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研究生:陳立純
研究生(外文):Li-Chun Chen
論文名稱:第二型中老年糖尿病患流感疫苗接種的健康信念和代謝控制指標之探討
論文名稱(外文):The Association Between Health Believes about Influenza Vaccination Among Elderly Type 2 Diabetes Patients and Metabolic Control Indicator
指導教授:陳芬如陳芬如引用關係李洮俊李洮俊引用關係
指導教授(外文):Fen-Ju ChenYau-Jiunn Lee
學位類別:碩士
校院名稱:義守大學
系所名稱:醫務管理學系
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:2016
畢業學年度:104
語文別:中文
論文頁數:88
中文關鍵詞:糖尿病流感疫苗健康信念代謝控制指標
外文關鍵詞:DiabetesInfluenza VaccinesHealth BeliefMetabolic Control Indicators
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許多國內外的研究報告顯示,流感疫苗對健康的年輕人有70%防護效果,老年人或免疫力較差的高危險群則可減少50%罹患流感之嚴重性及其併發症,並可減少80%之死亡率,所以老年人及高危險群患者接種流行性感冒疫苗是預防罹患流感以及與流感相關的併發症而導致死亡或住院最佳的方式。
然而根據衛生福利部統計資料顯示,2012年因流感死亡的人數有164位,其中有16.5%患有糖尿病;2013年因流感死亡的人數有71位,其中有16.9%患有糖尿病(衛福部統計處, 2015)。糖尿病患是屬於罹患流感高風險的族群,因流感引發的併發症及致死率又比一般人高,所以更應該接受施打流感疫苗,因此第二型中老年糖尿病患流感疫苗接種率是關切糖尿病患存活的重要議題。
本研究目的為1.了解第二型中老年糖尿病患流感疫苗接種之意願及其拒絕施打之原因;2. 了解第二型中老年糖尿病患其個人健康行為對施打流感疫苗意願的影響;3. 了解第二型中老年糖尿病患其個人健康信念對施打流感疫苗意願的影響;4. 了解第二型中老年糖尿病患接受施打流感疫苗行為與其代謝控制指標之相關。
本研究以健康信念模式為理論架構,分析接受流感疫苗接種與拒絕接種之第二型中老年糖尿病患在人口學特性、代謝控制指標、個人健康行為與健康狀態上的差異及影響接受疫苗注射因素。採回溯性研究與次級資料分析,立意取樣方式選取南部某糖尿病專科診所50歲以上第二型糖尿病患共264人。問卷內容包含人口學特性、健康行為、健康狀態、流感疫苗健康信念,問卷調查後採用SPSS 18.0統計軟體,以描述性統計、t檢定、卡方檢定、羅吉斯迴歸等進行資料統計分析。
研究結果顯示施打疫苗者年齡顯著較未施打疫苗者高(χ2 =8.906,p=0.003)。糖尿病罹病期有施打疫苗者較未施打疫苗者長(13.69± 7.97 v.s 10.61± 6.61,p =0.002)、較不同意「覺得自己比別人容易生病」(p<0.001)。在「自覺接種流感疫苗利益」方面,有施打疫苗者較未施打流感疫苗認同高(17.44±3.166 v.s 13.81±4.599,p<0.001)。有施打流感疫苗接收疫苗注射行動線索較多(28.34±4.15 v.s 23.97±4.06,p<0.001)。第二型中老年糖尿病患其疫苗接種行為與代謝疾病控制指標無顯著影響。由研究結果得知糖尿病患流感疫苗施打意願與病患之年齡、糖尿病罹病期、自覺接種流感疫苗利益性及行動線索有獨立之關連。由於年齡及糖尿病罹病期皆沒有辦法調整,因此本研究結果認為在流行性感冒的防疫推展上,欲加強糖尿病患之流感注射意願,醫療專業人員扮演很重要的角色,所以強化醫病關係、增加病患對醫療專業人員的信任感是非常重要的。
建議醫療專業人員要具備流行性感冒及疫苗的正確知識,以提供民眾正確資訊,就醫病患之親友應一併列入衛教及提供疫苗施打相關資訊服務之對象。並藉由社區健康推廣運動、電台廣播媒體及門診時利用病患候診空間進行衛教講座,宣導流感疫苗的正確觀念。而各地方政府的衛生單位應多加舉辦流行性感冒及疫苗的健康教育課程,藉此傳遞預防接種正確的訊息。

