Abstract
摘要：背景：懷孕婦女感染流感後容易產生併發症，造成對母親或是胎兒的不良後果，因此世界衛生組織與我國衛生福利部將孕婦列為應優先施打流感疫苗的對象，但台灣孕婦接種流感疫苗涵蓋率仍偏低。台灣是一個多元族群的國家，孕婦是否接種流感疫苗的態度隨著不同族群與其文化背景，可能有不同的考量；且伴侶對於孕產婦是否接種疫苗具有影響力。目的：本研究旨在(1)理解不同族群之孕婦與其伴侶對於接種流感疫苗的態度與考量；(2)建構懷孕婦女與其伴侶於孕產期實際接種流感疫苗之預測模式；(3)提出並試行提升孕婦與其伴侶接種意願之策略。方法：於台灣北、中、南、東四區域各選取一家婦產科門診進行收案。選樣條件：(1)妊娠滿12週之孕婦與其男性配偶，(2)孕婦與其配偶年齡均在20歲以上，(3)夫妻雙方均同意參與研究、同意訪談錄音與簽署同意書者；排除條件：(1)懷孕過程婦女曾發生相關重大疾病或(2)胎兒或新生兒具有先天異常。第一年採質性訪談與立意取樣40對孕產婦與其伴侶(孕婦之男性配偶)，理解多元族群的孕婦與其伴侶對於流感疫苗之看法，以內容分析法，找出各族群共同考量與特殊的考量。每一個區域預計訪談10對孕期夫婦，但將以資料飽和度為收案數結束的準則。第二年以連續取樣與世代研究進行大樣本調查，調查全台五大族群孕婦及其伴侶對於接種疫苗的態度調查，於產後時期追蹤實際施打情形，檢力分析與預估流失率須1320人，以結構方程模式(SEM)建構台灣孕婦與其伴侶實際接種流感疫苗行為之概念模式。第三年以隨機控制試驗，針對台灣多元族群孕婦與其伴侶接種流感疫苗的考量，製作推廣衛教資訊(懶人包)與簡短影片，以概念模式中無法改變的因素做為控制變數，以檢驗措施的效果。主要結果指標為：孕期流感疫苗接種意圖與實際接種行為，將以進行廣義線性模式(GEE)分析。依據檢力分析與流失率估計，估計實驗組與控制組各需招募60對。預期結果：此計畫將(1)理解不同族群之孕婦與其伴侶對於接種流感疫苗的態度與考量；(2)建構懷孕婦女與其伴侶於孕產期實際接種流感疫苗之預測模式；(3)提出並試行提升孕婦與其伴侶接種意願之策略。預期可有效提升孕婦與其伴侶接種流感疫苗之意圖與行為。
Abstract: Background: Pregnant women are susceptible to complications after influenza infection, causing adverse consequences to mothers and fetuses. World Health Organization and the Ministry of Health and Welfare of Taiwan have recommended pregnant women as the priority for influenza vaccines. However, the coverage rate of influenza vaccination among pregnant women remains low (< 30%) in Taiwan. As a multi-ethnic country, ethnicity and cultural background may affect pregnant women’s decision on receiving flu vaccination. Moreover, pregnant women’s partners may also influent pregnant women’s decision on receiving flu vaccination.Objective: This project aims to (1) understand the attitudes and considerations regarding influenza vaccination of pregnant couples among different ethnic groups; (2) construct a prediction model to predict influenza vaccination behaviors for pregnant couples; and (3) propose and examine the strategies that improve vaccination willingness and behaviors among pregnant couples among different ethnic groups.Methods: Antenatal clinics in North, Central, South, and East of Taiwan will be selected for recruiting participant. Inclusion criteria include (1) pregnant women who are 12 weeks of pregnancy and their male spouses, (2) pregnant women and their spouses are both over 20 years old, and (3) both couples agree to participate in research, agree to interview recordings and sign consent forms. Exclusion criteria included: (1) pregnant women with severe illness or (2) women with the fetus with congenital abnormality. In the first year, we will adopt qualitative interviews and purposive sampling for 40 pairs of pregnant women and their male spouses. Content analysis will induct the common and specific considerations of each ethnic group. Each region is expected to interview 10 pregnant couples. In the second year, a survey will be conducted using consecutive sampling and cohort study. The survey will collect the attitudes and consideration of pregnant women and their partners to the vaccination in five major ethnic groups in Taiwan. Their actual vaccination behavior will be collected in postpartum period. Considering power and estimated attrition rate, we need to recruit 1320 participants during antenatal period. Structural equation models (SEM) will be used to examine the prediction model of vaccination behaviors of Taiwanese pregnant couples among different ethnic groups. In the third year, a randomized controlled trial will be conducted among multi-ethnic pregnant couples’ vaccination in Taiwan. Short version of health education materials will be produced based on the findings in the second year. Main outcome indicators, influenza vaccination intention and behavior during pregnancy will be analyzed by generalized estimating equations (GEE). Based on the power analysis and estimated attrition rate, we will recruit 60 pairs of pregnant couples both in the experimental group and the control group.Expected results: This project is expected to (1) understand the attitudes and considerations regarding influenza vaccination of pregnant couples among different ethnics; (2) construct a prediction model for pregnant couples to predict the actual influenza vaccination behavior; (3) propose effective strategies (i.e., short form health education material) to improve vaccination willingness and behaviors among pregnant couples.
Keyword(s)
流感疫苗
接種
懷孕
伴侶
族群
健康信念模式
influenza vaccine
vaccination
pregnancy
partner
ethnics
Health Belief Model
