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研究生:溫筑婷
研究生(外文):Chu-Ting Wen
論文名稱:家庭成員共同健康行為及共同疾病之探討-以家庭群聚觀點
論文名稱(外文):Concordant Health Behavior and Disease among Family Members in Taiwan- A Perspective of Family Clustering
指導教授:王中儀王中儀引用關係
學位類別:碩士
校院名稱:中國醫藥大學
系所名稱:醫務管理學系碩士班
學門:商業及管理學門
學類:醫管學類
論文種類:學術論文
論文出版年:2015
畢業學年度:103
語文別:中文
論文頁數:337
中文關鍵詞:家庭群聚共同健康行為共同疾病家庭成員
外文關鍵詞:Family clusteringConcordant health behaviorsConcordant diseasesFamily members
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動機與目的:疾病可能產生家庭群聚現象,相關因素包括健康行為及遺傳等。因慢性疾病衝擊大眾健康及健保財政,以家庭角度進行共同疾病之檢視與預防顯得特別重要。惟台灣以家庭群聚觀點探討共同健康行為及罹患共同疾病之研究闕如,故本研究欲進行其相關性探討,並檢視相同疾病之種類、家庭比例(Familial Proportion)及相關因素。
方法:本研究為橫斷性研究,採初級資料進行分析,以自編結構式問卷針對台灣北中南部共四家醫院家醫科門診病患進行問卷調查,共回收有效問卷963份。統計分析方法以SPSS 12.0進行家庭比例、卡方檢定、二項式邏輯斯迴歸進行分析。
結果:家庭成員罹患相同疾病(大於等於三位家庭成員)之家庭比例最高前四項分別為肥胖(13.29%)、過敏性鼻炎(4.57%)、高血壓(3.12%)以及高膽固醇(1.77%)。結果顯示家庭成員共同健康行為(如:飲食、物質使用)易導致共同罹患高血脂、高膽固醇、高血壓、上呼吸道疾病、消化性潰瘍、慢性肝病、過敏性鼻炎、關節炎、過重/肥胖、職業傷害、癌症。此外,家庭成員罹患相同疾病之相關因素為年齡、教育程度、職業、宗教信仰、婚姻狀況。
結論:本研究證實健康行為與疾病皆存在著家庭群聚現象。時值衛生福利部推動論人計酬暨家庭責任醫師制度,疾病預防為重要議題,建議相關單位針對高風險可能對象家庭特性,進行有效之介入規劃,進而預防家庭疾病的發生。


Background and Objective: Diseases may aggregate in family, which may be closely related to health behaviors and genetic factors. In view of the impacts on public health and health insurance financing by catastrophic and chronic diseases, prevention for concordant diseases with a family approach has become critical. However, a nationally-representative study on this domain in Taiwan is still lacking. Therefore, this study attempted to investigate the association between concordant health behaviors and concordant diseases among family members, familial proportions, and the associated factors.
Methods: In a cross-sectional design, primary data of 963 valid family samples were collected using structured questionnaires at the family medicine outpatient clinics in four teaching hospitals of northern, central, and southern Taiwan. Major analysis methods include familial proportion, Chi-square test, and binomial logistic regression performed in SPSS 12.0.
Results: The highest top four ranked familial proportions of concordant diseases with at least three members suffering were obesity (13.29%), followed by allergic rhinitis (4.57%), hypertension (3.12%), and hypercholesterolemia (1.77%). Results indicated that the concordant health behaviors among family members, for example, diet and substance use, increased the risks of concordant diseases including hyperlipidemia, hypercholesterolemia, hypertension, upper respiratory disease, peptic ulcer, chronic liver disease, allergic rhinitis, arthritis, overweight/obesity, occupational hazard, and cancer. In addition, the factors associated with the concordance diseases included age, education, occupation, religion, and marital status.
Conclusion: This study has identified family clustering in both health behavior and disease. In the midst of the Family Physicians System and capitation reimbursement scheme being launched, this study seeks to provide valuable information for health authorities and health care institutions to target the high risked individuals for effective interventions in preventing concordant diseases in family.


摘要 i
Abstract ii
誌謝 iv
目錄 v
表目錄 vii
圖目錄 xii
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究重要性 4
第三節 研究目的 5
第二章 文獻探討 6
第一節 家庭群聚(Family Clustering) 6
第二節 相同疾病種類 7
第三節 罹患相同疾病之相關理論 12
第四節 健康價值觀 15
第五節 健康行為 16
第六節 共同健康行為與共同疾病之相關性 18
第七節 共同疾病之其他相關因素 19
第八節 文獻小結 21
第三章 研究設計與方法 22
第一節 研究架構 22
第二節 研究對象與資料來源 23
第三節 研究工具 24
第四節 研究變項操作型定義 26
第五節 分析方法 31
第四章 結果 33
第一節 問卷信效度分析 33
第二節 樣本之描述性統計 35
第三節 卡方獨立性檢定 63
第四節 二項式邏輯斯迴歸 191
第五章 討論 305
第一節 家庭成員罹患相同疾病種類之家庭比例 305
第二節 家庭成員共同健康行為與共同疾病種類之相關性 307
第三節 家庭成員罹患相同疾病種類之相關因素 311
第六章 結論與建議 314
第一節 結論 314
第二節 貢獻 314
第三節 建議 315
第四節 研究限制 316
參考文獻 317
附錄 331


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