以健康信念模式探討臺灣原鄉地區原住民長者接種COVID-19疫苗之影響因素

Abstract

背景 COVID-19防疫政策中，疫苗注射為重要一環，原住民長期處於健康不平等之背景之下，部分台灣原住民地區COVID-19疫苗接種率偏低，原因不明。因原住民區高齡人口眾多，老年族群又屬於COVID-19高風險族群，為維護疫情下原住民族長者健康權，本研究以健康信念模型與對醫師與醫療照護系統之信任，加上社會人口學與醫療因子，探討台灣原住民區原住民長者COVID-19疫苗接種影響因素，研究結果預期可以提供給醫療防疫團隊與相關部會作為決策之參考。 方法 本研究採用橫斷式調查法，以結構式問卷收集資料，於2022年5月13日至2022年7月18日期間，訪問台灣南部某原住民地區居住超過六個月以上、且年齡大於 55 歲(含)以上的原住民，採全區調查，以健康信念模型與對醫師與醫療照護系統之信任和社會人口學與醫療相關因子，多面向探討台灣原住民區原住民長者 COVID-19疫苗接種影響因素，應用雙變項與多變項分析來檢查關聯性，主要結果是COVID-19疫苗接種行為。本研究通過ＩＲＢ與ＣＲＢ，且執行前通過地方部落會議投票許可辦理在地研究。 結果 本研究受訪者年紀多為55-64歲（50%），其中女性（64%）、布農族（73%）、有婚姻關係（51%）、基督教（91%）、小學學歷（59%）；工作狀況多為無業（51%）或從事農業相關工作（39%）、每月可以自行支配的金額多來自老人津貼，約9999元以下（76%）、大多不是中低收入戶（95%）且與家人同住（80%）；在健康習慣因子方面，受訪者大多數患有慢性病（86%），約一半受訪者在去年一年內未接種流感疫苗（52%），多數沒有抽菸（76%）、嚼檳榔（88%）或飲酒習慣（53%）。以卡方檢定發現發現對 COVID-19 疫苗接種具有統計學顯著影響 (p < 0.05) 的預測變量有是否有生活伴侶（p=0.04）、是否獨居 (p=0.03)與過去一年是否有接種流感疫苗(p=0.004)等因子。以獨立樣本t檢定分析健康信念模型與信任變項與COVID-19疫苗接種的相關性，在未曾接種過COVID-19疫苗的組別，相較於曾接種過COVID-19疫苗的組別，自身覺得受到COVID-19對健康的威脅程度較低(p=0.02,95% C.I. -0.80- -0.07)、自覺接種COVID-19疫苗的好處比較低(p< 0.001,95% CI-1.61- -0.87)、自覺接種COVID-19的障礙較高(p<0.001,95% C.I. -1.14- -0.46)，在行動線索的程度表現也較低(p<0.001,95% C.I. -1.81- -0.90)。在對醫師的信任(p=0.08,95% C.I. -1.820- 0.05）與對醫療照護體系的信任(p=0.59,95% C.I. -0.25-0.44），則沒有顯著差異。依本研究羅吉斯迴歸分析結果發現，HBM 結構中每一面向皆與COVID-19疫苗接種的行為相關。 結論 使用HBM模式探討原住民區長者COVID-19疫苗接種行為影響因子對防疫政策制定者與第一線醫療提供者而言相當重要，應了解並加強驅動因素，使防疫政策能在保有文化敏感度前提下，提升疫苗施打意願，維護原民長者健康。

Background Coronavirus disease 2019(COVID-19) has spread rapidly since it was first detected. It caused a global pandemic severely impacting the economies and depleting medical health systems in many countries. COVID-19 vaccination is the internationally recognized and recommended policy to effectively control the outbreak. However, vaccine inequity exists between countries as well as within countries. Researches has shown that indigenous peoples have higher hospitalization and mortality rates after being diagnosed with COVID-19, in addition, they have lower COVID-19 vaccination rates. In Taiwan, lower vaccination rates noted in some indigenous area and the reasons have not been rigorously explored. Medical and environmental conditions to indigenous elderly are more adversely. Therefore, it is important to explore the predictor factors for COVID-19 vaccination and adjust strategy so as to protect the indigenous elders during the pandemic. Method This is a questionnaire-based cross-sectional study, conducted between May 13, 2022 and July 18, 2022. This study designed based on the original HBM structure and sociodemographic and health-related factors, the variates of trust in physicians and in healthcare system were also included. Participants were indigenous peoples who lived in one tribal area seated southern of Taiwan for more than six months and were older than 55 years old. Reliability and validity would be examined using Cronbach's alpha test and exploratory factor analysis. The participants` characteristics would be described by descriptive analytics. Bivariate analysis including Pearson's chi-square test and independent sample T tests were used to analyze the correlation between dependent and independent variables. Finally, binary logistic regression was performed in order to investigate determinants of COVID-19 vaccination. Results Most of the participants in this study were 55-64 years old (50%), including female (64%), Bunun (73%), marriage (51.0%), Christian (91%), primary school education (59%); the working status is mostly unemployed (51%) or engaged in agricultural related work (39%). The variables found to have a statistically significant effect (p < 0.05) on vaccination against COVID-19 via chi-square test were having life partner or not (p=0.04), living alone or not (p=0.03) and received influenza vaccination in the past year or not (p=0.004). Using independent simple t test to analyze the correlation between vaccination against COVID-19 and HBM or trust variables. Those did not receive any COVID-19 vaccination, compared with those received at least one dose, perceived lower threats from COVID-19(p=0.02,95% C.I. -0.80- -0.07), perceived less benefits to do vaccination (p< 0.001,95% CI-1.61- -0.87), perceived higher barriers to accomplish COVID-19 vaccination (p<0.001,95% C.I. -1.14- -0.46) , lower degree to react to the cues which encouraged them to do vaccination (p<0.001,95% C.I. -1.81- -0.90). There were no significant differences between the trust variates and COVID-19 vaccination. According to the result of logistic regression analysis of this study, each dimension of HBM is significantly correlated with COVID-19 vaccination. Conclusion This study uses health belief model combined with sociodemographic and health factors and trust in physicians and the healthcare system to explore the factors associated with COVID-19 vaccination among indigenous elders. Vaccine promotion led by tribal opinion leaders, explore and overcome vaccine hesitancy, and improve disease awareness, might be the actual strategies to increase the chance of indigenous elders being vaccinated. During the COVID-19 pandemic, the preventive plan for the indigenous people should be compiled based on the cultural sensitivity and the preexisting medical inequality, it might increase the acceptance of indigenous people to new medical treatments.