臺灣博碩士論文加值系統

背景：
現代社會因出生率下降及國民平均壽命延長，造成人口結構的改變，老化現象越加明顯。老年人口比例持續增加，使民眾對於健康照護的需求日趨殷切。另一方面，由於時代進步，科技發展及網路日益普及，在資訊通訊科技與電子化醫療器材相結合下，可為民眾提供更多元化的健康照護服務。
本研究探討社區醫院在提供社區式遠距照護服務系統後，社區民眾對遠距照護服務系統之可接受度及對健康自我管理之成效分析。
設計：
本研究採橫斷式（cross-sectional）研究設計法，立意取樣方式 (purposive sampling)，採用結構式問卷收集資料。樣本對象為高雄市某社區醫院復健科門診之社區病患。有效樣本共 49 份，問卷信度結果：科技接受模式量表之 Cronbach''s α為 0.87；健康自我管理行為量表之 Cronbach''s α為 0.92，信度良好。
問卷內容包括四部份： 「病患基本資料表」、 「科技接受模式量表」、 「健康自我管理行為量表」、 「付費意願及可近性調查表」；所得資料以SAS 9.2 視窗版進行描述性統計分析、獨立樣本t 檢定、單因子變異數分析、皮爾森相關係數及多元迴歸進行統計分析。
結果：
(1)「科技接受模式量表」 結果: 男性，學歷較高，疾病有固定追蹤，且追蹤較頻繁之民眾對遠距照護服務系統之「自覺易用性」顯著較高。學歷較高及曾聽過遠距照護服務系統之民眾對遠距照護服務系統之「自覺有用性」顯著較高。（2）「健康自我管理行為量表」 結果: 「疾病有固定追蹤」之民眾在所有構面之成效顯著高於疾病沒有固定追蹤者。「疾病有固定追蹤且追蹤較頻繁」 之民眾在「健康責任」、「執行疾病的醫療相關活動」、「運動」 三個構面之成效顯著高於疾病追蹤較不頻繁者。「使用過遠距服務系統」之民眾在「執行疾病的醫療相關活動」及「飲食習慣」二個構面之成效顯著高於沒有使用過遠距服務系統者。（3）「使用態度」顯著正面影響「使用意願」。（4）以迴歸分析方式及校正人口學變項後歸納出 「自覺有用性」與「使用態度」間之迴歸係數為0.323；「自覺易用性」與「使用態度」間之迴歸係數為0.506。「使用態度」與「使用意願」間之迴歸係數為0.703。（5）每月可支配所得在3萬元以上之民眾願意付費在家使用遠距照護服務系統之比例較高。願意付費者以每月支付一百元以下為最多，其次為每月支付一百零一元至三百元。（6） 從家中到社區醫院/社區定點使用遠距照護服務系統可接受之時間，以不超過5-10分鐘為最多。
結論：
社區民眾對於社區醫院提供之遠距照護服務系統接受程度多為正向，同時社區民眾也認為使用社區醫院提供之遠距照護服務系統後可提升民眾健康自我管理行為。社區醫院提供遠距照護服務系統可以提供社區民眾接受便利之照顧服務，而且在醫院內有固定人員管理與諮詢，應是可以考慮推展之方向。

關鍵詞：遠距照護、科技接受模式、健康自我管理、付費意願、可近性

BACKGROUND：Ageing phenomena is more obvious in our population structure due to declined birth rate and prolonged average life expectancy. More demand of health care is required due to increasing proportion of elderly population. As things progress, technological developments and the increasing popularity of Internet combined with information communications technology (ICT) and medical devices can provide more diversified health care services. The purpose of this study is to evaluate community resinents’ acceptance and change of health-care behaviors after telecare services provided in a community hospital.
DESIGN：The study adopted cross-sectional and purposive sampling by using structured questionnaires to collect information. Sampling objects were community residents from rehabilitation outpatient department clinics of a community hospital with 49 valid samples. Reliability results of the questionnaires revealed: Cronbach’s alpha value of technology acceptance model scale and health self-care behavior scale were 0.87 and 0.92, respectively. The questionnaires included 4 sections: “basic patient information”, “technology acceptance model (TAM) scale”, “health self-management behavior scale”, and questionnaires about “willingness to pay and accessibility investigation”. The collected data was analyzed with descriptive statistics, t-test, one-way ANOVA, Pearson’s correlation and regression analysis by using SAS Version 9.2 for Windows software.
