疾病信念與健康服務的利用

Abstract

摘要 本研究目的為了解民眾疾病信念與健康服務利用之間的關係，即不同的疾病歸因與醫療化信念是否會影響健康照護服務的使用，健康照護服務的使用則包括了是否使用與使用的型態。 本研究採量性研究的方式，量性資料來源為「台灣地區社會變遷基本調查」2000年之原始資料檔，受訪對象為全台灣20歲以上的民眾，抽樣方式依地區分層並依抽取率與單位大小成比率 ( PPS ) 方式進行抽樣，實際抽出樣本數為1895人，完訪率53.74%。 研究結果有以下發現： 1. 個人特質與疾病信念之間有很強的相關的，像是性別、年齡、宗教信仰、教育程度、收入、居住地，都是影響醫療化程度及疾病歸因的重要因素。 2. 醫療化信念與服用補品及民俗療法中的安太歲之間有達到統計上的顯著水準；但是疾病歸因只與三類民俗療法的使用之間有達到統計上的顯著意義，即接觸靈媒、看風水及安太歲。 3. 在邏輯斯迴歸與多項式邏輯斯迴歸中，控制了社會人口學特質及健康狀況之後，除了疾病歸因與服用非西藥、安太歲以及看風水之間的關係有達到統計上的顯著水準外，其餘不管是個別的健康服務利用或是合併後的多元健康服務利用皆與疾病歸因與醫療化信念沒有達到統計上的顯著水準。 由於二手資料的限制，在疾病歸因及醫療化信念的測量方式的缺失需要再進一步討論。建議有關健康服務利用及求醫行為的理論應該要把認知部分包含在內，以提升模式的解釋及預測力。

Abstract This study aims to examine the relationship between illness beliefs and health services utilization, or more specifically, exploring illness attributions and medicalization beliefs in relation to the use of a wide range of health services. Data for this study were derived from “Taiwan social change survey” of 2000. Based on PPS sampling, this nation-wide survey interviewed adults 20 years and older and finally collected valid data from 1895 adults, which constituted a response rate of 53.74%. The major findings are: 1. Strong associations were found between individuals’ sociodemographic characteristics and illness beliefs. Variables like sex, age, education, religion, income and residential areas were all associated significantly with medicalization beliefs and illness attributions. 2. Medicalization beliefs were significantly related to use of tonics and “pacifying Taisui,” a type folk medicine, but illness attribution only had strong impact on the use of three folk modalities, i.e., visiting spiritual practitioners or Shamen, practicing Fengshui, and Pacifying Taisui. 3. By using logistic regression and multivariate logistic regressions, after controlling for the effects of sociodemographic characteristics and health status variables, neither medicalization beliefs nor illness attributions had significant impacts on health services utilization, both analyzed individually for each type of service or while they were combined into a single variable, except the relationship between illness beliefs and taking non-western medicine, practicing Fengshui, Pacifying Taisui. Due to the limitation caused by using secondary data, the deficiency in the quality of measurement for illness attributions and medicalization beliefs was discussed. It is suggested that theoretical models for health services utilization or health-seeking behavior should include cognitive constructs to improve their explanatory and predictive power.