應用健康信念模式探討長者參與失能預防服務意願之性別差異

Intention to Participate in Disability Prevention Services Among Older Adults: An Exploration of Gender Differences Using the Health Belief Model

背景：政府推動社區預防及延緩失能服務，不同性別的參與度不同，尤其男性參與度偏低，故須了解影響不同性別參與的因素以發展有效策略。
目的：探討失能可預防性態度與健康信念模式核心概念對社區長者參與服務意願的影響，以及性別差異。
方法：採橫斷性設計，調查200位65歲以上社區長者，以結構式問卷測量失能可預防性態度、健康信念模式核心概念及參與服務意願。資料分析採t檢定、卡方檢定及迴歸分析，並採PROCESS模型探討中介效應。
結果：女性長者的失能可預防性態度（t = -2.856, p < .01）、自覺利益（t = -3.069, p < .01）、預防自我效能（t = -2.986, p < .01）及參與意願（t = -3.405, p < .01）比男性正向；男性則自覺障礙較高（t = -2.542, p < .05）。不分性別，失能可預防性態度透過提升自覺利益、降低自覺障礙間接影響參與意願；在男性群體，還透過提升自我效能產生效應，總間接效應在男性（β= 0.61）比女性（β= 0.23）的更高。
結論／實務應用：長者的失能預防服務參與意願有性別差異。服務提供者宣導參與利益、降低參與障礙外，更應強調失能的「可預防性」，並針對男性長者提升其預防自我效能。

Background: Rates of participation in public initiatives to prevent and delay disability differ by gender, with notably lower participation by males. Identifying gender-specific factors is essential for developing effective strategies to boost participation rates.
Purpose: In this study, the attitudes toward the preventability of disability and the core constructs of the Health Belief Model (HBM) were considered in terms of their influence on intention to participate in preventive services among community-dwelling older adults. Gender-based differences in the influence of each factor were examined.
Methods: A cross-sectional design was adopted. A total of 200 community-dwelling older adults aged 65 and above were surveyed using a structured questionnaire. Attitudes toward the preventability of disability, core HBM constructs, and intention to participate in services were measured. Data were analyzed using t-tests, chi-square tests, and regression analyses, and mediation effects were examined using the PROCESS model.
Results: Compared to their male counterparts, the female participants exhibited more positive attitudes toward preventability (t = -2.856, p < .01), perceived benefits (t = -3.069, p < .01), self-efficacy (t = -2.986, p < .01), and intention to participate (t = -3.405, p < .01). The male participants reported higher perceived barriers (t = -2.542, p < .05). Attitudes toward preventability were found to influence intention to participate indirectly in all participants by enhancing perceived benefits and reducing perceived barriers; for males, this also included an increase in self-efficacy. This indirect effect was stronger in the male (β= 0.61) than female (β= 0.23) group.
Conclusions/ Implications for Practice: Intention to participate in disability prevention services differs by gender. In addition to promoting the benefits of participation and reducing barriers, service providers should place greater emphasis on the preventability of disability and focus on enhancing preventive self-efficacy in promotions targeted at male older adults.