以健康信念模式探討婦女未來補施打德國麻疹疫苗之意願及願付價格之相關因素研究

Abstract

摘要 研究目的：探討影響德國麻疹陰性婦女未來補施打意願與願付價格之相關因素。

資料來源：本研究運用臺北市衛生局「婦女補接種疫苗以防治先天性德國麻疹症候群胎兒之行為影響因素探討：以健康信念模式為框架」計畫之次級資料進行分析。該計畫係依據健康信念模式編製問卷，問卷中各構面之專家內容效度(Content Validity Index, CVI)值均為0.95以上，信度檢驗Cronbach's Alpha值均為0.7以上。該計畫針對民國101至102年臺北市婚後孕前健康檢查資料庫及民國99至101年臺北市立聯合醫院婦幼院區的孕產婦資料庫中，檢查德國麻疹抗體為陰性的婦女共139位進行問卷調查。本研究乃自該資料中選取產前檢查德國麻疹抗體為陰性的婦女且至調查時點仍未補接種者共99位為研究對象，在扣除研究變項缺失值的個案後，共88位做為探討影響未來是否願意補接種之研究樣本，89位婦女則做為分析影響未來補施打德國麻疹疫苗意願程度之研究樣本；此外，共89位個案則做為進行影響其疫苗願付價格相關因素分析之樣本。

方法：本研究除運用敘述統計外，亦運用相關係數與關連性強度檢定自變項與德國麻疹陰性婦女補接種德國麻疹之意願及願付價格之相關性及關係強度。此外，針對依變項之特性，本研究分別運用迴歸分析、順序羅吉斯模型(ordered logit model)，以及羅吉斯迴歸分析(logistic regression model)，探討在控制社會人口學變項、過去疾病狀況與疫苗使用狀況、先天性德國麻疹症候群與德國麻疹相關知識之情況下，影響德國麻疹陰性婦女未來補施打意願及願付價格之相關因素為何。

結果：在控制其他因素之下，自覺障礙性越低，未來補接種意願之可能性越高(OR=1.29; p=0.012)；自我效能越高，未來補接種意願的程度越高(p=0.013)；此外，願付價格的平均為NT$1,395.51，標準差為NT$1,154.08，而影響願付價格之重要因素為每月家戶收入(p<0.01)；若將願付價格分為三區間，則影響願付價格之重要因素為每月家戶收入(p=0.003)與全職工作(p<0.05)。

結論與建議：在未來補接種MMR疫苗意圖方面，受到重要他人不支持其施打MMR疫苗、較不擔心疫苗副作用、自覺障礙性低，以及德國麻疹抗體陰性婦女克服施打障礙的可能性，其未來補接種疫苗之意願越高；在願付價格方面，雖然健康信念模式與願付價格無顯著關係，但每月家戶收入為顯著因素。若願付價格分三區間，則受到德國麻疹抗體陰性婦女是否全職工作與每月家戶收入影響 建議未來衛生教育策略，應強化婦女克服他人不知持其施打疫苗之障礙，以及提供疫苗安全性、疫苗的費用等其他資訊，以提升未來補施打意願。若德國麻疹抗體陰性婦女未來需要額外自費補施打MMR疫苗，政府應該考慮財務的可近性以降低財務障礙，亦須為有全職工作者考量時間成本。Abstract Objective To examine the factors associated with the intention and the willingness of women to pay for the Measles, Mumps and Rubella (MMR) vaccination.

Data Sources We used data from the research called “A pilot study of implementing catch-up immunization program through pre-conceptional and prenatal screening to eliminate congenital rubella sundrome (CRS)” sponsored by the Taipei Department of Health. This study has designed a questionnaire based on the Health Belief Model, where the Content Validity Index (CVI) was above 0.95, and its internal consistency measure (Cronbach's Alpha) was greater than 0.7. There were 139 women whose antibodies were negative during their preconceptional check up program by the Taipei city government from 2012 to 2013 or their prenatal care in Taipei City Hospital, Fuyu Branch, from 2010 to year 2012, that were collected from this study, and we used 99 of these women who had never been vaccinated at the time of the survey. After deleting the cases with missing data, there were 88 and 89 women who were then used to analyze the factors associated with their intention of having a vaccination or not as well as their degrees of intentions respectively. In addition, there were 89 women who were used to analyze the factors associated with their willingness to pay (WTP).

Methods In addition to descriptive statistics, this study also used correlation analysis and other measures of association, to analyze the correlation and the strength of association between the independent variables and the two independent variables, intentions, and the WTP. Based on the nature of dependent variables, we used statistical methods such as regression model, ordered logit model, and logistic regression model, to analyze the factors associated with the intention and the WTP for an MMR vaccination after controlling for the socio-demographic variables, previous medical history, previous vaccinations, knowledge of rubella, and the congenital rubella syndrome.

Results After controlling for other variables, and the lowering of their perceived barriers, the more likely they would be to have an MMR in the future (OR=1.29; p=0.012); the higher self-efficacy, the higher the degree of their intention of receiving an MMR (p=0.013). Moreover, the mean of willingness to pay for the MMR was NT$1,395.51, standard deviation was NT$1,154.08. The significant factor affecting the WTP was their monthly household income (p<0.01). If the WTP was categorized into three, then the significant factors included household income (p=0.003), and full-time workers status (p=0.01).

Conclusions and Recommendations In terms of whether or not the women would receive an MMR vaccination, factors such as it was less likely that the women were affected by their significant others to not procure the vaccination, minor concerns about the possible side effects of the vaccination, lower barriers, and the more likely the women could overcome the barriers, then the higher the intention that they would have an MMR vaccination. In terms of the WTP, although the health belief model could not predict the WTP, other factors such as household monthly income were a significant factor. If the WTP was classified into three categories, monthly household income, and whether the women were full-time workers, could determine the amount of the WTP. In conclusion, our study suggested that the program needs to empower women who would be able to overcome numerous barriers of not being vaccinated raised from their significant others who did not support their choice for a vaccination, and focus more on safety, vaccination expenses, and other information, in order to increase the intention to proceed with the vaccination. If having the vaccination were to cause women to be out of pocket, then the government should not only consider ways of reducing the financial accessibility for the lower socioeconomic groups, but also should consider the time costs of those who are employed.