運用健康信念模式探討台灣民眾於國外旅遊時進行安全性行為之意圖及相關因素

Abstract

背景：梅毒、淋病、後天免疫缺乏症候群與人類免疫缺乏病毒感染，以上這四種主要因性接觸而導致感染的疾病，簡稱性傳染病 (sexually transmitted diseases，以下簡稱STDs)，已成為確診人數最多的法定傳染病。在COVID-19疫情來臨之前，航空業蓬勃發展，廉價航空的興起使得出國旅遊成為國人生活當中普遍的活動之一。國外的研究發現，由於性開放程度增加，旅行者在旅遊期間發生危險性行為的機會增加，進而增加感染STDs的風險，而鄰近台灣的東南亞與西太平洋感染STDs人數占全球感染人數的一半，然探討出國時安全性行為意圖的研究於國內較少見，有鑑於此，本研究以行為科學為基礎，使用健康信念模式 (Health Belief Model, HBM) 探討國人於國外不同於台灣的時空背景之下，正確使用保險套意圖影響因素為何？藉此提供防疫策略具體有用的參考資料。 目的：以HBM為基礎，透過自擬的結構式問卷，探討台灣民眾於國外旅遊時進行安全性行為之意圖及相關因素，做為未來制定性病防治政策之實證參考依據。 方法：本案於2020年3月2日至同年3月22日期間，透過社群媒體及電子布告欄發放網路問卷，針對現居台灣、年齡在15歲以上，規劃六個月內有出國行程者進行招募，共計1,041位研究參與者納入最終統計分析，問卷依據HBM五大構念 (自覺罹患性、自覺嚴重性、自覺利益、自覺障礙以及行動線索) 設計建構而成，透過探索性因素分析萃取出五個潛在因素，運用多變項羅吉斯迴歸，探討國人出國時安全性行為之意圖與其社會人口學、健康信念及行動線索與其他性相關背景之關聯性。 結果：一、社會人口學變項中：女性相較於男性，出國時安全性行為的意圖較低 (AOR=0.63)；而性伴侶性別為異性者，其出國時安全性行為的意圖較高(AOR=1.96)。二、健康信念相關構念方面： (1) 自覺罹患性：自覺會因為在性行為時使用物質助興而感染性病可能性相對高度者，其出國時安全性行為的意圖較高 (AOR=2.05)，而自覺會因為無套性交而感染性病可能性相對高度者，其出國時安全性行為的意圖反而較低 (AOR=0.60)。(2) 自覺嚴重性：自覺得到性病將會面臨死亡威脅相對高度者，出國時安全性行為高意圖是相對低度者的1.5倍。(3) 自覺利益：認為戴保險套可避免因為治療性病所產生的醫療花費 (AOR=1.60) 及戴保險套可以安心享受性愛 (AOR=1.84)，其信念相對高度者，出國時安全性行為意圖越高。(4) 自覺障礙：認為在國外保險套取得不易 (AOR=0.68) 及使用保險套會降低性行為時的快感 (AOR=0.54)，其信念相對高度者，出國時安全性行為意圖越低。三、在其他性相關背景變項中：有使用交友軟體APP尋找性伴侶經驗者 (AOR=0.50)，及具有較高意圖於出國時發生性行為者 (AOR=0.49)，其出國時安全性行為意圖較低，而自助旅行者比起跟團旅行者，其出國時安全性行為意圖較高 (AOR=1.74)。 結論：國人出國時安全性行為意圖與其健康信念有顯著關聯，未來若欲提高國人出國旅行時安全性行為意圖，增加現行性傳染病衛教成效，可參採本研究之研究結果，提高民眾對於性病的自覺罹患性、安全性行為的自覺利益，並降低其自覺障礙，提供適性之衛教，以提高安全性行為意圖，有效避免性病的感染。

Background: Syphilis, gonorrhea, acquired immune deficiency syndrome, and human immunodeficiency virus infection are known as sexually transmitted diseases (STDs) as they are mainly caused by sexual contact, and the aforementioned four STDs have become the most common notifiable diseases in Taiwan. Before the COVID-19 pandemic, the aviation industry was booming, and the rise of low-cost airlines made traveling abroad one of the common activities in the lives of people in Taiwan. International research found that the chance of risky sexual behavior increases among tourists, which in turn increases the risk of STD infection. Southeast Asia and the Western Pacific are close to Taiwan and jointly account for half of the STD cases in the world. However, there is a paucity of research on the safe sex intention when traveling abroad among people in Taiwan. Therefore, based on behavioral science, this study used the Health Belief Model (HBM) to explore the factors influencing condom use when traveling abroad in a foreign context different from Taiwan. This research could provide specific and useful reference materials for STD prevention strategies. Objectives: Using the HBM as the theoretical foundation, a quantitative survey was conducted to explore the safe sex intention and associated factors when traveling abroad among people in Taiwan. The findings could serve as empirical evidence for future development of STD prevention and control policies. Methods: From March 2 to March 22, 2020, an anonymous online questionnaire was distributed through social media and electronic bulletin boards, targeting people who were living in Taiwan, aged 15 and above, and planning to travel abroad within six months. A total of 1,041 study participants were recruited and included in the final statistical analysis. The questionnaire was designed and constructed according to the five constructs of the HBM (i.e., Perceived Susceptibility, Perceived Severity, Perceived Benefits, Perceived Barriers, and Cues to Action). Through exploratory factor analysis, five factors were extracted, and multivariate logistic regression was used to explore the factors associated with safe sex intention when traveling abroad among people in Taiwan. Results: First, regarding sociodemographic variables: females had lower safe sex intention when traveling abroad than males (AOR=0.63) and those with opposite-sex behavior had higher safe sex intention when traveling abroad (AOR=1.96). Second, regarding the HBM constructs: (1) Perceived Susceptibility: Those who perceived a relatively high risk of contracting STDs owing to substance use during sex had higher safe sex intention when traveling abroad (AOR=2.05). Those who perceived a relatively high risk of contracting STDs because of condomless sex had lower safe sex intention when traveling abroad (AOR=0.60). (2) Perceived Severity: Those who perceived that STDs were likely to cause death had 1.5 times the odds of having high safe sex intention when traveling abroad. (3) Perceived Benefits: Those who believed that using condoms during sex can help avoid medical expenses for STD treatment (AOR=1.60) and can allow them to enjoy sex (AOR=1.84) had higher safe sex intention when traveling abroad. (4) Perceived Barriers: Those who believed that it was difficult to obtain condoms abroad (AOR=0.68) and that condom use would reduce sexual pleasure (AOR=0.54) had lower safe sex intention when traveling abroad. Third, regarding other sex-related background variables: those who had experience using dating apps to find sex partners (AOR=0.50) and those who had high intention to go abroad to have sex (AOR=0.49) had lower safe sex intention when traveling abroad; backpackers had higher safe sex intention when traveling abroad than group travelers (AOR=1.74). Conclusions: This study found that people’s safe sex intention when traveling abroad was significantly associated with their health beliefs. On the basis of the empirical findings of this study, future programs can be developed for people in Taiwan to increase their safe sex intention when traveling abroad and to increase the effectiveness of current STD health education programs. The results of this study can provide specific and practical implications for tailored health education strategies to increase people’s Perceived Susceptibility to STDs, increase their Perceived Benefits of safe sex, and reduce their Perceived Barriers to safe sex, so as to increase their safe sex intention and effectively prevent the transmission of STDs.