臺北市信義區學齡前幼兒家長對其子女接種流感疫苗的意願因素分析

Abstract

流行性感冒（簡稱流感）因具傳播速度快、變異多、自然宿主廣的特徵，因此各國對流感的防治均十分重視。而疫苗被視為流感防治的重要利器，因此預防流感，最有效方法是接種流感疫苗，我國自2009年開始提供4-6歲幼兒免費接種流感疫苗，然而臺北市信義區4-6歲幼兒流感疫苗接種率偏低（13.86％），本研究藉2010年臺北市信義區家長對學齡前幼兒接種流感疫苗意願調查，分析探討 (1)社會人口學、(2)健康信念、(3)預防行為、(4)政府信賴度及(5)醫療服務對流感接種之影響，以作為日後推動政策之參考。 做法採橫斷式研究調查法，以健康信念模式為基礎，自2010年11月15日至30日由臺北市信義區8所幼托機構協助發放1,549份問卷，回收得975份，其中525份為有效樣本（53.8％），問卷信度內部一致性(Cronbach'sα係數)達0.72。比較有無接種2010年流感疫苗兩組間之差異，先卡方檢定(Chi-square test)進行單變項分析；再以變異數分析(Analysis of Variance , ANOVA)探討家長對政府信賴度與流感的健康信念相關性；最後，以多變項逐步迴歸(multivariable stepwise regression)，分析多變項因子與接種2010年流感疫苗之相關性。 本研究顯示僅20%的幼兒已接種2010年流感疫苗。其中家長願意讓幼兒接種疫苗為正值疾病流行季（22%）、疫苗有效安全（21%）及小孩易生病怕被傳染（19%）；而不願意接種流感疫苗的主因是質疑疫苗安全性（21%）、疫苗負面新聞多（15%）、孩子生病中不宜接種（15%）。而家長讓其子女接種流感疫苗與母親職業、2009年曾接種流感疫苗、到校提供流感疫苗接種服務、流感相關健康信念及對政府信賴度共五項有顯著統計差異(p<0.05)。其中未接種組較接種組在國光疫苗信賴度(13% vs. 30%，p=0.0002)、國外廠牌疫苗(31% vs. 54%，p<.0001)及政府政策信賴度(27% vs. 50%，p<.0001)為低。而對政府信賴度「高」者，在自覺疾病易感性與嚴重度(21.29±2.58 vs. 20.09±2.55，p=0.0011)及自覺行動利益(12.98±2.29 vs. 10.39±2.30，p<.0001)平均得分均較高，但自覺行動障礙上卻較低(9.24±1.85 vs. 10.40±1.23，p<.0001)。控制年齡、職業及教育程度後，2009年有接種流感疫苗[Odds Ratio (OR)=16.6，95% Confidence Interval (CI)=6.97-39.50，p<.0001]、會鼓勵他人接種流感疫苗(OR=1.8，95% CI=1.31-2.70，p=0.0005)及整體滿意度高(OR=2.7，95% CI=1.75-4.25，p<.0001) 的家長較有高意願讓子女接種2010年流感疫苗。 本研究的結論是家長不願讓其子女接種流感疫苗最主要原因為對流感疫苗的信心不足(對國光疫苗信賴最低)，在2009年我國與他國實施新的流感疫苗接種計畫時，政府在打疫苗前的風險溝通不足，導致民眾質疑流感疫苗的安全性，尤其此新型流感疫苗為首次國產自製大量疫苗，接種前的萬全準備更為重要。 建議未來若需提升流感疫苗接種率，首重流感疫苗安全，秉持公正公開的透明資訊，應主動對民眾說明各廠牌的流感疫苗人體試驗結果及提供流感疫苗不良反應統計數據，以增加民眾對政府政策的信賴度；另外未來在流感疫苗宣導的主軸，除強調利已外(如預防得流感)，應強化接種流感疫苗的利他優勢(如接種流感疫苗可保護自已與親友)，而基層醫療院所與衛生單位也需扮演家長與民眾接種流感疫苗的溝通橋樑，落實在基層醫療院所提供接種服務，提升家長讓其子女接種流感疫苗之意願。面臨未來更多的流感疫情的挑戰，不僅提供流感疫苗接種服務，更要即時掌握國內、外流感疫訊，落實社區流感防治策略，將平日防疫作為視同作戰，才能克敵制勝。未來研究應檢視提升流感疫苗接種率之策略，並在流感疫苗接種季結束後，再評估流感疫苗接種率是否有提升。

