臺灣博碩士論文加值系統

研究背景：
子宮頸癌是台灣常見婦女癌症之一，衛生福利部自1995年實施全民健保後，提供30歲以上婦女每年一次免費的子宮頸抹片檢查。推動至今，篩檢率僅五成左右，為提升多年未篩檢婦女的篩檢率，國民健康署曾針對36歲以上且超過六年未做抹片的婦女提供免費人類乳突病毒 (HPV) 檢測自採套組，但成效不彰。而國外研究發現婦女對HPV自採的接受度頗高，若能有效推廣，或許能改善婦女子宮頸癌篩檢率，因此此檢驗方式之應用值得進一步探討與評估。
研究目的：
探討影響新北市婦女接受HPV自採之個人層次因素及地區層次因素。
材料與方法：
本研究設計為橫斷性研究，在2011年7月至9月期間，針對新北市九區中36至69歲六年內未接受子宮頸抹片檢查的婦女，以結構式問卷，透過面訪方式進行調查，並立即邀請婦女接受HPV自採。問卷內容包括本研究探討之個人層次因素，包括年齡、教育程度、工作狀況、HPV及HPV自採知識、HPV自採態度、吸菸、運動習慣、抹片檢查史、性伴侶數目、家族癌症史及自評健康狀況。地區層次因素資料則來自政府網站，包括地區人口學 (人口密度、65歲以上人口百分比例)、社經地位 (高教育程度人口百分比、低收入戶數百分比) 及醫療資源與抹片篩檢率 (每萬人之醫療院所、三年內抹片篩檢率)。資料分析使用SPSS 18.0及HLM 7.0軟體，以描述性統計、卡方檢定、簡單邏輯斯迴歸以及多層次分析─階層線性模式等方法進行分析。

結果：
本研究共有900位婦女，其中245位 (27.2 %) 婦女接受HPV自採。在同時控制個人與地區層次變項下，個人層次因素中，「HPV及HPV自採知識」與接受HPV自採呈正相關 (OR=1.081，95% CI=(1.021,1.145))。「HPV自採態度」與接受HPV自採呈正相關 (OR=1.038，95% CI=(1.029,1.048))。在同時控制個人與地區層次變項下，地區層次因素中，「人口密度」與接受HPV自採呈負相關 (OR=0.999，95% CI=(1.000,1.000))。「高教育程度人口百分比」與接受HPV自採呈正相關 (OR=1.211，95% CI=(1.075,1.364))。「低收入戶數百分比」與接受HPV自採呈正相關 (OR=2.486，95% CI=(1.080,5.723))。
結論：
本研究之HPV自採接受率較國內以其他方式邀請多年未接受子宮頸癌抹片檢查之婦女的HPV自採接受率高出許多。婦女對於「HPV及HPV自採知識」及「HPV自採態度」越佳，接受HPV自採的可能性越高。「人口密度」越低的地區，婦女接受HPV自採的可能性越高。「高教育程度人口百分比」及「低收入戶數百分比」越高的地區，婦女越可能接受HPV自採。因此本研究之結果與方式可作為未來研究、衛生教育和政策制定的方向及參考，建議衛生單位可多提供HPV及HPV自採相關資訊給多年未篩檢之婦女，進一步提高子宮頸癌篩檢率。

Background：
Cervical cancer is one of the common female cancers in Taiwan. Many women still have never or not regularly participated in cervical screening because of some psychosocial factors. Self-sampling HPV testing appears to be an acceptable strategy for women in many studies. In Taiwan, acceptability of self-sampling HPV testing related factors among under-screened women needs to be discovered.
Objective：
This study aimed to investigate HPV self-sampling behavior and related factors from both individual and regional perspectives among women in New Taipei city.
Materials and methods：
This is a cross-sectional study with self-designed structured questionnaire. Face-to-face interviews at home were applied to collect date during July to September, 2011. Under-screened women living in nine districts of New Taipei City with age between 36 to 69 years old were sampled and approached. We investigated individual level factors including the age, education level, work conditions, HPV and HPV self-sampling knowledge, HPV self-sampling attitude, smoking, exercise habits, history of Pap testing, number of sexual partners, family history of cancer and perceived health status. We also investigated regional level factors including regional demography (i.e. population density and percentage of people over 65 years of age), socioeconomic status (percentage of high-education population, percentage of low-income households) and medical resources and pap screening rate (number of medical institutions per million people, screening rate of Pap smear within three years). SPSS 18.0 and HLM 7.0 software were used to analyze our data. Descriptive statistics, Chi-square Test, Simple logistic regression and Hierarchical Linear Modeling were performed to answer study questions.
Results：
A total of 900 women met the study criterions. Two hundred and forty-five women (27.2%) completed HPV self-sampling. In individual level, HPV and HPV self-sampling knowledge and attitude are both significantly correlated with the probability of accepting self-sampling HPV test. In regional level, population density, percentage of high-education population, and percentage of low-income households are all significantly associated with the probability of accepting HPV self-sampling. Except population density, all other significant factors show positive relationships with HPV self-sampling behavior.
Conclusion：
In our participants, their acceptance rate of HPV self-sampling test was higher than prior study in Taiwan. In addition, both individual and regional factors were found significantly associated their acceptability. These findings could serve as important references for health agencies or researchers for health education, policy making, and research in the further to increase the screening rate of cervical cancer.

第一章 諸論 1
第一節 研究背景與動機 1
第二節 研究目的 6
第三節 研究之重要性 7
第四節 名詞解釋 8
第二章 文獻探討 10
第一節 子宮頸癌及子宮頸癌篩檢 10
第二節 HPV自採接受度之相關研究 18
第三節 影響婦女接受HPV自採之相關因素 24
第三章 研究方法 41
第一節 研究架構 41
第二節 研究假說 43
第三節 資料來源與研究對象 45
第四節 研究工具與測量 46
第五節 資料分析與處理 56
第四章 研究結果 60
第一節 樣本之基本描述 60
第二節 雙變項分析 70
第三節 多變項分析 75
第五章 討論 89
第一節 研究對象之HPV-DNA自我採檢行為 91
第二節 個人層次因素與HPV-DNA自我採檢行為之關係 93
第三節 地區層次因素與HPV-DNA自我採檢行為之關係 95
第六章 結論與建議 97
第一節 結論 97
第二節 建議 98
第三節 研究限制 99
參考文獻 100
英文參考文獻 100
中文參考文獻 108
網路參考文獻 111
附錄 112
婦女接受HPV自採服務之影響因素問卷 112

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