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研究生:賴金英
研究生(外文):Chin-ying Lai
論文名稱:台灣50至69歲婦女未接受乳房攝影篩檢相關因素之探討
論文名稱(外文):Factors Associated with Non-Utilization of Mammographic Screening Services in Women Aged 50 to 69 Years in Taiwan
指導教授:陳秋媛陳秋媛引用關係
指導教授(外文):Chiu-yuan Chen
學位類別:碩士
校院名稱:南華大學
系所名稱:自然醫學研究所
學門:醫藥衛生學門
學類:其他醫藥衛生學類
論文種類:學術論文
論文出版年:2011
畢業學年度:99
語文別:中文
論文頁數:114
中文關鍵詞:篩檢國民健康訪問調查乳房攝影乳癌安德遜健康服務利用行為模式
外文關鍵詞:mammographynational health interview surveybreast cancerscreeningAndersen behavioral model of health services use
相關次數:
  • 被引用被引用:5
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  研究背景:乳癌在台灣女性癌症的年發生率排名第一,死亡年齡中位數僅56歲,但民眾接受乳房攝影篩檢比例偏低。國外文獻指出乳房攝影篩檢行為與年齡、教育程度、種族及癌症病史等有關,可是台灣以代表性樣本的研究報告仍然缺乏。
  
  研究目的:探討台灣50至69歲婦女未接受乳房攝影的相關因素。
  
  研究方法:研究資料來源為國家衛生研究院「民國94年國民健康訪問調查個人問卷(12至64歲及65歲以上)」,參考安德遜健康服務利用行為模式,針對可能影響台灣婦女乳房攝影篩檢行為之相關因子,利用單變項及多變項羅吉斯廻歸進行統計分析。
  
  研究結果:台灣50至69歲婦女接受乳房攝影篩檢比例僅佔24.3%。在單變項分析中,與台灣中老年婦女未接受乳房攝影篩檢之顯著相關因子包括年齡、教育程度、籍貫、身體質量指數、每月平均收入、購買健保外之其他商業保險、居住地區、全身性健康檢查、因更年期接受荷爾蒙治療及喝酒習慣。多變項羅吉斯迴歸分析顯示,影響台灣中老年婦女未接受乳房攝影篩檢之顯著獨立因子包括較低教育程度、有工作、每月平均收入較低、沒有購買健保外之其他商業保險、從來沒有接受過全身性健康檢查及從來沒有因更年期接受過荷爾蒙治療。
  
  結論:醫院及衛生單位在策劃乳房攝影篩檢方案時,可參考本研究發現的顯著相關因子,藉以加強婦女接受乳房攝影篩檢的意願,減少乳癌對女性生命之威脅。
  Background: The morbidity of breast cancer ranks at the top of female cancers in Taiwan with a median age of mortality of only 56 years. However, the proportion of women with a history of mammographic screening was low. International literature indicated that the participation of mammographic screening was associated with age, education level, ethnicity, and previous history of cancer. Nevertheless, studies using nationally representative sample were not yet available for the Taiwan population.
  
  Aim: The objective of the present study was to investigate factors associated with non-utilization of mammographic screening in women aged between 50 to 69 in Taiwan.
 
  Methods: Data were obtained from the 2005 National Health Interview Survey in Taiwan. Based on the Andersen behavioral model of health services use, factors associated with mammographic screening was evaluated using univariate and multiple logistic regression analyses.
 
  Results: Only 24.3% of the women aged 50 to 69 years had mammographic screening. Results from the univariate logistic regression analysis indicated that mammographic screening was associated with age, education level, birthplace, body mass index, average monthly salary, having an insurance plan other than the National Health Insurance, levels of urbanization of home city, history of health examination, history of menopausal hormone replacement therapy, and alcohol use. Results from multiple logistic regression analysis indicated that the non-utilization of mammographic screening was associated with a lower level of education, having a job, a lower average monthly salary, not on an insurance plan other than the National Health Insurance, no history of health examination, and had never used menopausal hormone replacement therapy.
 
