陸玓玲Luh, Dih-Ling陳雅琪CHEN, YA-CHIYA-CHICHEN公共衛生學系碩士班2026-03-172024-07-3120242024-07-16https://handle.ncl.edu.tw/11296/8a9sy7https://scholars.csmu.edu.tw/handle/123456789/5733研究背景:COVID-19疫情自出現後便以極快的速度擴散至世界各地，各國的盛行率、死亡率居高不下，在大流行初期藥物及疫苗尚未推出，故各國政府以各種政策及規定強制人們採取預防行為以阻斷傳染途徑，這對於人們的生活產生極大影響。隨著疫苗及藥物的出現，全球的疫情逐漸獲得控制，各國也開始放寬防疫政策，在世界衛生組織解除全球流行警戒後，民眾的自覺COVID-19威脅、心理健康與預防行為也發生了改變。在台灣COVID-19仍持續傳播的情況下，政府調降防疫階級可能對於自覺COVID-19威脅、心理健康與預防行為產生影響，因此本研究旨在探討疾病降級、自覺COVID-19威脅、心理健康與預防行為之間的關係。 研究目的:(1).探討疾病降級對自覺COVID-19威脅、心理健康與預防行為的調節作用；(2).探討疾病降級對預防行為的直接與間接效果；(3).探討疾病降級、自覺COVID-19威脅與預防行為的關係是否受到性別調節。材料方法:本研究係針對某一大學生世代進行兩次橫斷式研究（cross-sectional study），第一次橫斷研究調查期間於西元2023年3月20日至5月5日(n=1052)，第二次橫斷究調查期間為西元2023年10月16日至12月1日(n=1052)。透過線上問卷方式詢問大學生自覺COVID-19威脅、心理健康與預防行為。研究使用SAS9.4軟體與process v4.3分析自覺COVID-19威脅、心理健康、預防行為間的關係，並進一步探討疾病降級與性別對其的影響。 結果:(1).疾病降級調節了自覺易感性與嚴重度和戴口罩行為之間的關係(p=0.0011、p=0.0326)，在疾病降級後，自覺易感性與嚴重度高的大學生，戴口罩頻率較高；(2).疾病降級直接負向影響戴口罩與洗手行為頻率(p<.0001、p=0.0011)，透過自覺嚴重度負向影響戴口罩與洗手行為頻率(效果=-0.11；95%信賴區間[-0.20，-0.03]、效果=-0.09；95%信賴區間[-0.17，-0.03])，也透過心理健康負向影響洗手行為頻率(效果=-0.05；95%信賴區間[-0.10，-0.01])；(3).性別調節了自覺COVID-19嚴重度與戴口罩和洗手行為間的關係(p=0.0361、p=0.0110)，男性受到自覺COVID-19嚴重度的影響較大。 結論：本研究發現疾病降級調節了自覺COVID-19威脅和戴口罩行為之間的關係。疾病降級會直接負向影響預防行為頻率，在中介效應上會透過自覺COVID-19嚴重度間接負向影響預防行為的頻率，也會透過心理健康間接負向影響和洗手行為的頻率。性別調節自覺COVID-19嚴重度與預防行為間的關係。研究限制及重要建議：研究限制:本研究研究對象資料來自於大學生的自我報告，其中包含回憶性質的問題因此可能存在回憶偏差或社會期許偏差。此外，本研究對象為中山醫學大學的學生，因此可能無法將結果外推至台灣地區之大學生的情況。由於本研究為橫斷面調查，因此可能無法推斷變項間的因果關係重要建議:建議可擴大研究範圍至台灣其他縣市之大學生，或使用不同研究方法了解不同時間點對於自覺COVID-19威脅、心理健康與預防行為的影響。Background:Since its emergence, the COVID-19 pandemic has rapidly spread worldwide, leading to high prevalence and mortality rates in many countries. In the early stages of the pandemic, before the introduction of drugs and vaccines, governments implemented various policies and regulations to compel people to adopt preventive behaviors to block transmission routes, significantly impacting daily life. With the advent of vaccines and treatments, the global situation gradually came under control, and countries began to relax preventive policies. After the World Health Organization lifted the global emergency alert, changes were observed in people's perceived COVID-19 threat, mental health, and preventive behaviors. In Taiwan, where COVID-19 continues to spread, the government's de-escalation of the alert level may affect perceived COVID-19 threat, mental health, and preventive behaviors. Therefore, this study aims to explore the relationships among disease de-escalation, perceived COVID-19 threat, mental health, and preventive behaviors.Objectives:(1). To examine the moderating effect of disease de-escalation on perceived COVID-19 threat, mental health, and preventive behaviors.(2). To investigate the direct and indirect effects of disease de-escalation on preventive behaviors.(3). To determine whether the relationships between disease de-escalation, perceived COVID-19 threat, and preventive behaviors are moderated by gender.Methods:This study conducted two cross-sectional surveys on a cohort of university students. The first survey period was from March 20 to May 5, 2023 (n=1052), and the second survey period was from October 16 to December 1, 2023 (n=1052). Online questionnaires were used to assess students' perceived COVID-19 threat, mental health, and preventive behaviors. The data were analyzed using SAS 9.4 software and PROCESS v4.3 to explore the relationships among perceived COVID-19 threat, mental health, and preventive behaviors, and to further examine the effects of disease de-escalation and gender on these relationships.Results:(1). Disease de-escalation moderated the relationship between perceived susceptibility and severity and mask-wearing behavior (p=0.0011, p=0.0326). After the disease de-escalation, students with higher perceived susceptibility and severity wore masks more frequently.(2). Disease de-escalation directly negatively affected the frequency of mask-wearing and hand-washing behaviors (p<.0001, p=0.0011). It also negatively affected the frequency of mask-wearing and hand-washing behaviors through perceived severity (effect=-0.11; 95% CI [-0.20, -0.03], effect=-0.09; 95% CI [-0.17, -0.03]), and through mental health, it negatively affected the frequency of hand-washing behavior (effect=-0.05; 95% CI [-0.10, -0.01]).(3). Gender moderated the relationship between perceived COVID-19 severity and mask-wearing and hand-washing behaviors (p=0.0361, p=0.0110), with males being more affected by perceived COVID-19 severity.Conclusions:This study found that disease de-escalation moderated the relationship between perceived COVID-19 threat and mask-wearing behavior. Disease de-escalation directly negatively affected the frequency of preventive behaviors and indirectly negatively affected the frequency of preventive behaviors through perceived COVID-19 severity. It also indirectly negatively affected the frequency of hand-washing behavior through mental health. Gender moderated the relationship between perceived COVID-19 severity and preventive behaviors.Limitation & Suggestions:Limitation: The study relied on self-reported data from university students, which may include recall bias or social desirability bias. Additionally, the study subjects were students from Chung Shan Medical University, so the results may not be generalizable to all university students in Taiwan. As this study is cross-sectional, it may not infer causal relationships between variables.Suggestions: It is recommended to expand the research scope to include university students from other counties in Taiwan, or to use different research methods to understand the effects of perceived COVID-19 threat, mental health, and preventive behaviors at different time points.後疫情時代大學生疾病降級自覺COVID-19威脅心理健康預防行為Post-Pandemic Erauniversity studentsdisease de-escalationperceived COVID-19 threatmental healthpreventive behaviorsthesis