| Abstract: | 目的：
使用Andersen健康服務利用行為模式作為理論架構，探討前傾因素、使能因素、需求因素及個人健康行為因素，與苗栗縣民眾施做FOBT之關係。
材料方法：
本研究為橫斷式個案對照研究。採用國民健康署104年癌症篩檢輔導計畫－苗栗縣地區資料，研究對象以苗栗縣符合FOBT篩檢年齡50- 74歲之民眾，依其2015年之FOBT篩檢行為分為四組：規律篩檢（非首篩且已做者，對照組）、不規律篩檢（非首篩未做者）、首次篩檢（首篩已做者）、從未篩檢（首篩未做者），調查期間為2015年12月至2016年4月以家戶訪查問卷進行資料收集。測量人口學變項、社會學變項、大腸癌篩檢態度、大腸癌篩檢知識、施作FOBT篩檢障礙、FOBT自我效能、個人及家族疾病史、行動線索、個人健康行為等變項。最終回收808人，四組完訪率分別為：規律篩檢（對照組）51.79%、不規律篩檢40.56%、首次篩檢38.77%、從未篩檢29.60%。以SAS 9.4進行卡方檢定及ANOVA檢定檢視各變項與篩檢行為之關係，後將顯著變項以多元羅吉斯迴歸進行多變項分析。
研究結果：
FOBT篩檢行為皆以規律篩檢者為參考組，在前傾因素中，相較於規律篩檢，年齡越小，使用大腸癌篩檢可能性較低（首次篩檢OR=0.78、不規律篩檢OR=0.92、從未篩檢OR=0.82）；相較於規律篩檢，在首次使用篩檢教育程度為國中或高中職，使用大腸癌篩檢可能性較低（OR=0.33，OR=0.43）；相較於規律篩檢，從未篩檢的大腸癌及其篩檢態度較低 （OR=0.91）。在使能因素中，相較於規律篩檢組，從未篩檢組個人月收入越高，其使用篩檢可能性越低；從未篩檢組完成FOBT採檢程序之障礙為規律篩檢組的1.17倍；FOBT自我效能越高，則越有可能進行大腸癌篩檢。而在需求因素及個人健康行為因素與大腸癌篩檢行為無顯著相關。
結論：
本研究以Andersen健康服務利用行為模式為理論架構，探討苗栗縣民眾大腸癌篩檢行為之影響因素，發現前傾因素（年齡、教育程度、大腸癌及其篩檢態度）與使能因素（個人月收入、完成FOBT採檢程序之障礙、FOBT自我效能）與篩檢行為有關。未來建議針對符合資格族群辦理大腸癌相關健康講座，以提升其癌症篩檢知識、態度及障礙進而提升其自我效能，可結合勞工定期健康檢查提供篩檢，以提升民眾篩檢意願。
Objectives:
The purpose of this paper is based on the Andersen’s Behavioral Model to discuss the predisposing factors, enabling factors, need factors and the personal health behavior factors of colorectal cancer screening behavior among people in Miaoli County.
Methods:
This study is using the Health Promotion Administration, Ministry of Health and Welfare’s 2015 cancer Screening Counseling survey which collected from September, 2015 to January, 2016 in Miaoli County. We conducted a cross-sectional household questionnaire survey based on community-based case-control study design. All 808 participants who conform living in Miaoli County and the FOBT screening age on 2015 is between 50 and 64. Participants will be divided into four groups as (1) ever-screenees and had complete FOBT screenees in 2015(regular screenees, as control group, the participation rates were 51.79%), (2) ever-screenees but did not complete FOBT in 2015 (irregular screenees, the participation rates were 40.56%), (3) never- screenees and had complete FOBT (first screenees, the participation rates were 38.77%), (4) never-screenees and did not complete FOBT (never screenees, the participation rates were 29.60%). Independent variables such as demographic variables, sociological variables, colorectal cancer screening attitudes, colorectal cancer screening knowledge, impaired FOBT screening, FOBT self-efficacy, personal and family disease history, action cues and personal health behaviors which using logistic regression model for multivariable analysis.
Results:
The FOBT regular screenees as control group, in predisposing factors that younger people complete FOBT screenees is lower than elders ( irregular screenees Odd ration (OR)=0.78, first screenees OR=0.92 and never screenees OR=0.82). The first screenees’s education is junior or senior high who completed FOBT screenees were lower than regular (OR=0.33, OR=0.43). And never screenees’s colorectal cancer screening attitudes is lower (OR=0.93). In enabling factors, compared with regular screenees, the never screenees who personal income was higher, the probability to complete FOBT is lower. And the never screenees’s FOBT obstacles is higher than regular. The FOBT self-efficacy has higher probable to do the FOBT screening. There is more opportunity to complete the FOBT screening when self-efficacy is higher. On the other hand, need factors and the personal health behavior factors has nonsignificant relationship to FOBT screening.
Conclusions:
This study is based on the Andersen's Behavioral Model to discuss the Related factors of colorectal cancer screening behavior among people in Miaoli County. We found that predisposing factors (age, education and colorectal screening attitude), enabling factors (personal incomes, complete FOBT inspection procedures and FOBT self-efficacy) is related to screening behavior significantly. It is recommended to organize health seminars related to colorectal cancer for eligible ethnic groups to improve their cancer screening knowledge, attitudes and obstacles and to enhance their self-efficacy. Screening can be tested with labor regular health examinations to increase people’s willingness to screen. |