Many studies have revealed that receiving influenza vaccination could prevent influenza infection in 70% of the healthy and young population, 50% in the elderly or immunocompromised population, and reduce mortality by 80%. Therefore, influenza vaccination is currently the most effective way in preventing high risk and elderly patients from getting influenza infection and its severe complications, including hospital admission and death.
According to the data provided by the Ministry of Health and Welfare, in 2012, 164 people died of influenza, and 16.5% had diabetes; in 2013, 71 people died of influenza, and 16.9% had diabetes (Department of Statistics, Ministry of Health and Welfare, 2015). The diabetic population is prone to influenza infection and has a higher rate of complication and mortality. So they should receive influenza vaccination. The rate of influenza vaccination in the elderly T2DM diabetic population is a very important issue related to their survival.
The purpose of this study is to determine: 1.the rate of influenza vaccination in the elderly T2DM diabetic population, and find out why some refuse this action 2.whether healthy behavior will affect vaccination willingness 3.whether health believes will affect vaccination willingness 3.whether influenza vaccination will affect metabolic profiles.
This study is based on the concept of Health Believes. It further analyzes the differences in the demographic distribution, metabolic profiles, personal health behaviors and health status among the type 2 elderly patients who agreed or refused to have influenza vaccination. This is a retrospective cohort study conducted at a diabetic specialized clinic in southern Taiwan. Total of 264 patients diagnosed with type 2 diabetes mellitus over the age of 50 years were included in the study. The domains included in the questionnaire are the following: demographic characteristics, healthy behaviors, health status and health believes toward influenza vaccination. The data was analyzed by SPSS 18.0, using descriptive statistics, t-test, Chi-square and logistic regression.
The results revealed that compared with those who refuses influenza vaccination, those who agreed on vaccination were older (χ2 =8.906,p=0.003), had a longer duration of diabetes (13.69± 7.97 v.s 10.61± 6.61,p =0.002) , and disagreed on “I’m prone to getting sick comparing with others” (p<0.001) (perceived susceptibility). In the aspect of “the benefits of influenza vaccination” (perceived benefits), the vaccinated group had higher scores (17.44±3.166 v.s 13.81±4.599,p<0.001).The vaccinated group also had higher score in the “cues to action” aspect (28.34±4.15 v.s 23.97±4.06,p<0.001). Metabolic profiles did not differ among the 2 groups. From this study, we noticed that the willingness to have influenza vaccination is associated with age, diabetes duration, perceived benefits and cues to action. The age of the individual and his/her diabetes duration could not be altered. Therefore this study suggests that medical professionals play a very important role in influenza prevention and the promoting of influenza vaccination. Enhancing the doctor-patient relationship and the trust in the medical team will be a very important key.
This study suggests that medical professionals should have sufficient and correct knowledge about influenza and its vaccination. Adequate information and health education about influenza vaccination should be provided not only to the patients, but also to their family members. The correct concept could be promoted via community activities, TV or radio broadcasts, or even during the waiting time in OPD sessions. Health department of local government should also hold seminar and lectures concerning this topic to disseminate the correct concept.

第一章 緒論 1
第一節 研究背景 1
第二節 研究動機 3
第三節 研究目的 4
第二章 文獻回顧 5
第一節 流行性感冒、流感疫苗與影響預防注射原因 5
第二節 糖尿病與流行性感冒 10
第三節 預防接種與健康信念相關研究 13
第三章 研究方法 17
第一節 研究架構 17
第二節 研究設計 19
第三節 研究假設 20
第四節 研究對象與抽樣方法 21
第五節 研究工具 22
第六節 資料收集 27
第七節 倫理考量 28
第八節 資料分析 29
第四章 研究結果 30
第一節 人口學特性與流感疫苗接種之關係 30
第二節 健康行為、健康狀態與流感疫苗接種之關係 33
第三節 健康信念與流感疫苗接種之關係 41
第四節 有無施打疫苗與代謝指標的變項分析 52
第五章 討論 55
第一節 人口學特性與流感疫苗接種之關係 55
第二節 第二型中老年糖尿病患健康行為、健康狀態與流感疫苗接種之關係 57
第三節 第二型中老年糖尿病患之健康信念程度與流感疫苗接種之關係 58
第四節 第二型中老年糖尿病患之無施打疫苗與代謝指標的關係 61
第六章 結論與建議 62
第一節 結論 62
第二節 研究建議 64
第三節 研究限制及未來研究方向 66
中文文獻 67
英文文獻 70
附錄一、研究工具使用同意書 74
附錄二、流感疫苗問卷 75

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英文文獻
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