運用修正型健康信念模式建立不同健康風險族群接受口腔黏膜健康檢查可能性之預測模型-以台灣無檳社區居民為例

Abstract

口腔黏膜檢查為偵測口腔癌之有效措施，口腔癌為台灣男性第四位之惡性腫瘤，本研究旨在探討具有酒精、檳榔及吸菸等習慣造成罹患口腔癌之不同健康風險族群接受口腔黏膜檢查的社會心理差異。本研究運用修正型健康信念模式探討參與無檳社區活動計劃居民接受口腔黏膜檢查之信念，共有866位完成問卷測量，本研究依據參與者是否有喝酒、嚼檳榔、吸菸等習慣區分為罹患口腔癌之高、中與低風險組，並採用結構方程模式建立及比較三組不同健康風險組接受口腔黏膜檢查的可能性與影響路徑之差異。重要結果如下： 一、本研究依據Rosenstock, Strecher 與Becker (1988)之修正型HBM藉由SEM建立台灣地區成人接受口腔黏膜健康檢查可能性適配度良好，預測力為37%。 二、「行動線索」與「自我效能」於健康信念與接受口腔黏膜健康檢查的可能性之間具中介作用。 三、不同健康風險組於社會人口學變項與健康信念、自我效能、行動線索及接受口腔黏膜健康檢查的可能性等變項具顯著差異。 四、本研究提出的修正型健康信念模式可預測高、中與低風險組接受口腔黏膜健康檢查可能性分別為 50%、37%&30 %，並顯示不同健康風險組影響接受口腔黏膜健康檢查可能性之路徑模式有顯著性差異。 五、在排除口腔癌篩檢經驗參與者後之高風險組模式解釋力提昇至 61%，並顯示出「行動線索」在已有口腔癌篩檢經驗者之知覺罹患性與接受口腔黏膜健康檢查的可能性之間具決定性的影響力。 六、修正型健康信念模式對男性組與女性組之解釋力分別為 38%與 35%。男性組之知覺罹患性與知覺行動利益可直接且正向影響接受口腔黏膜健康檢查之可能性。 不同健康風險組接受口腔黏膜檢查可能性之健康信念與影響路徑有顯著差異，建議未來教育介入針對不同健康風險族群宜採取不同介入模式。Oral mucosal examination (OME) is an effective measure to detect oral cancer, which is the fourth leading cause of cancer deaths among males in Taiwan. Nonetheless, there is a lack of literature concerning the likelihood of undergoing OME among different health risk groups based on individuals’ habits of drinking alcohol, chewing betel quid, and smoking cigarettes. This study applied modified Health Belief Modeling (HBM) to explore the likelihood of undergoing OME among a sample of individuals participating in a “Community Free from Betel Quid Chewing＂Campaign. Eight-hundred and sixty-six participants completed questionnaires measuring demographic characteristics, alcohol drinking, betel quid chewing, cigarette smoking and health beliefs, cues to action, self-efficacy, and likelihood of undergoing OME. This study used structural equation modeling (SEM) to investigate the direct and indirect paths to predict the likelihood of undergoing OME across three different health risk groups. Classification of participants into groups with high, moderate, and low risk of developing oral cancer was based on the whether or not the participants drank alcohol, chewed betel quid, and smoked cigarettes. Results: 1. Results indicate that the modified HBM model fit the data well and successfully explained substantial variance in the likelihood of undergoing an OME for adults in Taiwan. 2. Cues to action and Self-efficacy as mediate the association between health beliefs and Likelihood of undergoing an OME. 3. Significant differences were found among the three groups in demographic characteristics, health beliefs, cues to action, self-efficacy, and paths influencing the likelihood of undergoing an OME. 4. The modified HBM demonstrated good fit among the high-, moderate-, and low-risk groups and explained 50%, 37%, and 30% of the variance of undergoing OME, respectively. The direct and indirect paths influencing the likelihood of undergoing OME varied significantly among the three groups. 5. The modified HBM demonstrated good fit among the male-, and female groups and explained 38%, and 35% of the variance of undergoing OME, respectively. The male’ perceived susceptibility and perceived benefits positively and directly influenced the likelihood of undergoing OME. 6. The results indicated that, when we excluded participants with OCSE from the three groups, the accounted variance for the high-risk group improved from 50% to 61%; As a result, we suggest that cues to action play an critical role between perceived susceptibility and the likelihood of undergoing an OME in the model of participants with OCSE. Based on the interpretation of the results, this study recommended responsive interventions to improve the effectiveness of the betel quid-free campaign.