  Conclusions: When hospitals and health units are planning
for their mammographic screening programs, the factors associated with non-utilization of mammographic screening found in the present study can be used as a basis for enhancing the willingness of women to obtain mammography and thereby reducing the threat of breast cancer in Taiwan.
中文摘要 ..................................................................................................i
英文摘要 ................................................................................................iii
目次 .........................................................................................................v
附表目次 ..............................................................................................viii
附圖目次 ................................................................................................ix
表目次 .....................................................................................................x
圖目次 ....................................................................................................xi
 
第一章 緒論 ........................................................................................1
1.1研究背景與動機 ........................................................................1
1.2研究目的 ....................................................................................3
 
第二章 文獻探討 ................................................................................4
2.1乳癌的流行病學 ........................................................................4
2.1.1乳癌的形成與分期 .............................................................4
2.1.2乳癌發生率 .........................................................................7
2.1.3乳癌死亡率 .........................................................................8
2.1.4乳癌的危險因子 ................................................................12
2.2乳癌檢查 ...................................................................................16
2.2.1乳房自我檢查 ....................................................................16
2.2.2乳房超音波 ........................................................................17
2.2.3乳房攝影 ............................................................................18
2.2.4核磁共振 ............................................................................22
2.2.5正子電腦斷層掃瞄檢查 ....................................................22
2.3乳房攝影篩檢政策 ...................................................................24
2.4健康行為 ...................................................................................28
2.4.1健康信念模式 ....................................................................28
2.4.2安德遜健康服務利用行為模式 ........................................31
2.5影響婦女接受乳房攝影篩檢之因素 .......................................37
 
第三章 研究材料與方法 ...................................................................43
3.1研究架構 ...................................................................................43
3.2研究對象 ...................................................................................45
3.3資料來源 ...................................................................................47
3.4資料處理 ...................................................................................51
3.5統計方法 ...................................................................................52
 
第四章 研究結果 ...............................................................................53
4.1研究樣本特性 ...........................................................................53
4.2婦女接受乳房攝影篩檢情形 ...................................................63
4.3婦女乳癌篩檢之認知 ...............................................................65
4.4婦女未接受乳房攝影篩檢與相關因素之分析 .......................67
4.4.1單變項羅吉斯迴歸分析 ....................................................67
4.4.2多變項羅吉斯迴歸分析 ....................................................79
 
第五章 討論 .......................................................................................82
5.1 安德遜健康服務利用行為模式對於婦女是否接受乳房攝影篩檢的影響.......82
5.2婦女接受乳房攝影篩檢比例與健康認知 ...............................83
5.3婦女未接受乳房攝影篩檢之相關因素探討 ...........................84
5.4研究限制 ...................................................................................88
 
第六章 結論與建議 ...........................................................................89
6.1結論 ...........................................................................................89
6.2建議 ...........................................................................................90
 
參考文獻 ................................................................................................92
一、中文部分 ...................................................................................92
二、英文部分 ...................................................................................97
 
附錄A ....................................................................................................109
 
附表目次
附表2.1乳癌分期 ...............................................................................5
附表2.2各國乳癌篩檢政策 ...............................................................27
 
附圖目次
附圖2.12008年乳癌發生率與死亡率的台灣與各國比較 ..............9
附圖2.2癌症自然史與三段五級預防 ..............................................11
附圖2.3健康信念模式 ......................................................................30
附圖2.4第一階段的安德遜健康服務利用行為模式 ......................34
附圖2.5第五階段的安德遜健康服務利用行為模式:包含環境和個人特質.......35
 
表目次
表2.1 利用健康服務利用行為模式之相關研究 .............................36
表2.2 探討影響婦女接受乳房攝影篩檢相關因素之研究 .............40
表2.3 婦女接受乳房攝影篩檢與相關因素之相關性 .....................41
表4.1 研究樣本潛在因素特性之分佈 .............................................55
表4.2 研究樣本促成因素特性之分佈 .............................................58
表4.3 研究樣本需求因素特性之分佈 .............................................60
表4.4 研究樣本健康行為因素特性之分佈 .....................................62
表4.5 台灣50至69歲婦女接受乳房攝影篩檢情形 .........................64
表4.6 台灣50至64歲婦女乳癌篩檢之認知 .....................................66
表4.7 婦女未接受乳房攝影篩檢與潛在因素之單變項羅吉斯迴歸分析 ........69
表4.8 婦女未接受乳房攝影篩檢與促成因素之單變項羅吉斯迴歸分析 ...........73
表4.9 婦女未接受乳房攝影篩檢與需求因素之單變項羅吉斯迴歸分析..............76
表4.10婦女未接受乳房攝影篩檢與健康行為因素之單變項羅吉斯迴歸分析......78
表4.11婦女未接受乳房攝影篩檢與相關因素之多變項羅吉斯迴歸分析..............81
 
圖目次
圖3.1 研究架構 .....................................................................................44
圖3.2 研究樣本篩選流程 .....................................................................46
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