33(4), 192-198.
Cain, K., Benoit, S., Winston, C., & Mac Kenzie, W. (2008). Tuberculosis Among Foreign-Born Persons in the United States. Journal of the American Medical Association, 300(4), 405-412.
Chan, P., Huang, L., Wu, Y., Yang, H., Chang, I., Lu, C., et al. (2007). Tuberculosis in Children and Adolescents, Taiwan, 1996-2003. Emerging Infectious Diseases, 13(9), 1361.
Chang, L., Hung, L., Chou, Y., & Ling, L. (2007). Applying the Health Belief Model to Analyze Intention to Participate in Preventive Pulmonary Tuberculosis Chest X-Ray Examinations among Indigenous Nursing Students. The Journal of Nursing Research, 15(1), 78-87.
Dye, C., Watt, C., Bleed, D., Hosseini, S., & Raviglione, M. (2005). Evolution of tuberculosis control and prospects for reducing tuberculosis incidence, prevalence, and deaths globally. Journal of the American Medical Association, 293(22), 2767-2775.
Emili, J., Norman, G., Upshur, R., Scott, F., John, K., & Schmuck, M. (2001). Knowledge and practices regarding tuberculosis: a survey of final-year medical students from Canada, India and Uganda. Medical Education, 35(6), 530-536.
Emili, J., Scott, F., Upshur, R., Schmuck, M., & John, K. (2002). Attitudes Toward Tuberculosis of Final Year Medical Students From Canada, India, and Uganda. Teaching and Learning in Medicine, 14(3), 168-174.
Figueiras, M. J., & Aleves, N. C. (2007). Lay perceptions of serious illnesses: An adapted version of the Revised Illness Perception Questionnaire (IPQ-R) for healthy people. Psychology & Health, 22(2), 143-158.
Gibson, N., Cave, A., Doering, D., Ortiz, L., & Harms, P. (2005). Socio-cultural factors influencing prevention and treatment of tuberculosis in immigrant and Aboriginal communities in Canada. Social Science & Medicine, 61(5), 931-942.
Haddad, M., Wilson, T., Ijaz, K., Marks, S., & Moore, M. (2005). Tuberculosis and Homelessness in the United States, 1994-2003. Journal of the American Medical Association, 293(22), 2762-2766.
Hadjichristodoulou, C., VAsilogiannakopoulos, A., Spala, G., Mavrou, I., Kolonia, V., Marinis, E., et al. (2005). Mycobacterium tuberculosis transmission among high school students in Greece. Pediatrics International, 47(2), 180.
Hoa, N., Thorson, A., Long, N., & Diwan, V. (2003). Knowledge of tuberculosis and associated health-seeking behaviour among rural Vietnamese adults with a cough for at least three weeks. Scandinavian Journal of Public Health, 31, 59-65.
Hsu, Y., Chen, C., Sun, H., Jou, R., Lee, J., & Su, I. (2006). Association of NRAMP 1 gene polymorphism with susceptibility to tuberculosis in Taiwanese aboriginals. Journal of the Formosan Medical Association, Taiwan yi zhi, 105(5), 363.
Jackson, M., Harrity, S., Hoffman, H., & Catanzaro, A. (2007). A survey of health professions students for knowledge, attitudes, and confidence about tuberculosis, 2005. BioMed Central Public Health, 7(1), 219.
Khan, J., Irfan, M., Zaki, A., Beg, M., Hussain, S., & Rizvi, N. (2006). Knowledge, attitude and misconceptions regarding tuberculosis in Pakistani patients. Journal-pakistan medical association, 56(5), 211.
Lee, L., Chen, C., Suo, J., Chen, S., Chen, C., & Lin, R. (1993). Family factors affecting the outcome of tuberculosis treatment in Taiwan. Journal of the Formosan Medical Association, 92(12), 1049-1056.
Lee, J., Lee, C., Suo, J., Chiang, I., Lin, C., Lin, T., et al. (2003). Drug resistance of Mycobacterium tuberculosis in eastern Taiwan. Tzu Chi Medical Journal, 15(4), 229-234.