RESULT：(1). Results of TAM questionnaires: People with male gender, higher educational status, regular and frequent disease follow-up showed significant higher attitude in “perceived ease of use”; People with higher educational status, ever heard of telecare system showed significant higher attitude in “perceived usefulness”. (2). Results of self health-management behavior questionnaires: People with regular disease follow-up behaved significantly better in all aspets. People with regular and frequent disease follow-up behaved significantly better in “health responsibility”, “carry out disease-related medical activities” and “exercise”. People with experience of using telecare system behaved significantly better in “carry out diseased-related medical activities” and “diet habits”. (3). “attitude toward using” was positively correlated with “behavioral intention to use”. (4). The regression coefficient was 0.323 between ”perceived usefulness” and “attitude toward using”; 0.506 between “perceives ease of use“ and “attitude toward using”；0.703 between “attitude toward using” and “behavioral intention to use”. (5). People with monthly disposable income over NTD $30000 were more likely to pay for home telecare system, and the majority of them wished to pay for less than NTD $100 per month. (6). To use this telecare system outside of home, the majority of community residents could accept a trip distance within 5-10 minutes of time.
CONCLUSION：Comminuty residents mostly showed positive attitudes toward community hospital-provided telecare system and beleived that telecare system can help promoting their health self-care behaviors. With constant staff member in charge of managing telecare device and providing advisory to users, community hospital-provided telecare system could be a possible way to promote and expand telecare service in the future.

Keywords：Telecare, Technology acceptance model, Health self-care, Willingness to pay, Accessibility

論文審定書 I
誌謝 II
中文摘要 III
ABSTRACT V
目 錄 VII
圖 次 VIII
表 次 VIII
第一章 緒論 1
第一節 研究背景及動機 1
第二節 研究目的 3
第二章 文獻探討 5
第一節 遠距照護服務 (TELECARE SERVICE) 5
第二節 國內遠距照護發展 7
第三節 國外遠距照護相關研究 10
第四節 科技接受模式 13
第五節 健康自我管理行為 15
第三章 研究方法 17
第一節 研究設計 17
第二節 研究架構 17
第三節 研究假設 19
第四節 資料收集 20
第五節 研究工具 21
第六節 資料處理與統計分析 23
第四章 研究結果 24
第一節 信度分析 24
第二節 敘述性統計分析 25
第三節 差異分析 33
第四節 相關分析 43
第五節 迴歸分析 44
第六節 假設驗證 46
第五章 討論與建議 47
第一節 研究討論 47
第二節 研究限制 50
第三節 研究貢獻 50
第四節 研究建議 51
參考文獻 52
英文文獻： 52
中文文獻： 54
附件: 社區醫院遠距照護服務系統問卷 56

英文文獻：
Ajzen, I., &; Fishbein, M. (1980). Understanding attitudes and predicting social behaviour.
Anker, S. D., Koehler, F., &; Abraham, W. T. (2011). Telemedicine and remote management of patients with heart failure. [Review]. Lancet, 378(9792), 731-739. doi: 10.1016/S0140-6736(11)61229-4
Bakken, S., Grullon-Figueroa, L., Izquierdo, R., Lee, N. J., Morin, P., Palmas, W., . . . Consortium, I. D. (2006). Development, validation, and use of English and Spanish versions of the telemedicine satisfaction and usefulness questionnaire. J Am Med Inform Assoc, 13(6), 660-667. doi: 10.1197/jamia.M2146
Barlow, J., Bayer, S., &; Curry, R. (2003). The design of pilot telecare projects and their integration into mainstream service delivery. [Research Support, Non-U.S. Gov''t]. J Telemed Telecare, 9 Suppl 1, S1-3. doi: 10.1258/135763303322196132
Barlow, J., Wright, C., Sheasby, J., Turner, A., &; Hainsworth, J. (2002). Self-management approaches for people with chronic conditions: a review. [Review]. Patient Educ Couns, 48(2), 177-187.
Davis, F. D., Bagozzi, R. P., &; Warshaw, P. R. (1989). User acceptance of computer technology: a comparison of two theoretical models. Management science, 35(8), 982-1003.
DOH. (2008). Whole System Demonstrator Programme. London.
