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研究生:許淑雲
研究生(外文):Shu-Yun Hsu
論文名稱:流感疫苗接種意願行為之實證研究和流感疫苗接種對老人急性心肌梗塞影響
論文名稱(外文):An Empirical Study of the Willingness of Having Influenza Vaccination and the Effect of Influenza Vaccination on prevention of Acute Myocardial Infarction in the elderly
指導教授:趙黛瑜趙黛瑜引用關係
口試委員:陳秋瑩趙正敏李建璋廖勇柏
口試日期:2016-07-26
學位類別:博士
校院名稱:國立中興大學
系所名稱:微生物暨公共衛生學研究所
學門:獸醫學門
學類:獸醫學類
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:63
中文關鍵詞:健康信念模式結構方程模式流感疫苗老人
外文關鍵詞:Health Belief ModelStructure Equation Modelthe Elderlywith Influenza Vaccine.
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目標:台灣同時面臨老年化與少子化之雙重問題,流感已成為全球兒童與老人共同問題且越來越受重視,因此,如何提升其疫苗施打率則是探討重點。方法:研究一:以雲林縣3-6歲幼童之家長為研究對象進行調查;研究二:以2005年全民健保資料庫中,所投保族群中的百萬抽樣歸人檔為分析的族群,隨機抽出與全國性別及年齡分布相似的100萬人,依此抽樣名單,得到這100萬人在2001-2010年的醫學就診記錄,其中包含了疾病診斷碼以及醫師曾執行的醫令處置等。本研究探討疫苗株與流行株(2005及2006 data)或完全不吻合(2007 data)對AMI的影響,以及疫苗株與流行株完全吻合(2008 data)與完全不吻合 (2007 data)對AMI的影響。
結果:研究一之結構方程模式分析結果:嚴重性對接種意向達到統計顯著正向影響(p<0.05);效益性對接種意向達到統計顯著影響(p<0.05);接種意向對接種行為達到統計顯著影響(p<0.05),其中「效益」對「接種意向」的徑路係數值最高。然而,在感染性對接種意向未達到統計顯著影響(p>0.05),自覺嚴重度及自覺行動利益對接種意向呈現顯著正向影響,而自覺罹病性對接種意向未呈現影響;接種意向對接種行為呈現顯著正向影響。
研究二為探討疫苗吻合度對預防急性心肌梗塞的影響:2005年接種疫苗後罹患急性心肌梗塞的風險性分別為男性1.24(95% CI 0.85-1.82) 和女性 0.76 (95% CI 0.50-1.15);2006年則分別為男性0.89 (95% CI 0.65-1.23) 和女性 1.31 (95% CI 0.87-1.98) ;2007年分別為男性1.06 (95% CI 0.77-1.46)和女性0.97 (95% CI 0.65-1.44)。在疫苗株與流行株完全不吻合或不完全吻合時,打流感疫苗並無法預防急性心肌梗塞。疫苗株與流行株完全吻合(2008 data)與完全不吻合 (2007 data)對AMI的影響,於2007年接種完全不吻合疫苗後罹患急性心肌梗塞的風險性分別為男性0.99(95% CI 0.75-1.32) 和女性 1.10 (95% CI 0.80-1.51);2008年接種完全吻合疫苗後罹患急性心肌梗塞的風險性則分別為男性0.68 (95% CI 0.51-0.91) 和女性 0.74 (95% CI 0.53-1.03)。
結論:幼兒家長自覺小孩得流感的嚴重性及施打的好處對接種意向呈現顯著,接種意向對接種行為呈現顯著正向影響。另探討疫苗吻合度對預防急性心肌梗塞的影響:在疫苗株與流行株完全不吻合或不完全吻合時,打流感疫苗並無法預防急性心肌梗塞。在疫苗株與流行株完全吻合時,打流感疫苗可預防急性心肌梗塞,在男性特別顯著,此結果可供衛教策略上的參考。
關鍵字:健康信念模式、結構方程模式、流感疫苗老人


