婦女子宮頸抹片篩檢之健康信念、就醫選擇因素、資訊來源與接受抹片篩檢之相關研究
-以花蓮縣光復鄉為例
郭德貞1 陳姿蓉2 陳秋慧3 林文潔4 戴郁秋5 高東麟6
1 慈濟技術學院醫務管理系助理教授
2 花蓮縣萬榮鄉衛生所公共衛生護士
3 台北市立聯合醫院松德院區精神醫療網專任助理
4 慈濟醫院關山分院醫事室組員
5 慈濟大學公共衛生研究所碩士生
6 慈濟醫院巴金森研究中心助理
摘要
台灣地區婦女抹片檢查篩檢率為42-55%，較世界各國的抹片篩檢率為低；花蓮縣子宮頸抹片篩檢率27.6%，光復鄉為篩檢率最低之鄉鎮（14.9%），本研究的目的為瞭解花蓮縣光復鄉婦女對子宮頸抹片的健康信念、就醫選擇因素及資訊來源，對婦女接受抹片篩檢之影響。本研究以居住在花蓮縣光復鄉三十歲以上女性為研究對象，依2006 年選舉名冊抄得4999 人，採比率抽樣1000 人，以村進行分層取樣，每戶一人為代表，實際訪得774人。
研究結果以2006 年（1-7 月）的篩檢率43.0%為最多，過去三年內及五年內接受過篩檢均在60%~70%之間，以三年內66.3%為最多。未接受子宮頸抹片檢查之因素：最多的原因為太忙，沒有時間佔20.4%（126 人），其次為覺得身體健康，不需要做之原因佔18.2%（112 人）。60~69 歲者較40~49 歲者篩檢利用的OR 為1.96。大家庭者較小家庭者篩檢利用的OR 為1.02；外省人較原住民抹片檢查篩檢利用的OR 為0.23。健康信念中對子宮頸癌高危險群認知分數每增加一分則抹片檢查利用多出6%。就醫成本篩檢利用的OR 為0.93 是負向影響抹片檢查利用。
本研究對政府政策方面提出建議：（一）多提供假日或夜間巡迴醫療車進入偏遠地區社區。（二）增加子宮頸抹片檢查和職場結合的方案。對衛生主管機關的建議為：（一）宣導高危險群者，應嚴格遵守每年一次篩檢。若無法配合時，可告知接受疫苗接種。（二）加強婦女對子宮頸抹片檢查的認知及觀念。（三）加強學生衛生教育及相關保健知識，培養起預防勝於治療的觀念。
關鍵字：子宮頸抹片篩檢、健康信念、就醫選擇因素、資訊來源
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Women’s Health Beliefs, Medical Care Choices, and Information Sources as related to Pap Smear Rates in Guangfu Township, Taiwan
De-Jhen Kuo1 Zi-Rong Chen2 Chiu-Hui Chen3
Wen-Jie Lin4 Yu-Qiu Dai5 Dong-Lin Gao 6
1 Department of Health Administration,Tzu-Chi College of Technology
2 Hualien County Wan-rong Township clinic
3 Taipei City Psychiatric Center
4 Department of Medical Affairs, Tzu Chi Guanshan Branch Hospital
5 Department of Public Health ,Tzu-Chi University
6 Tzuchi Hospital Parkinson disease center
Abstract
The rate of women’s taking Pap smear exams in Taiwan (42- 55%) is much lower than that found in other developed countries. In Taiwan, Hualien County has the lowest rate of Pap smear among all counties, with a screening rate of 27.6%, and Guangfu Township in Hualien County has the lowest rate among all towns, at 14.9%. The purpose of this study was to understand the demographic factors, and other factors, such as health beliefs, medical care choices, and information sources affecting the Pap smear rate for women in Guangfu Township, Hualien County. In this study, the targeted research
subjects were females more than thirty years old residing in Guangfu Township, Hualien County. According to the 2006 electoral roll, there were 4999 families registered in the seven villages of Guangfu Township. With the expectation of obtaining 1000 subjects, a stratified sampling method was used throughout each of villages by contacting a person from each household. Through in-person visitations, a total of 774 women met the criteria and responded to our inquiries.
The results among the 774 subjects showed that the 2006 screening rate was 43.0%. There were 482 (62.3%) subjects who received at least one screening within the past three years and 513 (66.3%) who underwent exams within the past five years. The two most commonly reported reasons for not receiving Pap smears were: too busy / no time availabla accounting for 20.4% (126), followed by in good health / feel no need accounting for 18.2%
(112). Using the 40-49 year old age group as a reference, the odds ratio for the 2006 screening rate was highest among the 60 ~ 69 year old group at 1.96. Using families having only one adult female with child/children as a reference, the odds ratio for the 2006 screening rate was highest among respondents in households with three generation and extended family members present at 2.02. Using respondents who were Aboriginals as a reference, the odds ratio for the 2006 screening rate was lowest among females with Mainland Chinese ancestry at 0.26. Respondents with higher cognitive scores on a health belief questionnaire concerning cervical cancer risks were more likely to have had a Pap smear screening in 2006. In regards to medical care choices, the primary reason for not receiving a screening was unavailability of convenient access to such services. Based on these results, our recommendations for government policy revisions are as follows: provide more access to Pap smear exams during holidays or in the evenings in remote areas via mobile medical vehicles, and increase the number of Pap smear-workplace integration programs. With a basis in promoting the concept the “prevention is better than a cure,” our recommendations to health authorities are as follows: increase women's Pap smear
awareness, enhance students’ health education and related health knowledge, and disseminate information among high-risk groups with a focus on those who should strictly comply with annual screening requirements, offering vaccinations in cases where clients have extenuating mobility/accessibility issues.
Keywords：Pap smear, health belief, medical care choices, information sources.