DOH. (2011). Whole system demonstrator programme: Headline findings: December 2011: DOH.
Doughty, K., Monk, A., Bayliss, C., Brown, S., Dewsbury, L., Dunk, B., . . . Lowe, C. (2007). Telecare, telehealth and assistive technologies—do we know what we''re talking about? Journal of Assistive Technologies, 1(2), 6-10.
Fishbein, M., &; Ajzen, I. (1975). Belief, attitude, intention and behavior: An introduction to theory and research.
Hu, P. J.-H., Chau, P. Y., &; Sheng, O. R. L. (2002). Adoption of telemedicine technology by health care organizations: an exploratory study. Journal of organizational computing and electronic commerce, 12(3), 197-221.
Jonker, A. A., Comijs, H. C., Knipscheer, K. C., &; Deeg, D. J. (2009). Promotion of self-management in vulnerable older people: a narrative literature review of outcomes of the Chronic Disease Self-Management Program (CDSMP). Eur J Ageing, 6(4), 303-314. doi: 10.1007/s10433-009-0131-y
LeRouge, C., Hevner, A. R., &; Collins, R. W. (2007). It''s more than just use: An exploration of telemedicine use quality. Decision Support Systems, 43(4), 1287-1304.
Lorig, K., Lubeck, D., Kraines, R. G., Seleznick, M., &; Holman, H. R. (1985). Outcomes of self‐help education for patients with arthritis. Arthritis &; Rheumatism, 28(6), 680-685.
Lorig, K. R., &; Holman, H. (2003). Self-management education: history, definition, outcomes, and mechanisms. Ann Behav Med, 26(1), 1-7.
Mistry, H. (2012). Systematic review of studies of the cost-effectiveness of telemedicine and telecare. Changes in the economic evidence over twenty years. [Review]. J Telemed Telecare, 18(1), 1-6. doi: 10.1258/jtt.2011.110505
NIH. (1997). SELF-CARE BEHAVIORS AND AGING Guide (Vol. 26).
Orem. (2013). Dorotha Orem''s Self-Care Theory Retrieved 05-01-2013, from https://sites.google.com/site/oremstheory/outline
Rahimpour, M., Lovell, N. H., Celler, B. G., &; McCormick, J. (2008). Patients'' perceptions of a home telecare system. Int J Med Inform, 77(7), 486-498. doi: 10.1016/j.ijmedinf.2007.10.006
Sintonen, S., &; Immonen, M. (2013). Telecare services for aging people: Assessment of critical factors influencing the adoption intention. Computers in Human Behavior, 29(4), 1307-1317. doi: 10.1016/j.chb.2013.01.037
Steventon, A., Bardsley, M., Billings, J., Dixon, J., Doll, H., Beynon, M., . . . Newman, S. (2013). Effect of telecare on use of health and social care services: findings from the Whole Systems Demonstrator cluster randomised trial. Age Ageing. doi: 10.1093/ageing/aft008
Takahashi, P. Y., Pecina, J. L., Upatising, B., Chaudhry, R., Shah, N. D., Van Houten, H., . . . Hanson, G. J. (2012). A randomized controlled trial of telemonitoring in older adults with multiple health issues to prevent hospitalizations and emergency department visits. Archives of internal medicine, 172(10), 773-779. doi: 10.1001/archinternmed.2012.256
van den Berg, N., Schumann, M., Kraft, K., &; Hoffmann, W. (2012). Telemedicine and telecare for older patients--a systematic review. [Review]. Maturitas, 73(2), 94-114. doi: 10.1016/j.maturitas.2012.06.010
WHO. (2010). Telemedicine: Opportunities and developments in Member States: report on the second global survey on eHealth (pp. 8-10): World Health Organization.
中文文獻：
內政部. (2013). 內政統計通報-week10204 - 101年底人口結構分析.
任維廉, 呂堂榮, &; 劉柏廷. (2009). 科技接受行為模式之整合分析－三個主要模式之比較. [An Integrated Analysis of Technology Acceptance Behaviour Models: Comparison of Three Major Models]. MIS REVIEW：An International Journal, 101-138.
行政院經濟建設委員會. (2012). 中華民國2012 年至2060 年人口推計.
行政院衛生署. (2012a). 100年下半年及全年醫療業務監理指標簡報.
