彰化縣民眾大腸癌篩檢行為與大腸癌篩檢相關知識、態度之關聯性：個案對照研究

目的：探討彰化地區民眾大腸癌篩檢相關知識、態度與大腸癌篩檢行為之關係，並運用多層次分析方法，了解衛生所社區經營程度與民眾大腸癌篩檢行為之關聯。材料與方法：本研究為橫斷式研究，採個案對照研究法，研究對象為50-74歲之民眾，資料收集時間從2015年9月至2016年1月，共完訪814人，完訪率為40.70%。依變項為大腸癌篩檢行為，分為四組：規律篩檢組(曾經做過篩檢，並在2015年已做檢查)、不規律篩檢組(曾經做過篩檢，但在2015年未做檢查)、首次篩檢組(從未做過篩檢，但在2015年已做檢查)、從未篩檢組(從未做過篩檢，在2015年未做檢查)，其中規律篩檢組為對照組。自變項包括大腸癌篩檢相關知識(大腸癌篩檢知識、大腸癌政策知識)、態度(大腸癌篩檢態度、疾病預防整體態度)及地區層次衛生所社區經營程度。本研究以SAS9.4版統計軟體進行雙變項分析、多變項分析，且利用HLM6.0版統計軟體進行多層次分析，本研究統計水準為0.05。研究結果：調整重要變項後，從未篩檢組之大腸癌篩檢知識分數、大腸癌政策知識分數、疾病預防整體態度分數部分皆較規律篩檢組低；而首次篩檢組在疾病預防整體態度分數較規律篩檢組低；不規律篩檢組在大腸癌篩檢知識分數較規律篩檢組低，至於地區層次變項皆與大腸癌篩檢行為無關。結論及建議：大腸癌篩檢相關知識越好、疾病預防整體態度越正向規律篩檢的可能性越高，建議未來增加大腸癌篩檢衛生教育之機會，進而提升大腸癌規律篩檢的情況。

Objectives:The purpose of this paper is to describe the relationship between screening behavior and knowledges, attitudes, and awareness of CRCS. Using multilevel analysis to specify the relationship between the screening behavior and the management status of local public health center.Methods:We conducted a cross-sectional household questionnaire survey based on community-based case-control study design. Data of 814 participants was collected from September, 2015 to January, 2016. FOBT screening behaviors(Dependent variable) in 2015 were divided into four groups, namely (1) ever-screenees and completing FOBT in 2015 (regular screenees, as control group), (2) ever-screenees but not completing FOBT in 2015 (irregular screenees), (3) never-screenees and completing FOBT (first screenees), (4) never-screenees and not completing FOBT (never screenees).Independent variables such as knowledge of CRCS, attitudes of CRCS, and area variables (management status of local public health center, etc.) Using multi-nominal logistic regression model and multilevel analysis model for multivariable analysis.Results:The major finding as follow: the general disease preventing attitudes of first, and never screenees were lower than regular screenees; the knowledge of CRCS of irregular and never screeneeswere lower than regular screenees;the awareness about CRCS policy of the never screenees was lower than regular screenees. However, the attitudes of CRCS and area variables were unrelated to FOBT screening behaviors. Conclusion:People with better knowledge of CRCS or more positive in general disease preventing attitudes are more likely to be regular screenees. Increasing opportunity of health education in CRCS may provoke the rate of regular CRCS behavior.Keyword: colorectal cancer screening; knowledge; attitude; public health center; multilevel analysis