子宮頸病變婦女健康行為、癌病素養之相關因素與衛教介入成效：縱貫性研究

Abstract

目的：過去的研究少有針對子宮頸病變診斷初期的婦女深入探討健康相關行為的分布情形、生活型態和相關因素。本研究旨在探討：(1)子宮頸病變婦女在癌前病變診斷前後，在「健康行為」、「健康行為改變」、「健康行為自我效能」、「子宮頸癌素養」、情緒狀態等的影響情形。(2)衛生教育措施介入對「健康行為」、「健康行為改變」、「健康行為自我效能」、「子宮頸癌素養」的影響。 方法：本研究為一縱貫性研究(longitudinal study)，研究對象包括308位婦女(158子宮頸病變婦女、150位抹片正常婦女)，分為二個研究階段，共有5次資料收集時間點。子宮頸病變婦女分別於：(1)調查性研究階段(the period of a survey stage)，針對三個月內曾被診斷為子宮頸病變婦女，進行初次(第1時間點)、三個月後(第2時間點)及六個月後(第3時間點)之健康行為與相關因素的資料收集；(2)介入性研究階段(the period of an interventional stage)，以第3時間點收集資料為前測，以傾向分數(propensity score)配對調整婦女年齡、教育程度、身體質量指數、手術及病情的差異性，依衛教手冊和手機應用程式給予方式的不同分為三種衛教工具型態組，於不同時間給予並於兩個月後(第4時間點)及四個月後(第5時間點)收集資料。 結果： 子宮頸病變組與抹片正常組兩組婦女在社經地位、教育程度及婚姻交友狀況有顯著差異性；子宮頸病變組婦女有較高的「健康行為」、「健康行為改變」、「子宮頸癌素養」得分，較低的自我效能得分。 縱貫式觀察二個研究階段：子宮頸病變組婦女的「健康行為改變」和「子宮頸癌素養」的得分會隨著時間顯著增加；健康促進行為得分增加後維持穩定狀況；自我效能的得分在調查性階段沒有顯著變化，在介入性階段則有顯著下降情形，在控制干擾因子後未達統計顯著。提供兩種工具(手冊及手機應用程式)比只提供手冊工具有較高的「子宮頸癌素養」得分，手機應用程式工具和衛教手冊在不同健康行為改變次量表及自我效能有不同果效。 結論： 以衛教作為介入性措施，對於子宮頸病變婦女能增加「健康行為改變」和「子宮頸癌素養」。手機應用程式工具在危害控制健康行為改變、癌症預防自我效能有較好成效；手冊在「子宮頸癌素養」及「健康促進行為改變」有較好成效。手冊及手機應用程式兩種工具並用能提升「子宮頸癌素養」。

Purpose : The purpose of this study is aimed to study (1) related factors of health behaviors (including health behavior, change of behavior and self-efficacy) and cancer literacy among women with pre-cervical cancerous (Pre-CCa) lesions, and (2) effect of health education on the health behaviors and CCa literacy. Method : The study was designed as a longitudinal study enrolling 158 pre-CCa women (during the diagnosis stage) and 150 control women (with normal Pap smear result). All the pre-CCa cases were evaluated 5 times and the control cases once. This study could be divided into two periods： the period of an survey stage (including the 1st, 2nd and 3rd measure time) and the period of an interventional stage (including the 3rd, 4th and 5th measure time). The data collected at the 3rd measure time in the period of the interventional study. Propensity score matching was used to adjust the differences between pre-CCa women’s age, education, body mass index, surgery types and treatment situations. The influences of various educational tools including the book or the mobile application program (App) were still investigated. Result : There are significant differences of socioeconomic, education, marriage and couple, initial intercourse age, initial childbirth age, numbers of lifetime partners, body image, anxiety, self-report health status between pre-CCa and control women. Pre-CCa women’s were found higher scores of health behavior, change of behavior and CCa literacy but lower score of self-efficacy than the control women. For the Pre-CCa women, their scores of health-promotion behavior, change of behavior and CCa literacy were significantly increased with time during the whole followed periods (including 2 periods). Furthermore, use of App and book tools simultaneously was effective on the score of pre-CCa literacy and, only App use was effective than only book use on the score of change of Risk-Control behavior and Cancer-prevention self-efficacy, only book use was effective than only App use on the score of change of Health-promotion behavior and pre-CCa literacy. Conclusion： The health education intervention can make positive effect on the change of behavior and CCa literacy. The former could be influenced by the use of App tool and the later by the combined use of App and book tools.