運用修正型健康信念模式比較不同健康風險族群接受口腔黏膜檢查之信念與可能性－－以台灣無檳社區計畫活動為例

Application of the modified Health Belief Model for undergoing oral mucosal examination:comparison of different health risk groups

Objectives:Oral mucosal examination (OME) is an effective measure for detecting oral cancer,which is the fourth leading cause of cancer deaths among males in Taiwan.Despite this fact,there is a lack of literature concerning the likelihood of undergoing an OME among different health risk groups based on individuals' habits of drinking alcohol,chewing betel quid,and smoking cigarettes.Methods:We applied a modified form of the Health Belief Model (HBM) to explore the likelihood that a sample of individuals participating in a "Community Free from Betel Quid Chewing" campaign would undergo an OME.Eight-hundred and sixty-six participants completed questionnaires measuring demographic characteristics,alcohol drinking,betel quid chewing,cigarette smoking,health beliefs,cues to action,self-efficacy,and likelihood of undergoing an OME.We used structural equation modeling (SEM) to investigate the direct and indirect paths,to predict the likelihood of undergoing an OME,in three different health risk groups.Classification of participants into groups of high,moderate,and low risk of developing oral cancer was based on the whether or not the participants drank alcohol,chewed betel quid,or smoked cigarettes. Results:The modified HBM demonstrated a good fit among the high,moderate,and low-risk groups,and explained 50%,37%,and 30% of the variance of undergoing an OME,respectively.The direct and indirect paths influencing the likelihood of undergoing an OME varied significantly among the three groups.Conclusions:Based on the findings, care must be taken when selecting responsive health education for provision to participants with different health beliefs and levels of risks.目標：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。方法：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，我們依據參與者是否有喝酒、嚼食檳榔、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族群接受口腔黏膜檢查的可能性與影響路徑之差異。結果：證明修正後的健康信念模式對高、中與低風險組模型配適度良好並可解釋三組接受口腔黏膜檢查之可能性分別為50%、37%、30%，且三組在健康信念影響接受口腔黏膜檢查可能性之直接與間接路徑上有顯著差異。結論：不同健康風險族群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以提高無檳社區計畫之有效性。