以社會行銷的觀點探討都市社區 整合性健康照護網絡計劃與癌症篩檢成效

Abstract

背景及目標： 因國人十大死因以惡性腫瘤為首，癌症防治重點應早期發現、早期治療，癌症篩檢時常被國人忽略，因為健康信念差異產生的障礙，造成目前癌症篩檢率偏低，尤其以大腸直腸癌、口腔癌的篩檢率不到兩成，因此本研究目的在於以因地制宜的執行整合性健康照護網絡計劃，以提升癌症篩檢成效。 方法： 本研究為橫斷式研究，計劃執行期間為100年1月30日至100年12月30日，利用社會行銷的概念，透過行銷4Ps規劃整合性健康照護網絡策略，並評價參與者與計劃成效之相關性。第一部分促進民眾參與癌症篩檢行為，例如集點換贈品、婦女月刮刮卡的活動、民間社團宣傳、鄰里廣播設站等方式，第二部分另促進轄區內基層醫療提供者的在地資源整合，並進行結盟，給予工作人員優勢能力訓練、創造與衛生所的互動機會及輔導合約診所篩檢流程的建置、並提供誘因，增加癌症篩檢成效。樣本以立意取樣，研究測量以結構式自填問卷，問卷利用探索性因素分析建構效度、Cronbach alpha建構問卷內在一致信度。第一部份請接受服務的民眾填寫防癌行為有關的問卷，內容包括：基本人口學資料、自覺疾病威脅性、行動線索、癌症知能、獲得篩檢利益、障礙及自我效能等量表。第二部份以新莊合約基層院所為研究族群，請診所或藥局人員填寫社區健康照護網絡計劃運作的問卷，包括：診所或藥局的基本特性、工作人員基本資料、對健康照護網絡運作之優勢向度、劣勢向度、機會向度及威脅向度。 結果： 實習期間共收集民眾687份問卷，合約診所工作人員223份問卷。從篩檢的民眾問卷萃取出獲得宣傳訊息、行為障礙兩個重要因素，運用邏輯斯迴歸分析，控制其他變項，探討影響民眾參與社會行銷篩檢行為，以獲得宣傳訊息因素達統計相關。基層醫療工作人員問卷調查萃取出機會、優勢、劣勢因素，經廣義估計方程式並調整干擾變項及聚集效應後，子宮頸抹片檢查篩檢成效、免疫法糞便潛血檢查篩檢成效、口腔癌篩檢成效與機會、優勢因素皆有顯著相關。 結論： 本研究發現整合性健康照護網絡計劃提供以下有效的相關因素，包含有效的宣傳訊息會促使民眾前來接受癌症篩檢，而創造機會給子宮頸抹片檢查提供者並強化工作人員的優勢能力給免疫法免疫法糞便潛血檢查、口腔癌篩檢的提供者，必能增加癌症篩檢成效。此研究結果以俾往後在執行以社區導向的癌症篩檢計畫上，能有一定參考的價值，亦幫助基層公共衛生實務推動

Background: Cancer has been the leading cause of death in Taiwan. Cancer control is an important early detection and treatment. The differences of health beliefs from the users may ignore the cancer screenings behavior. To bring of low cancer screening rate, especially in colorectal cancer and oral cnacer screening rate often less than 20%. The aim of this study is to investigate the prevalence and possible causal factors of social marketing project related to the user and the provider. Methods: The study was cross-sectional designed and divided into two parts. The period of the project is from Jan. 2011 to Dec. 2011. We design multifaceted social marketing intervention project including mass media, small media, scratch card, collecTable exchange for gift to user, client incentives, strength of traning capability, opportunity of learning interactive, counseling process to provider, increase cancer screening in primary care settings serving in xinzhuang urban New Taipei city. The participants in the 1st part were invited from user. Each participant completed a structured questionnaire which includes demographic data, perceived threat, cue to action, perceived benefits, perceived barriers, self efficacy and cancer knowledge. The 2nd part would be performed at contract clinics. Each subject completed the questionnaire which includes opportunity, strength, weakness and threat. Result: The period of 687 users and 223 subjects participated in the marketing activities. In the 1st part, we found the information factor from the exploratory factor analysis in the questionnaire. In the multiple logistic regression analysis we considered sex, age, race, belief, occupation, smoking and drinking, exercise and cancer knowledge. The information factor score was significantly and indicated that user with social marketing campaign. In the 2nd part, the provider was considered by controlled cluster effect and practice division, nature of practice and staff age. The opportunity factor score and strength factor score are effective of cancer screenings. Conclusion: We clearly integrated healthcare network program associated with information factor that induced user to receive cancer screening services. The program created opportunities, intensifying strength for provider to increase the amount of cancer screening. Further studies provide social marketing approach for community-based intervention to promote cancer screenings.