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研究生:黃若雯
研究生(外文):Huang,Jo-Wen
論文名稱:探討新冠肺炎疫情發生時 民眾就醫行為之改變
論文名稱(外文):Investigation on the Behavior Change When Seeking Medical Care under the Effect of COVID-19 Pandemic
指導教授:朱正一朱正一引用關係
指導教授(外文):Chu, Cheng-I
口試委員:蕭正光謝佳容
口試委員(外文):Cheng-Kwang ShawHsieh Chia-Jung
口試日期:2021-05-27
學位類別:碩士
校院名稱:慈濟大學
系所名稱:公共衛生學系碩士班
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2021
畢業學年度:109
語文別:中文
論文頁數:68
中文關鍵詞:就醫行為延遲折扣
外文關鍵詞:hospitalizing behaviordelay discounting
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研究背景與目的:新冠肺炎重創全球,讓世界各國的民眾恐慌,生活方式與習慣截然改變,也導致許多民眾不敢出外就醫。台灣因初期疫情控制得當,所受衝擊相對和緩,讓民眾尚可擁有正常生活,但前往醫院就醫的情形多少仍受影響。延遲折扣的概念是在探討人們在不同的獎勵情況下,是否傾向於立即或很快地消費以獲得較小的獎勵(或效益),或是選擇接受延遲消費以獲得較大的獎勵(或效益)。因台灣民眾前往醫院就診的使用率高,本研究藉由延遲折扣的概念探討在此波新冠肺炎疫情影響下,民眾的就醫行為是否有所改變。
研究方法:研究對象為台灣一般民眾,以問卷調查法,透過survey cake網路問卷收集相關資料,收案時間為2021年1月4日至2021年1月7日,這段期間台灣疫情屬於趨緩的,總共收取177份樣本,排除受試者為領取慢處方箋及重大傷病卡的21份及2份未清楚填寫經常就醫的場所,計收取有效樣本154份。統計方法包括描述性統計、McNemar test、Cochran’s Q test及條件式邏輯斯迴歸分析等。
研究結果:在新冠肺炎疫情發生後,民眾原本的就醫頻率並無明顯改變,不過在醫療院所選擇時,較傾向至中大型醫院就醫。在延遲折扣方面,本研究受試者則多選擇立即就醫,較不會延遲等候數日才就醫。換句話說,一般民眾的延遲折扣k值較高,其意涵為民眾尋求治療以減輕病苦的衝動性越大,亦即面對當時已然趨於穩定的新冠肺炎疫情的避險意識與行為並不高。
結論:依據本研究結果,在新冠肺炎疫情發生且趨於和緩時,民眾在其生病時會產生較大的病識感,因此可能會想盡早就醫,並且尋求較大型的醫院看診,以獲取較好的疫情防護與治療。另外,本研究延遲折扣的k值,解釋為「民眾尋求治療以減輕病苦的衝動性」時,其結果與過去研究符合,故未來研究當可應用延遲折扣之相關理論來探討重大疫情下民眾就醫行為的改變。
關鍵字: 就醫行為、延遲折扣
Background: Amidst the Covid-19 era, the entire world went into panic. Our lifestyles have changed drastically, and large number of individuals are hesitant to seek for medical treatment. In the early stage of pandemic, Taiwan’s epidemic control has been relatively successful. Most of the nation’s citizens could carry on a normal lifestyle, yet there are some effects on the public, to seek for medical assistants from the hospitals.
Delay discounting is conceptualized as when an individual will be given a different scale of rewards, the tendency of which that particular individual will prefer a smaller reward that is available immediately, or a larger reward that is delayed. This is often used as an index of impulsivity or impatience.
The public of Taiwan have been known to routinely utilize medical treatments all year long for any kind of health issues. Under the strong influence of pandemic, this study is trying to investigate the delay discounting effect on the public’s behaviors in seeking healthcare, which are the decisions to seek for medical treatments and frequency of medical visits.
Method: The 177 subjects of this study were the public citizen of Taiwan, subjecting to answer a questionnaire that collected their decisions to seek for medical treatments and frequency of medical visits, before and after the Covid-19 pandemic. They accessed to the questionnaire through survey cake online questionnaire platform, in the period where new Covid-19 cases in Taiwan were relatively rare, during Jan 4th and Jan 7th of 2021. A total of 23 respondents, who have IC cards for severe illness or prescriptions for patients with chronic illnesses, and invalid responses, were excluded. A total of 154 valid responses are collected and analyzed using statistical methods of McNemar, Cochran’s Q test, conditional logistic model.
Result: After the Covid-19 pandemic, the frequency that the public seeking for medical visits had no significant changes. On the part of medical facilities selection, they tended to go to regional, district hospitals and medical centers, instead of clinics. From the perspective of delay discounting in the effect of decision making, majority of study subjects decided to seek for medical treatments immediately, with the k value between 1.80 and 1.99. As much as 83.7% respondents were determined to visit medical facilities when Covid-19 cases were rising, with the highest k value of 1.99. Majority of the public with higher k value indicated the public had decided to alleviate their illness at the moments of happening, a sign of the high impulsivity to mitigate their suffering. This group has lower cognitive risk avoidance behaviors in a seemingly mild and stable pandemic situation in Taiwan, at that specific period of study conducted. In contrast, the remaining 16.3% subjects decided to postpone or cancel their medical visits, with a very low k value of -0.18.
Conclusion: The study results showed that at the moment when the pandemic had been controlled, the public have a higher sense of illness when they are not feeling well. This could lead to immediate medical visits, moreover heading towards hospital scaled facilities instead of clinics, as a mean to receive a much higher quality of infection control and healthcare. The delay discounting value, k in this study is explained as the impulsivity of the public seeking mitigation of their suffering. The results of this study are consistent with the previous study. The delay discounting results in this study could theoretically, provide a foundation toward investigating the change of behaviors in seeking healthcare in the public, when a severe pandemic happens in the future.

Keywords: behaviors in seeking healthcare, delay discounting

中文摘要 III
Abstract IV
謝辭 V
目錄 VI
表目錄 VIII
圖目錄 IX
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的與問題假設 3
第三節 研究流程 4
第四節 名詞釋義 5
第二章 文獻探討 6
第一節 傳染病疫情與嚴重度 6
第二節 公共衛生的「三段五級」與防疫 8
第三節 就醫行為 12
第四節 延遲折扣 18
第三章 研究方法 22
第一節 研究對象 22
第二節 研究工具 22
第三節 資料處理與分析 25
第四章 研究結果與討論 28
第一節 人口學變項之描述與分析 28
第二節 人口學變項疫情前後就醫頻率與醫療院所選擇之分析 30
第三節 延遲折扣描述與分析 43
第四節 研究問題回應與假設驗證 46
第五章 研究結論與限制 48
第一節 研究結論 48
第二節 研究限制 49
參考文獻 51
中文部分 51
英文部分 53
附錄 55
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