| 摘要: | 論文名稱：海外服務人員對於旅遊相關之疾病知識態度及行為研究
研究所名稱：臺北醫學大學醫務管理學研究所
研究生姓名：侯君穎
畢業時間：一百零二年學年度第二學期
指導教授：楊哲銘臺北醫學大學醫務管理學研究所教授暨所長
近年來由於生活條件的改善及全球化，使得越來越多的國人有出國旅遊的機會。台灣近年經濟發展快速，與臨近的國家交通頻繁，雖然在本國多年來沒有嚴重的傳染病發生，但許多疾病是由鄰近國家來台的旅客、由本國人或外國旅客帶入的。旅遊醫學門診與相關教育訓練可加強民眾對於這些法定傳染病的了解與提供適當的預防措施與衛教。目前台灣罕有針對出國民眾進行其知識、態度及行為的問卷調查，因此，了解旅外民眾對旅遊醫學的知識態度行為模式，並評估經由適當的衛教是否可以增進其對旅遊醫學門診的接受程度，對相關防疫政策的推行而言有著重要的意義。
本研究乃針對台灣至邦交國進行長期海外服務(最短滯留時間長於六個月)的替代役男進行問卷調查，以獲得其對旅遊醫學的基本概念、取得旅遊健康資訊的管道及旅遊相關傳染性疾病 (流行性腦脊髓膜炎、瘧疾、黃熱病、狂犬病、A 型肝炎)的知識、態度及行為之認知情形。
本研究採用的研究方法主要是採用橫斷式問卷調查，根據文獻回顧設計問卷，內容包括基本資料，對於數種熱帶傳染性疾病的預防知識，以及海外志工對旅遊醫學的知識、態度、行為。利用教育訓練課程發放問卷，以自填問卷方式進行試驗，得到所需資訊，以統計軟體進行統計分析。
本研究主要是採用前後測問卷調查研究方法，在前後測之間給予衛教課程介入。於2011年06月01日至2011年12月31日間，針對國際合作發展基金會(International Cooperation and Development Fund; ICDF)海外服務人員行前訓練課程學員發放103份問卷，回收103分問卷，扣除掉填答不完整或無法配對之問卷，總計回收92分成對問卷，有效問卷回收率為89.3%。統計方法包含描述性統計及成對樣本T檢定。主要研究結果如下：
1.疾病知識方面，「流行性腦脊髓炎知識」 (t＝-7.97，p < .00)、「瘧疾知識」(t＝-3.74，p < .00)、「黃熱病知識」(t＝-7.05，p < .00)、「狂犬病知識」(t＝-12.95，p < .00)、「A肝知識」(t＝-6.73，p < .00)之T值達顯著，且各變數之「前測」平均數小於「後測」平均數，這樣的結果顯示，衛教課程的實施，有助於提升國際志願服務者在「流行性腦脊髓炎知識」、「瘧疾知識」、「黃熱病知識」、「狂犬病知識」、「A肝知識」等方面的知識。然而，「曬傷及中暑知識」(t＝-3.205，p＞.10) 之T值未達顯著，表示衛教課程實施前後，國際志願服務者在「曬傷及中暑知識」方面並無顯著改變。
2.「旅遊醫學門診內容」之T值(t＝-3.25，p < .00)達顯著，且該變數之「前測」平均數小於「後測」平均數，這樣的結果顯示，衛教課程的實施，有助於提升國際志願服務者對於「旅遊醫學門診內容」之瞭解。
3.「接受旅遊醫學門診意願」之T值(t＝-3.65，p < .00)達顯著，且該變數之「前測」平均數小於「後測」平均數，這樣的結果顯示，衛教課程的實施，有助於提升國際志願服務者「接受旅遊醫學門診意願」之程度。
根據以上結果，本研究提出以下幾點建議：
1. 本研究的結果顯示給予旅遊相關健康疾病知識的衛教，對於知識層面的進步是有效果的。疾病的認識程度越深，對於採取預防措施的意願也越高。同時，瞭解旅遊醫學門診的程度與主動就診諮詢的意願也上升。 所以臨床工作者，特別是第一線的基層醫師應多給予民眾相關衛教，以提升民眾對於旅遊醫學的知識與採取預防措施的意願。
2. 本研究的對象皆為年輕的海外服務人員，是否可以代表民眾全體的結果也未能下定論。未來研究可擴大收集資料的對象，擴及不同年齡、旅遊目的、旅遊型態的民眾。以作為未來政策的制訂與推行方式、臨床實際作業與服務提供內容的參考指標。
3. 研究的結果可以得知，知識的增加同時改變了行為意願與態度。因此中央主管機關應增加主動性的衛教，預期將可增加民眾旅行前尋求專業醫療的諮詢與接受行前預防性醫療措施的意願。
關鍵字：旅遊醫學，衛教，認知，態度
In the recent years, with the improvement of economic conditions and the influence of globalization, people have more chances to travel abroad. Taiwan's rapid economic development and the tight connection with neighboring Asia countries also increase the risk of transmission of infectious disease due to the increasing international travelers. Travel medicine clinic can increase the public understanding of these infectious diseases, and provide preventive measures and health education for these travelers. Currently, only few studies have been conducted to evaluate the knowledge, attitudes and behavior of international travelers in Taiwan. Therefore, to evaluate the knowledge, attitude and behavior (KAB) to travel medicine, and to assess the efficacy of travel medicine education, are important for the implementation of epidemic prevention policy in Taiwan.