Lienhardt, C., Sillah, J., Fielding, K., Donkor, S., Manneh, K., Warndorff, D., et al. (2003). Risk factors for tuberculosis infection in children in contact with infectious tuberculosis cases in the Gambia, West Africa (Vol. 111): American Acadmy Pediatrics.
Marinac, J., Willsie, S., McBride, D., & Hamburger, S. (1998). Knowledge of tuberculosis in high-risk populations: survey of inner city minorities. The international journal of tuberculosis and lung disease: the official journal of the International Union against Tuberculosis and Lung Disease, 2(10), 804.
Marks, S., DeLuca, N., & Walton, W. (2008). Knowledge, attitudes and risk perceptions about tuberculosis: US National Health Interview Survey. International Journal of Tuberculosis and Lung Disease, 12(11), 1261-1267.
Orrett, F., & Shurland, S. (2001). Knowledge and awareness of tuberculosis among pre-university students in Trinidad. Journal of community health, 26(6), 479-485.
Petty, R. E., & Cacioppo, J. T. (1981). Attitudes and Persuasion: Classic and Contemporary Approaches. Dubuque, Iowa: Wm. C. Brown Company.
Promtussananon, S., & Peltzer, K. (2005). Perceptions of tuberculosis: Attributions of cause, suggested means of risk reduction, and preferred treatment in the Limpopo province, South Africa. Journal of Health Population and Nutrition, 23(1), 74-81.
Shah, N., Pratt, R., Armstrong, L., Robison, V., Castro, K., & Cegielski, J. (2008). Extensively Drug-Resistant Tuberculosis in the United States, 1993-2007. Journal of the American Medical Association, 300(18), 2153.
Singh, U., Bala, A., & Goel, R. (2006). Knowledge about Tuberculosis in Senior School Students of Punjab. Indian Journal of Community Medicine, 31(2), 4p.
Teixeira, E., Menzies, D., Cunha, A., Luiz, R., Ruffino-Netto, A., Scartozzoni, M., et al. (2008). Knowledge and practices of medical students to prevent tuberculosis transmission in Rio de Janeiro, Brazil. Revista Panamericana de Salud Publica, 24, 265-270.
Wang, J., Fei, Y., Shen, H., & Xu, B. (2008). Gender difference in knowledge of tuberculosis and associated health-care seeking behaviors: a cross-sectional study in a rural area of China. BioMed Central Public Health, 8, 354.
Westaway, M. (1989). Knowledge, beliefs and feelings about tuberculosis. Health education research, 4(2), 205-211.
World Health Organization (2009). Global tuberculosis control : epidemiology, strategy, financing : WHO report 2009.
Wu, P., Chou, P., Chang, N., Sun, W., & Kuo, H. (2009). Assessment of Changes in Knowledge and Stigmatization Following Tuberculosis Training Workshops in Taiwan. Journal of the Formosan Medical Association, 108(5), 377-385.
Yu, M., Bai, K., Chang, J., & Lee, C. (2004). Tuberculosis incidence and mortality in aboriginal areas of Taiwan, 1997-2001. Journal of the Formosan Medical Association, 103, 817-823.