Influenza has characteristics of fast transmission, easy reassortment and involving many different hosts. Therefore, vaccine has been regarded as most important prevention measure in public health. The Department of Health in Taiwan has provided free influenza vaccine for 4-6-year-old children since 2009, yet the vaccine coverage rate of this age group in Xinyi District, Taipei City was relative low (13.86%). This study aimed to investigate the impact of socio-demographic, health belief, preventative behavior, trust ability to government, and medical service on vaccination of influenza by a survey on parents’ willingness of pre-school children influenza vaccination in Xinyi District, Taipei City in 2010. This cross-sectional study, based on health belief, was conducted from November 15 to November 30, 2010. Of 1529 questionnaires delivered with the assistance of eight nurseries in Xinyi District, Taipei City, 975 questionnaires responded and 525 questionnaires were effective samples (effective sample rate 53.8%). The internal reliability of the questionnaire reached as Cronbac's α of 0.72. Comparing the differences in factors associated vaccinated vs unvaccinated nursery children, chi-square test was assessed for univariate analysis. Furthermore, the relationship between parents’ confidence in government and their health belief was examined with analysis of variance (ANOVA). Lastly, factors that might be associated with the nursery children receiving the 2010 influenza vaccine were all assessed simultaneously by multivariate logistic regression for controlling important confounders. The results showed that only 20% of pre-school children received the 2010 seasonal influenza vaccine. The primary factors of parents’ willingness to allow their children to have influenza vaccination were the timing fitting for influenza epidemic season (22%), the effectiveness and safety of vaccine (21%) and being afraid of getting sick (19%). The major factors of parents’ unwillingness to allow their children receiving influenza vaccination were doubtfulness of vaccine safety (21%), negative news of vaccine (15%), their children’s were illness unsuitable for vaccination (15%). Univeraiate analyses found that significant factors for the 2010 vaccinated children were mothers’ occupation, received the 2009 influenza vaccines, providing vaccination service at nursery schools, positive influenza related health belief and trust in Government (p<0.05) whereas those for the 2010 unvaccinated children were lower trust in domestic vaccine (13% vs. 30%, p=0.0002), imported vaccine (31% vs. 54%, p<.0001) and government (27% vs. 50%, p<.0001). Additionally, those who trust government had higher scores in self-awareness of susceptibility and severity of influenza (21.29±2.58 vs. 20.09±2.55，p=0.0011) and lower action barriers (12.98±2.29 vs. 10.39±2.30，p<.0001). Further stepwise logistic regression analysis, controlling age, occupation and educational levels, the important factors for parents decision for children to be vaccinated were experienced the had 2009 influenza vaccination [Adjusted Odds Ratio(OR)=16.6, 95% Confidence Interval (CI) = 6.97-39.50, p<.0001], capability to encourage others to receive influenza vaccine (OR= 1.8, 95% CI = 1.31-2.70, p=0.0005) and their overall satisfaction (OR=2.7, 95% CI=1.75-4.25, p <.0001). In conclusion, major reasons for unvaccinated pre-school children were the lack of confidence in the vaccine (especially the lowest trust in domestic vaccine). As Taiwan and other countries implemented vaccination campaign in 2009, lacking of better preparedness in risk communication to the public by Government, the most crucial step, before vaccination is led to the uncertainty about influenza vaccine safety, particularly Taiwanese first domestically manufactured vaccine applied to mass-vaccination in schoolchildren in 2009. The key recommendation for increasing vaccine coverage is to elevate vaccine safety and risk communication by providing transparent information, the results of vaccine clinical trials of different brands and adverse events data to the public, advocating the vaccination’s benefit for their closely-related contacts and others, and notifying prevention measures through local clinics, hospitals and health organizations to increase their trust in Government. Facing many influenza epidemic challenges in the future, more different intervention strategies can be carefully evaluated their effectiveness with a prospective study design and supported sold data for providing better evidence-based public health policies.