The current study was conducted to evaluate the KAB of overseas alternative service men (minimum residence time is longer than six months) on travel medicine, including their basic concepts of travel medicine, the source of health information, and the knowledge on various infectious diseases including epidemic cerebrospinal meningitis, malaria, yellow fever, rabies, and A-type hepatitis. A cross-sectional survey by questionnaire was adopted in this study. The questionnaire assesses basic information, the knowledge for the prevention of various tropical infectious diseases, and the KAB to travel medicine of the personnel. The self-administered questionnaire survey was applied to the overseas alternative service men during their pre-mission training. The collected information was then analyzed statistically by statistical software.
This study adopted pretest and posttest survey to evaluate the efficacy of travel medicine education by comparing the score of subjects before and after the intervention. From June 1, 2011 to December 31, 2011, 103 questionnaires were distributed and retrieved during the pre-mission training course of oversea alternative service men held by International Cooperation and Development Fund (ICDF). Ninety-two valid questionnaires were retrieved, and the effective response rate was 89.3%. Descriptive statistics and paired samples T-test were applied for the analysis of the obtained data. The main results are as follows:
1. Disease knowledge: the T value of various groups including “epidemic encephalomyelitis” (t = -7.97, p <.00), “Malaria” (t = -3.74, p <.00), “Yellow Fever” (t = -7.05, p <.00), “Rabies” (t = -12.95, p <.00), “Hepatitis A” (t = -6.73, p <.00) were shown to be significant. For each variable, the "pre-test" average score was less than the "post-test" average score as well. The result indicated that the implementation of travel medicine education programs significantly improve the knowledge on "epidemic encephalomyelitis", "malaria", "Yellow fever"," rabies", and "Hepatitis A" for the personnel. However, the T value "sunburn and heatstroke” (t = -3.205, p> .10) was not significant, which indicated that the average knowledge level on this category was not changed after the implementation of the education programs.
2. The T value of “travel medicine clinic” (t = -3.25, p <.00) was significant, and the "pre-test" average score was less than the "post-test" average score. The result indicated that travel medicine education helps to improve the understanding for travel medicine clinic.
3. The T value of “willingness to visit travel medicine clinic” (t = -3.65, p <.00) was significant, and the "pre-test" average score was less than the "post-test" average score. The result indicated that travel medicine education helps to improve the willingness of the responders to visit travel medicine clinic.
Based on the findings, the current study suggested:
1. Travel medicine education helps to improve the travel-related health knowledge, which increases the awareness of the travel-related infectious disease and the willingness to visit travel medicine clinic. Therefore, primary care physicians could enhance public knowledge on travel medicine and their willingness to take preventive measures by giving travel-related health education.
2. The objects of this study are limited to young overseas alternative service men. Further studies might be applied to include subjects on various ages, travel destinations or purposes. A more comprehensive result may contribute to future policy formulation and implementation in the future.
3. The results of the study indicated that the increasing of the knowledge affects the attitude and the behavior of the subjects. The travel-related health education initiative by the authorities may increase the willingness of the public to seek for professional medical advice and receive preventive interventions prior to travel.
Keywords: travel medicine, health education, knowledge, attitude |
