以健康信念模式分析孕婦接受X染色體脆折症帶因者篩檢之意願

Abstract

X染色體脆折症為最常見之遺傳性智障疾病，患者的母親為此症的帶因者，而帶因者可經由產前遺傳診斷以避免疾病的發生。本研究以健康信念模式為基礎，旨在分析孕婦接受X染色體脆折症帶因者篩檢之意願；探討研究對象之社會人口學、個人特質與疾病知識對自覺帶因者之罹患性、嚴重性、帶因者篩檢之利益性、障礙性、行動線索及接受帶因者篩檢意願之影響。研究工具為結構式問卷，包括個人基本屬性、個人特質、疾病知識、健康信念、行動線索及接受帶因者篩檢之可能性等。研究場所為臺北縣某區域級醫院婦產科門診，研究對象為接受產檢之懷孕14週內孕婦共205位，以自填問卷的方式，進行資料收集。 研究結果如下：一、社會人口學變項與健康信念模式中各因素之關係，顯示大學教育程度者之自覺為帶因者罹患性顯著高於高中（職）以下者；教育程度較高者、家庭平均月收入較高者、無宗教信仰者及已婚者對自覺帶因者之嚴重性趨向較高的認知；有流產經驗者有較高的帶因者篩檢利益性認知；家庭平均月收入愈高者其自覺X染色體脆折症帶因者篩檢之障礙性愈低；≧34歲之高齡孕婦或經產婦比<34歲或初次懷孕之孕婦有較多的行動線索。二、研究對象之疾病知識與自覺為X染色體脆折症帶因者之罹患性、嚴重性、帶因者篩檢之利益性呈現顯著之正相關；與自覺帶因者篩檢之障礙性則呈顯著之負相關。三、在邏輯迴歸分析中對接受帶因者篩檢意願最具影響力之因素為自覺帶因者篩檢之障礙性，其次為自覺為帶因者之罹患性。 此外，根據研究結果，研究對象因不瞭解X染色體脆折症而導致帶因者篩檢之障礙性最大，因此建議醫療院所於婦產科門診針對此疾病及篩檢內容提供衛教單張，以增進孕婦之瞭解及減輕疑慮；且孕婦在接受帶因者篩檢前、後應由已認證之遺傳諮詢師或遺傳專科醫師進行專業之遺傳諮詢。

Fragile X syndrome (FXS) is the most common inherited mental retardation disorder. The patient's mother is always the carrier of this disease. Through prenatal diagnosis on carrier woman, this disease is preventable. Based on health belief model, the purpose of this study was to (1) document the acceptance of fragile X carrier screening among pregnant women, (2) explore the factors that influence pregnant women’s attitude for carrier screening. The study setting was in the obstetric OPD of a regional general hospital at Taipei County. 205 participants with gestational age less than 14 weeks filled out a self-administered questionnaire. The instrument included demographic data, personality traits, the knowledge on FXS, perceived susceptibility and severity, perceived benefits and barriers of taking action, cues in action and the acceptance of carrier screening. These data were analyzed using descriptive and inferential statistic. From inferential statistics, we found that 1. Compared with senior high school education, participants with tertiary education had higher perceived susceptibility. Participants with higher education, higher family income, married and atheists had higher perceived severity. Women who had experience of pregnancy loss had higher perceived benefits. Participants with higher family income had lower perceived barriers. Women with advanced maternal age (≥34 years of age) or multipara had more cues in action than age less than 34 years or primigravidae. 2. The knowledge of FXS were positively correlated with perceived susceptibility, severity and benefits and negatively correlated with perceived barriers. 3. Logistic regression analysis revealed that perceived barriers and susceptibility were the two major predictors for acceptance of fragile X carrier screening. From study results, we also discovered that the lack of knowledge on FXS was the most obstacle to the acceptance of fragile X carrier screening. Hospital needs to provide the FXS handout to these pregnant women to facilitate their decision on fragile X carrier screening. Moreover, the genetic counseling should be carried out by certified genetic counselor or clinical geneticist before and after the carrier screening.