Background and Aims: Taiwan is currently faced with the problems of aging and low birth rate while the flu has long been the common concern for both children and senior citizens all over the world, which draws more and more attention. Thus, the exploration of the enhancement of vaccination coverage becomes particularly important where the following two research methods were conducted. Methods: Study 1: research on parents of children aged 3 to 6 in Yunlin Country; Study 2: research on insured groups through sampling in millions from the 2005 National Health Insurance database. Then randomly sample one million people whose genders and ages distribution are similar with the national one from the insurance files at the end of 2005, finally, get their medical records during 2001 and 2010, which includes disease diagnosis code and physician orders, etc. This study discusses the effect of vaccine strain and epidemic strain (2005 & 2006 data) or total misfitness (2007 data) on AMI, and the effect of exact fit (2008 data) and misfit (2007 data) vaccine strain and epidemic strain on AMI.
Results: the analysis result of the structural equation pattern of Study 1: severity has statistically significant positive effect on the intention of vaccination (p<0.05); profitability has statistically significant effect on the intention of vaccination (p<0.05); the intention of vaccination has statistically significant effect on vaccination action (p<0.05), among of which the path coefficient value of the profitability to the intention of vaccination is highest. However, infectious has no statistically significant effect on the intention of vaccination (p<0.05); conscious severity and conscious action profitability has significant positive effect on the intention of vaccination; while conscious pathopoiesia has no effect on the intention of vaccination; the intention of vaccination has significant positive effect on the vaccination action.
Study 2 discusses the effect of vaccine fitness on the prevention of acute myocardial infarction: the risk of suffering from acute myocardial infarction after being vaccinated in 2005, male 1.24 (95% CI 0.85-1.82) and female 0.76 (95% CI 0.50-1.15); in 2006, male 0.89 (95% CI 0.65-1.23) and female 1.31 (95% CI 0.87-1.98); in 2007, male 1.06 (95% CI 0.77-1.46) and female 0.97 (95% CI 0.65-1.44). When the vaccine strain and epidemic strain are totally misfit or exact fit, influenza vaccine does not work on the prevention of acute myocardial infarction. The effect of exact fitness (2008 data) and misfitness (2007 data) of vaccine strain and epidemic strain on AMI,: the risk of suffering from acute myocardial infarction after being vaccinated with exact misfit vaccine in 2007, male 0.99(95% CI 0.75-1.32) and female 1.10 (95% CI 0.80-1.51); in 2008, the risk of suffering from acute myocardial infarction after being vaccinated with exact fit vaccine, male 0.68 (95% CI 0.51-0.91) and female 0.74 (95% CI 0.53-1.03).
Conclusion: The severities of influenza and benefit from vaccination realized by the parents with children have significant effect on the intention of vaccination; the intention of vaccination has significant positive effect on the vaccination action. It also discusses the effect of the vaccine fitness on the prevention of acute myocardial infarction: when the vaccine strain and epidemic strain are totally misfit or exact fit, influenza vaccine does not work on the prevention of acute myocardial infarction. When the vaccine strain and epidemic strain are exactly fit, influenza vaccine works on the prevention of acute myocardial infarction, especially for the male, which can be the reference for the health care education strategies.
Key words: Health Belief Model, Structure Equation Model, the Elderlywith Influenza Vaccine.



第一章 前言 1
第二章 Study one:健康信念模式在疫苗接種之應用 ~以幼童流感疫苗接種家長為例 8
第一節 文獻探討 8
第二節 材料及方法 16
第三節 結果 21
第四節 討論與結論 24
第三章 Study Two:老人接種流感疫苗對急性心肌梗塞的影響 28
第一節 文獻探討 28
第二節 材料與方法~疫苗株與流行株不完全吻合或完全不吻合對AMI的影響 30
第三節 結果 32
第四節 討論與結論 40
第五節 材料及方法~疫苗株與流行株完全吻合(2008 data)與完全不吻合 (2007 data)對AMI的影響 41
第六節 結果 43
第七節 討論與結論 51
第四章 論文總結 53
參考文獻 54
Publication list 63





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許淑雲, 廖宏恩, 洪百薰, 林柏煌, 高昆裕, & 王俊毅. (2010). 國小低年級學童家長對其子女接種流感疫苗意向之轉變情形及其相關因素分析-以雲林縣學童家長為例. 臺灣公共衛生雜誌, 29(4), 326-336.
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黃惠萍, 趙偉翔, 何麗莉, & 王宗曦. (2007). 2007 年老人流感疫苗預防接種意向電話調查報告. 疫情報導, 23(12), 683-692.
廖琪玉, & 陳漢瑛. (2007). 流感疫苗接種的健康信念與行為意向之研究-以北部某醫學中心醫護人員為例. 健康促進暨衛生教育雜誌(27), 1-21.
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1. 駱明潔, & 蔡端慧. (2015). 中部地區學齡前幼兒主要照顧者對流感認知及流感預防行為之調查研究. 疫情報導, 31(19), 464-472.
2. 蔡宗益, 賴寧生, 郭淑慧, & 江瑞坤. (2011). 南臺灣中老年健檢民眾接種 H1N1 疫苗的意願和其相關因素調查. 志為護理-慈濟護理雜誌, 10(3), 73-82.
3. 廖琪玉, & 陳漢瑛. (2007). 流感疫苗接種的健康信念與行為意向之研究-以北部某醫學中心醫護人員為例. 健康促進暨衛生教育雜誌(27), 1-21.
4. 黃惠萍, 趙偉翔, 何麗莉, & 王宗曦. (2007). 2007 年老人流感疫苗預防接種意向電話調查報告. 疫情報導, 23(12), 683-692.
5. 陳富莉, & 李蘭. (1999). 臺灣地區成年人之吸菸與嚼檳榔行為的組合及其相關因子探討. 中華公共衛生雜誌, 18(5), 341-348.
6. 許淑雲, 廖宏恩, 洪百薰, 林柏煌, 高昆裕, & 王俊毅. (2010). 國小低年級學童家長對其子女接種流感疫苗意向之轉變情形及其相關因素分析-以雲林縣學童家長為例. 臺灣公共衛生雜誌, 29(4), 326-336.
7. 李龍騰, 陳慶餘, 賴美淑, & 謝維銓. (1990). 實際基層醫療保健指數於不同門診之比較. 中華民國公共衛生學會雜誌, 10(2), 98-103.
8. 李金媛, 徐玉枝, & 蔡佳樺. (2008). 初次急性心肌梗塞之急診護理經驗. 北市醫學雜誌, 5(6_S), 765-774.
9. 朱正一, & 詹瑞慧. (2010). 流感疫苗接種行為相關因素探討-以台灣花蓮地區禽畜養殖業者為例. 臺灣公共衛生雜誌, 29(4), 337-346.
 
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