王保進（2006）。英文視窗版SPSS與行為科學研究【第三版】。台北：心理。
石玲如（2003）。台北市國中學生SARS信念、行為及相關因素之研究。未出版碩士論文，國立台北師範大學，台北。
行政院衛生署（2006）。結核病十年減半全民動員計畫。2009年5月19日檢自： http://www.cdc.gov.tw/ct.asp?xItem=15568&ctNode=1957&mp=1
行政院衛生署疾病管制局（2007a）。台灣結核病防治年報2007。台北：作者。
行政院衛生署疾病管制局（2007b）。「校園傳染病防治計畫」參考資料。2008年11月20日，檢自：http://www.hfu.edu.tw/~hc/96disease.pdf。
行政院衛生署疾病管制局（2008a）。傳染病統計暨監視年報-96年。台北：作者。
行政院衛生署疾病管制局（2008b）。傳染病防治手冊。台北：作者。
行政院衛生署疾病管制局（2009a）。結核病專區網站。2009年4月20日檢自：http://www.cdc.gov.tw/mp.asp?mp=230。
行政院衛生署疾病管制局（2009b）。第六章 結核病接觸者檢查。2009年4月20日檢自： http://www.cdc.gov.tw/public/Attachment/942096671.pdf。
吳明隆（2007）。SPSS問卷統計分析實務操作與應用。台北：五南。
吳紹筠、陳淑怡、汪宜珊、陳淑賢（2007）。某區域醫院肺結核病患護理指導之改善。長庚護理，18（2），233-243。
呂實雲、王貴鳳、吳怡君（2004）。醫院及學校結核病抽樣篩檢報告。疫情報導， 20（8），419-430。
沈君儀（2008）。城鄉民眾之傳播行為及其對傳染病風險知覺的影響。未出版碩士論文，國立台灣大學，台北。
岳少釜（2004）。花蓮縣山地鄉社區成人健康傳播管道之研究--以桿菌性痢疾防治為例。未出版碩士論文，慈濟大學，花蓮。
林杜凌、張瓊文、劉秀娟、陳美玲、賴珮芳、李翠鳳 （2009）。南投縣某家庭結核病聚集感染事件之調查與處理。疫情報導，25（2），96-102。
林金絲（2003）。實用傳染病防治學。台北：華杏。
胡雅容、黃振杰、劉�℅漶B李欣倫、劉士豪、賴明和等（2007）。宜蘭縣某榮民醫院呼吸照護病房疑似結核病群聚事件調查。疫情報導，23（12），693-704。
張玉婷、羅淑芬、施仁興（2005）。結核病患同住青少年對結核病知識、態度及健康促進行為之探討。慈濟護理雜誌，4（4），79-87。
張蓓貞編著（2004）。健康促進理論與實務。台北：新文京開發。
張麗春、洪麗玲、李怡娟、鄒治儉、侯叔雲（2005）。校園肺結核管理。學校衛生，47，71-85。
許建邦、羅秀雲、李政益、楊祥麟、王貴鳳、楊世仰（2008）。台灣都治（DOTS）執行經驗及成效初探。疫情報導，24（3），184-203。
郭素娥、藍忠孚、陳惠珠（1998）。高雄市肺結核患者與非患者對肺結核知識、態度與預防行為之比較。中華衛誌，17，293-301。
游忠豪（2004）。大高雄地區中學生對呼吸道傳染病知識和態度之研究。未出版碩士論文，國立高雄師範大學，高雄。
馮琦芳、詹俊庭、黃貝琴、柯靜芬、洪健榮、吳怡君等（2005）。花蓮縣高中肺結核個案之流行病學關連性探討：疫情報導。
詹珮君、曾俊華、蔡寶櫻、胡雅容、劉士豪、賴明和等（2008）。一位因結核病死亡之十四歲少女-我們應該如何為具傳染性之結核病個案的接觸者進行衛教？疫情報導，24（3）， 177-183。
劉美英、施秀、李品慧、簡大任、楊世仰、周如文等（2009）。2007年某校學生結核病群聚事件調查。疫情報導，25（2），103-115。
劉耿宏（2004）。彰化縣地區國小高年級學童傳染病預防行為及相關因素之研究。未出版碩士論文，台中師範學院，台中。
蔡宜真、潘翠瓊、顏慕庸、江大雄（2008）。臺北市2004-2006年安養照護機構結核病發生率之探討。疫情報導，24（9），696-706。
蔡淑芬、張慈桂（2008）。花蓮縣山地鄉與非山地鄉死亡率趨勢之探討，1986-2005年。台灣衛誌，27，365-372。
羅淑芬、楊美玲、江明珠、徐銘玉、林秀英（2008）。原住民對肺結核之知識、態度與行為。臺灣醫學，12（3），275-283。