行政院衛生署. (2012b). 衛教週報204期.
吳淑瓊, &; 張明正. (1997). 台灣老人健康照護之現況分析.
周春珍, 張蓓莉, 李冠慧, &; 李亭亭. (2009). 科技始於人性－淺談遠距醫療於老人健康照護之應用. [Technology Connecting People: Applying Telecare in Elderly Health Care]. 護理雜誌, 56(6), 76-80.
林育伶. (2011). 遠距照護服務系統於社區之評估研究. 中臺科技大學. Available from Airiti AiritiLibrary database.
林萬億. (2004-10-22). 誰來照顧老人, 中國時報.
邱曉彥, &; 陳靜敏. (2010). 資訊科技與社區護理之結合：遠距護理的興起. [Telenursing: The Integration of Information Technology and Community Health Nursing]. 源遠護理, 4(2), 5-10.
洪麗玲, 洪麗珍, &; 張彩秀. (2011). 使用遠距照護系統於高血壓患者自我管理行為之影響. [Effectiveness of Using a Tele-Health Care System on Self-Management Behaviors of Patients with Hypertension]. 醫療資訊雜誌, 20(3), 56-68.
郭嘉琪, &; 王秀紅. (2012). 系統性文獻回顧自我管理在國內慢性病介入研究之應用. [Applying Self-Management Intervention Studies to Patients with Chronic Illness: A Systematic Review]. 護理暨健康照護研究, 50-60. doi: 10.6225/jnhr.8.1.52
陳玉敏, &; 曾姿瑛. (2006). 慢性病老人自我照顧行為量表的發展與測試. 中國醫藥大學. Available from Airiti AiritiLibrary database.
陳佳慧, 蘇美如, 黃秀梨, 陳少傑, 戴玉慈, &; 陳恆順. (2004). 遠距居家照護系統. [Home Telehealth: Bring Care to the Site of Living]. 臺灣醫學, 8(6), 837-845.
陳美如, 陳冠宇, 江碩儒, 李俊秀, 余文瑞, &; 何清幼. (2011). 台北市高血壓個案對遠距健康照護服務接受度之初探. [The Acceptance of Taipei Citizen Telehealth Care Service Model on Hypertension]. 醫療資訊雜誌, 20(2), 4-16.
陳素惠. (2010). 遠距健康照護服務品質及滿意度對系統使用行為的影響-以竹山秀傳 U-Care 為例.
陸哲駒, 陳恆順, 鄭伯壎, &; 賴金鑫. (2004). 遠距醫療的發展與落實. [Development and Realization of Telemedicine]. 臺灣醫學, 8(6), 826-831.
湯光明. (2008). 以科技接受模式探討原住民成人數位學習之研究-以原住民族網路學院為例. (碩士), 暨南大學. Available from Airiti AiritiLibrary database. (2008年)
黃毓華, &; 邱啓潤. (1997). 高雄地區大學生健康促進生活型態之預測因子. [Predictors Contributing to Health-Promoting Lifestyles among College Students in Kaohsiung Area]. 中華公共衛生雜誌, 24-36.
黃毓華, &; 邱啟潤. (1996). 健康促進生活型態量表信度效度之評估. [Assessment of the Health - Promoting Lifestyle Profile on Reliability and Validity]. The Kaohsiung Journal of Medical Sciences, 529-537.
黃瑞珍. (2011). 老年人對遠距照護費費意願的探討 台灣老年學暨老年醫學會. 2011台灣老年學暨老年醫學會第十屆第三次年會暨學術研討會: 台灣老年學暨老年醫學會: 台北：台大醫學院.
詹火生, &; 林青璇. (2002). 老人長期照護政策-國家干預觀點之分析 國政研究報告. 民 93 年 (Vol. 10).
臺大醫院遠距照護中心. (2013). 臺大醫院遠距照護中心 Retrieved 05-01, 2013, from http://www.ntuh.gov.tw/telehealth/default.aspx
蔡宗宏, &; 莊碧焜. (2011). 遠距照護系統成效評估之研究. 電腦稽核(23), 113-135. doi: http://dx.doi.org/10.6224/JN.57.4.83
衛生署. (2013). 遠距健康照護服務發展計畫 Retrieved 05-01, 2013, from http://doh.telecare.com.tw/index.aspx