運用消費者行為模型探討南投縣民眾接受Af心房顫動智慧篩檢後續之轉診意願分析

Using a Consumer Behavior Model to Investigate Willingness Among Residents in Nantou County, Taiwan, to Accept Referral After Undergoing Intelligent Screening for Atrial Fibrillation

目的
高齡者的心房顫動發生率較高，在心房顫動全球流行病學研究中，死亡率男女比例約1：2，且世界衛生組織（WHO）強調健康公平性，不同群體間應無不公平之健康差異；因高齡化與地理限制，南投縣地處偏遠，為改善醫療可近性，推動Af心房顫動智慧篩檢，縮短診斷時間與提升綠色通道轉診意願。本研究探討南投縣民眾接受Af心房顫動智慧篩檢後之轉診意願。
方法
本研究採橫斷式設計，於2023年4月至11月期間，針對南投縣50歲以上民眾接受Af心房顫動智慧篩檢，以具信、效度問卷進行訪談，共回收有效問卷4,849份。問卷內容包含基本資料、篩檢過程、篩檢滿意度及後續轉診意願；資料分析採用SPSS 21版統計軟體進行。
結果
影響南投縣民眾接受Af心房顫動智慧篩檢後續轉診意願，主要因素為居住生活圈、就醫及檢查可近性、推薦使用意願及服務可近性。居住於南投次區域（odds=10.951, p<0.000）、就醫及檢查可近性（odds=10.659, p<0.011）、推薦使用此服務者（odds=7.886, p<0.025）、服務可近性（odds=5.263, p<0.006），均達統計上顯著差異，後續接受轉診意願較高。
結論
運用Howard-Sheth模型，本研究發現影響南投民眾Af心房顫動智慧篩檢後轉診意願的主因為居住生活圈與醫療可近性。建議強化綠色通道、設置大型醫療機構及推動遠距醫療服務，以提升就醫便利性。

Purposes
The incidence of Atrial fibrillation (Af) among older patients is high. Global epidemiological studies of Af have found that the ratio of men to women mortality rates is approximately 1 to 2, with the World Health Organization emphasizing health equity and the avoidance of unfair health disparities between different groups. Access to healthcare in Nantou County, Taiwan, is poor because of its aging population and geographic isolation. To address this problem, an intelligent screening program for Af was launched to shorten the time to diagnosis and increase the willingness of patients to accept referral for further treatment through fast-track channels. The present study investigated the willingness of Nantou County residents to accept referral after undergoing Af screening.
Methods
This cross-sectional study was conducted between April and November 2023, and the participants were Nantou County residents aged 50 and older who underwent intelligent screening for Af. Interviews were conducted using a reliable and validated questionnaire. A total of 4,849 valid questionnaires were collected. The questionnaire included questions on basic demographics, the screening process, satisfaction with screening, and willingness to be referred for further treatment. Data analysis was performed using IBM SPSS Statistics for Windows 21 Statistical software.
Results
Major factors affecting the willingness among Nantou County residents to undergo intelligent Af screening and subsequently accept referral included residence in Nantou County subregions (odds=10.951, p<0.000), access to healthcare and with proximity to medical care (odds=10.659, p<0.011) recommendations to use the Af screening service (odds=7.886, p<0.025), and access to the service (odds=5.263, p<0.006). These factors exhibited statistically significant differences in terms of willingness to accept referral in the future.
Conclusions
Using the Howard Sheth model, the study found that the main factors affecting the willingness of Nantou residents to accept referral following intelligent Af screening were residential living environment and access to healthcare and with proximity to medical care. Recommendations to make access to healthcare more convenient include improving fast-track channels, establishing large medical institutions, and promoting telemedicine services..