臺灣女同志與異性戀女性子宮頸抹片意圖之差異分析：探討抹片經驗及陽剛氣質之調節作用

Abstract

目標：在控制過去子宮頸抹片經驗 (Pap test experience)下，比較台灣女同志 (lesbian/bisexual women)與異性戀女性在健康信念上之差異，並探討影響其在未來三年內進行子宮頸抹片意願之相關因素。 方法：以地區（北、中、南、東）及年齡（21-29歲、30歲或以上）作分層抽樣，利用網路問卷的方式進行量性資料收集，有效樣本為1375位。 結果：本研究發現，近九成之女同志從未進行過子宮頸抹片檢查，比約五成的異性戀女性來得高。在從未進行過子宮頸抹片檢查的女性裡，相對異性戀女性，女同志有較低的抹片意願、較少的行動線索及較多的自覺障礙。基本上，除了從未進行過子宮頸抹片檢查的異性戀女性，接收較多行動線索之女性有較高的抹片意願；而除了曾進行過子宮頸抹片檢查的女同志，自覺較多障礙之女性則較沒有意願在未來三年內進行抹片檢查。另，陽剛氣質同時與性傾向及過去抹片經驗有顯著的交互作用：氣質陽剛且曾進行過抹片檢查的異性戀女性擁有較低的抹片意願(AOR=0.09)，除非其有較高之自覺罹患性 (AOR=4.23)；同樣地，氣質陽剛但從未進行抹片檢查的女同志亦擁有較低的抹片意願 (AOR=0.48)，除非其有較多之自覺利益 (AOR=1.31)。 結論：除了性傾向外，是否做過子宮頸抹片及擁有陽剛之性別氣質，也可能是導致台灣女性進行子抹意願之差異的重要因子。在政府致力消弭健康差異 (health disparities)之趨勢下，應更重視性少數族群的健康及提升醫療環境之性別敏感度，以促進健康上的性別平等。

Objectives: Pap test is an effective way to prevent cervical cancer; however, there still exist sexual orientation disparities in Pap test utilization. This study aimed to examine the differences in health beliefs and to explore the associated factors of Pap test intention among Taiwanese women, separately by their sexual orientation and Pap test experience. Methods: A sample stratified by region (north, center, south, and east) and age group (21-29 and ≥30) was drawn for heterosexual women, as well as for lesbian/bisexual women in Taiwan. Data from 1,375 participants were collected via an anonymous online survey. Results: An overwhelming majority of lesbian/bisexual women in Taiwan never had a Pap test (89.1%), compared with their heterosexual counterparts (54.9%). Among women who never had a Pap test, lesbian/bisexual women had lower Pap test intention, received fewer cues to action, and perceived more barriers than heterosexual women. In general, women who received more cues to action had significantly higher Pap test intention, except those heterosexual women who never had a Pap test; by contrast, women who perceived more barriers had significantly lower Pap test intention, except those lesbian/bisexual women with prior Pap test experience. Notably, butch-identity interacted with both sexual orientation and Pap test experience. Specifically, heterosexual women with a butch identity who had Pap test experience had lower Pap test intention (AOR=0.09), unless they perceived higher susceptibility (AOR=4.23); similarly, lesbian/bisexual women with a butch identity who never had a Pap test had lower Pap test intention (AOR=0.48), unless they perceived more benefits (AOR=1.31). Conclusions: This study demonstrated that sexual orientation disparities in Pap test intention may depend on whether women ever had a Pap test and had a butch identity. As the Taiwan Government strives to eliminate health disparities, more attention should be paid to sexual minorities’ health and gender sensitivity in the healthcare systems.