HBM,HLM疫苗的多變項決策分析與健康促進的策略模型於高齡長者：以PCV疫苗為例

Abstract

近年來，新興傳染病的威脅與高齡化社會的快速發展，使得疫苗接種意願（vaccine uptake intention）成為公共衛生政策關注的重點。然而，現有文獻大多聚焦於中壯年族群或一般老年人，對於「超高齡長者」（≥85 歲），特別是居住於高齡住宅社區的族群，其疫苗接種行為的研究相對有限。此類高齡者常同時面臨多重生理退化、慢性疾病、社交孤立與行動限制，導致其疫苗接種決策過程更為複雜，不僅仰賴個人風險認知或健康知識，更高度依賴醫療服務的可近性、社會支持與外部提示（cues to action）。 本研究以肺炎鏈球菌疫苗（PCV）為例，結合健康信念模式（Health Belief Model, HBM）、健康素養模型（Health Literacy Model, HLM）與多重行動線索（cue to action）構面，採用混合方法設計（Mixed Methods Design），深入剖析高齡者疫苗接種的多變項決策歷程。量化部分透過結構式問卷調查高齡住宅社區居民之疫苗知覺與行為傾向，並透過PLS-SEM統計模式進行驗證，找出不同因素的路徑關係找出關鍵因素，質性部分則進行深度訪談，包含社區醫護人員與住民與關鍵衛生單位與藥廠單位，探討其接種歷程中所遭遇之挑戰、影響與考量因素。 研究結果顯示，高齡者的疫苗接種意願受多重心理與社會因素交互影響。健康信念模型中之三項關鍵構面：「知覺效益」（Perceived Benefits）、「知覺障礙」（Perceived Barriers）與「自我效能」（Self-Efficacy），對於疫苗接種意願具顯著且直接的影響。在設計疫苗推廣策略時，須同時針對「利益最大化」與「障礙最小化」進行溝通設計，提升接受度。此外，「政策提示」（policy）為影響疫苗接種意願最具統計顯著性的行動線索，突顯政府制度設計與資源導入在行為轉化過程中之核心地位。特別是在高齡族群中，制度保障與可近性（accessibility）被視為行動決策的主要依據（如：免費接種、公費涵蓋、設站方便性）。在中介影響上，健康素養可透過知覺效益、知覺障礙與自我效能三構面進一步影響接種意圖。此外，社會網絡與媒體傳播的間接效果與實務潛力，因此親友經驗分享、媒體傳播像是LINE群組訊息與地方衛生政策皆為重要的行動線索來源，進一步引導接種行為。 本研究進一步建構出一套整合性策略模型，指出疫苗接種決策不應單一歸因於個體特質，因此本研究進一步以構建一個滿足五大節點的疫苗生態系（vaccination ecosystem）觀點建構高齡者疫苗推廣的系統性模型已回應疫苗的病患旅程地圖，疫苗接種行為的「系統性養成」：從認知啟動、信念轉化、意願產生到行動實踐，每一階段均可對應不同的策略接觸點（touchpoints），並由多元行動者依其角色進行串聯與補位。具體而言，政府部門、醫療機構、社區組織、媒體平台與疫苗供應商共同構成疫苗推廣的五大節點，各自發揮其「制度建構」、「專業背書」、「社會動員」、「訊息傳播」與「產品支持」的功能。並延伸可以再看到「三重協同效應」策略模型（triple synergy model），指出當政府資源補助與衛生單位的政策推廣（policy）為核心去串聯，媒體訊息傳播（正向的疫苗氣氛營造）、醫療專業支持（知識與健康素養的提升）及社區動員行動（社會網絡實體接觸與情感連線）三者同步啟動時，可以影響三個疫苗意願的三大信念（知覺效益、知覺障礙、自我效能），進而可產生接種意願的乘數效果（multiplicative effect）三層影響力 本文建議未來政策設計應強化社區型健康促進介入、建立信任導向的溝通平台，並提升照護現場的數位管理與決策支援系統。藉由整合性理解與介入，有望提升高齡者疫苗覆蓋率，進而強化台灣面對高齡社會的公共衛生韌性。

In recent years, the dual challenges of emerging infectious diseases and rapid population aging have elevated vaccination uptake intention as a critical issue in public health. However, most existing research focuses on middle-aged or general elderly populations, with limited attention to the “super-elderly” (≥85 years) populations, particularly those residing in elderly housing communities. These individuals often face complex decision-making processes influenced not only by personal risk perception and knowledge but also by limited mobility, social isolation, multimorbidity, and reliance on healthcare accessibility, social support, and external cues to action. This study uses the pneumococcal conjugate vaccine (PCV) as a case to explore the multivariate decision-making process behind vaccination among the elderly. It integrates the Health Belief Model (HBM), Health Literacy Model (HLM), and multiple cues to action through a mixed methods design. Quantitative data were collected via structured questionnaires among residents in wellness villages and analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM) to identify direct and indirect determinants. Qualitative interviews were conducted with community healthcare providers, residents, government health officers, and pharmaceutical stakeholders to further explore influencing factors and contextual challenges. Findings reveal that seniors’ vaccination intentions are shaped by intertwined psychological and social factors. Three key HBM constructs—perceived benefits, perceived barriers, and self-efficacy—show significant direct impacts on vaccination intention. Policy-driven cues were identified as the most statistically significant, highlighting the pivotal role of institutional design, accessibility (e.g., free vaccination, site convenience), and public resource allocation. Health literacy demonstrated an indirect influence through HBM constructs. Additionally, cues such as media dissemination (e.g., LINE groups), peer influence, and local health policy formed important triggers for behavioral activation. This study proposes an integrative strategy model emphasizing the vaccination ecosystem, structured around five critical stakeholders—government, healthcare providers, community organizations, media, and vaccine suppliers—each contributing to system-level support through institutional governance, professional endorsement, community mobilization, media framing, and product delivery. The model also introduces a triple synergy framework, suggesting that synchronized engagement across policy reinforcement, media influence, and professional-community collaboration can amplify perceived benefits, reduce barriers, and enhance self-efficacy—resulting in a multiplicative effect on vaccination intention. The study concludes by advocating for trust-based communication platforms, community-driven health promotion, and digital support systems in elderly care, aiming to increase vaccine coverage among the oldest-old and enhance public health resilience in Taiwan's aging society.