以計劃行為理論探討高中女校學生之戴套意圖：檢視性取向與性別氣質之調節作用

Abstract

背景：青少年危險性行為之後果，如罹患性傳染疾病、未婚懷孕等，均對其身體、心理造成衝擊，而未預期懷孕對於青少女之傷害尤其嚴重。在面對這些後果之處理能力尚不足時，亦恐造成家庭與社會負擔，故預防青少年危險性行為之發生，並增進其戴套意圖，為重要之公共衛生議題。然臺灣目前對於青少年性行為之研究，對象多為大學生，且較少利用健康行為理論為基礎，系統性地探討高中生之戴套意圖，遑論探討單一生理性別環境之下，高中女校學生之性取向與性別氣質，對其戴套意圖之潛在調節作用。 目的：運用具結構性之計劃行為理論 (Theory of Planned Behavior, TPB)，檢視高中女校學生，未來若發生性行為時之戴套意圖及其相關因素，以提供適性之衛教方案或介入策略發展之實證參考依據。 方法：本研究於2020年1月至3月期間，以TPB為架構編製之網路匿名自填式問卷進行資料收集，有效樣本為1,419位。透過探索性因素分析萃取出六個潛在因素，並運用多變項羅吉斯迴歸，以性取向分層，分別探討影響高中女校學生未來性行為時戴套意圖之相關因素，並檢視其與性別氣質之關聯。 結果：當高中女校學生之異性戀者具備以下特質時，其未來具高戴套意圖之勝算比皆顯著上升：正面行為結果評價相對中立 (AOR=1.51) 或正向 (AOR=2.27)、與心理感受相關之負面行為結果評價相對中立 (AOR=1.43) 或正向 (AOR=1.89)、具相對支持之主觀規範 (AOR=1.74)、在有利情境下具相對高度之自覺行為控制 (AOR=1.96)。然與套子相關之負面行為結果評價相對中立 (AOR=0.61) 或正向 (AOR=0.51)、或在相對正向中其為性別氣質陽剛者(AOR=0.49) 時，未來具高戴套意圖之勝算比顯著下降；而非異性戀者具備以下特質時，其未來具高戴套意圖之勝算比皆顯著上升：正面行為結果評價相對正向 (AOR=1.79)、與心理感受相關之負面行為結果評價相對正向 (AOR=2.64)、阻礙情境下之自覺行為控制相對高度 (AOR=1.92)。 結論：本研究以計劃行為理論探討高中女校學生之戴套意圖，除了發現與 TPB有關之重要影響因素，更發現性取向與性別氣質亦為重要調節因子。未來若欲提升高中女校生戴套意圖，在進行相關宣導時，應針對不同性取向、性別氣質對象，進行不同之介入策略，本研究結果有助於教師設計相關教材，作為實證參考依據。

Background: The consequences of adolescent sexual risk behaviors, including sexually transmitted diseases and unintended pregnancy, can have a large physical and psychological impact on them. Unintended pregnancy can be particularly disruptive for girls. Given their young age, adolescents are less able to tackle these problems and ensuing social consequences by themselves, so their families are likely to be involved as a result. Hence, to prevent sexual risk behaviors and to increase the intention to use condoms or findoms as needed among adolescents are an important public health issue. However, most adolescent sexual health research has targeted college students and relatively little is known about high school students. Even fewer studies, if any, have employed a health behavior theory to systematically explore the condom or findom use intention among girls’ senior high school students, and to examine the potential moderating effects of sexual orientation and gender characteristic in an all-girls school environment. Objectives: Based on the Theory of Planned Behavior (TPB), this study aims to explore the condom or findom use intention and associated factors among girls’ senior high school students. The empirical findings could inform tailored health education programs and intervention strategies in the female student population. Methods: The quantitative questionnaire is developed according to the TPB and the literature review. An anonymous online survey was conducted between January and March 2020 among girls’ public senior high school students in Taiwan. Responses from 1,419 participants were included in the multivariate logistic regression analyses. Items were factor-analyzed to form 6 factor-based subscales, whose scores were trichotomized. Data were stratified by sexual orientation to explore the TPB-based factors linked to having high intention to use condoms or findoms, and to examine the potential moderating effects of gender characteristic. Results: Among heterosexual girls’ senior high school students, those who perceived: (1) relatively neutral (AOR=1.51) or positive (AOR=2.27) attitudes about positive outcomes, (2) relatively neutral (AOR=1.43) or positive (AOR=1.89) attitudes about negative outcomes related to feelings, (3) relatively supportive subjective norms (AOR=1.74), and (4) relatively high control under facilitating conditions (AOR=1.96), were significantly more likely to have high intention to use condoms or findoms. However, among heterosexual girls, those who perceived relatively neutral (AOR=0.61) or positive (AOR=0.51) attitudes about negative outcomes related to condoms or findoms, and those with relatively positive attitudes who were masculine (AOR=0.49), were significantly less likely to have high intention to use condoms or findoms. By contrast, among their non-heterosexual counterparts, those who perceived: (1) relatively positive attitudes about positive outcomes (AOR=1.79), (2) relatively positive attitudes about negative outcomes related to feelings (AOR=2.64), and (3) relatively high perceived control under constraining conditions (AOR=1.92), were more likely to have high intention to use condoms or findoms. Conclusions: Using the TPB as the theoretical framework, this study found some TPB items were strongly associated with condom or findom use intention among girls’ senior high school students. Further, the study found that sexual orientation and gender characteristic are important moderating factors. Therefore, future health promotion programs to increase condom or findom use intention should be tailored for high school girls of different sexual orientation and gender characteristic. The empirical findings of this study can also inform the development of related health education programs.