張媚臺灣大學:護理學研究所袁美珍Yuan, Mei-JenMei-JenYuan2010-05-052018-07-072010-05-052018-07-072008U0001-0108200815591700http://ntur.lib.ntu.edu.tw//handle/246246/180337摘要研究主要目的為運用Ajzen（1985）的計劃行為理論（the Theory of Planned Behavior）來預測並解釋男性靜脈注射藥癮者共用針頭之行為意圖，並於一個月後追蹤自我報告的共用針頭實際行為。研究對象為臺北市某美沙冬門診接受美沙冬維持療法之男性靜脈注射藥癮個案。研究工具擬定為先進行15位對象之開放式訪談，由訪談內容找出共用針頭之顯著信念，再據以建構結構式正式問卷。由研究者採一對一訪談方式收集問卷資料，共收集146份問卷。研究結果如下：、研究對象認為自己於問卷施測後一個月內，很有可能或有可能共用針頭者為22.6％，很不可能或不可能共用針頭者為77.4％。、研究對象之態度、主觀規範、自覺行為控制三個變項皆與共用針頭行為意圖有顯著相關。態度、主觀規範、自覺行為控制三個變項可解釋研究對象共用針頭意圖75.3％的變異量，自覺行為控制為最主要的預測變項。、最近10次用藥行為的共用針頭現況，能在計劃行為模式內變項（態度、主觀規範、自覺行為控制）之外，顯著增加3％的共用針頭行為意圖的解釋變異量。、研究對象共用針頭的態度、主觀規範、自覺行為控制與其構成信念間皆呈顯著正相關，與計劃行為理論相符。、 以共用針頭行為意圖之平均值為切點，將研究對象分為高/低意圖組，兩組在行為信念與結果評價上有顯著差異，高意圖組認為共用針頭能「快速打到藥、馬上解癮」與「表達信任對方」的可能性顯著較低意圖組高，且高意圖組對該行為之結果評價比低意圖組好。、高/低意圖組在規範信念與依從動機上有顯著差異，雖然兩組均自覺重要參考對象認為研究對象不應該與他人共用針頭，低意圖組感受到「家人」、「藥頭」、「配偶/男女朋友」對其共用針頭的不贊同程度比高意圖組強烈，而低意圖組對於依從「家人」與「藥頭」的願意程度比高意圖組高。、高/低意圖組在控制信念與自覺力量上有顯著差異，高意圖組顯著比低意圖組更常發生「要打藥時，附近沒有藥局可以買到針」、「要打藥時，藥局已經關了，買不到針」、「要打藥時，身上沒有錢可以買針」、「拿到藥時，已經很啼了，等不及去買針」、「要打藥時，發現自己準備的針已經壞了」、「別人把針筒裡還沒打完的藥給您打」、「要打藥時，懶得去買針」與「要打藥時，因為怕被警察抓，不敢去買針」等八項促進共用針頭的狀況，且認為在該狀況下發生共用針頭的容易程度也比低意圖組高；低意圖組顯著比高意圖組更常發生「要打藥時，身上有自己專用或全新的針」，低意圖組在該狀況下發生共用針頭的困難程度較高意圖組高。、研究對象共用針頭的行為意圖與一個月後實際共用行為之間存在有顯著正相關，r值為0.874，可見共用針頭行為意圖對實際行為有相當高的預測力。結論：計劃行為理論能預測男性藥物成癮者共用針頭行為意圖，自覺行為控制為最主要的預測變項，而共用針頭現況可於模式內變項以外增加對意圖的解釋力。77.4％的研究對象認為自己在未來一個月不可能共用針頭，且共用針頭意圖與實際共用行為有顯著正相關，具相當高的預測力。建議：（1）持續推廣減害計畫；（2）強化個案管理護理品質；（3）善用藥癮者緊密的社會網絡。Abstracthis study is based on Ajzen’s（1985） the Theory of Planned Behavior and the purpose of this study is to predict and perceive the intention and behavior of needle sharing among male drug addicts. One month later we followed up the actual needle sharing behavior by using subject self-reports. The research subjects were selected from a Methadone clinic in Taipei who were male and receiving Methadone supportive treatments aggressively. Fifteen of research population were interviewed by open-ended questions and the salient beliefs were elicited. A formal structured questionnaire was then constructed according to the salient beliefs. A total of 146 respondents were interviewed face-to-face with their consent. The results shown are as follows：. 22.6％ study subjects thought that they would highly likely or likely to have needle sharing behavior within a month after the interview; and 77.4％ of them responded “highly unlikely” or “unlikely.”. The intention of needle-sharing had a significant correlated with study subjects’ attitude, subjective norm and perceived behavior control. They also explained the 75.3% of variation. However, the perceived behavior control was the main affecting variation in needle-sharing intention.. In addition to the internal variables of the Theory of Planned Behavior (attitude, subjective norm, and perceived behavior control), the frequency of needle sharing in last 10 times of drug injection can increase another 3% of the explanations of the variance of needle-sharing intention.. The attitude of respondents toward sharing needle intention was positively related to the sum of the product of behavioral beliefs multiplied by outcome evaluations （Σbi*ei). The subjective norm of respondents toward sharing needle intention was positively related to the sum of the product of normative beliefs multiplied by motivations to comply (Σnb*mc). The perceived behavioral control of respondents toward sharing needle intention was also positively related to the sum of the product of control beliefs multiplied by perceived power (Σcb*pp). These results were also consistent with the theory of planned behavior.. The respondents were divided into high/low intention groups by the mean score of needle-sharing intention. There were noteworthy differences in behavior beliefs and outcome evaluations between two groups. For instance, the high intention group is more likely to believe that “by sharing needles can inject drugs faster and relieve the onset of drug addiction immediately” and “they can trust other users” than the low intention group. Moreover, the high intention group had better outcome evaluations of those items.. There were significant differences in normative beliefs and motivations to comply between these two groups. Although both groups believed that most of their significant others thought they should not share needle with others, the low intention group perceived stronger disagreement of sharing needle behavior from family members, drug dealers and spouse/partner than high intention group. Besides, the low intention group were more willing to comply with family and family members, drug dealers, in terms of not sharing needle.. There were significant differences in control beliefs and perceived powers in between these two groups. The high intention group was more likely to have the following 8 situations happened: “ when needing an injection, there is no drugstore nearby to buy needles”, “when needing an injection, the drugstore is closed already, so I can’t buy a needle”, “when needing an injection, I do not have money to buy a needle”, “ when I get the drugs, craving for the drugs has become too strong so that I can''t wait to buy a needle”, “when I am going to inject myself, I find my needle is not working”, “others give me the drugs which was not finished injecting yet in the syringes”, “I am too lazy to buy a needle”, or “ I am afraid of being caught by the police so that I do not dare to buy a needle”. And under above circumstances, the high intention group also believed that they are very easy to share needles with others. On the other hand, the low needle-sharing intention group would have higher frequency of “while injecting drugs , I have my own needle or a brand-new needle with me”, and they believe when they have their own needles, it is more difficult to share needles with others. . The needle sharing behavior intention of respondents was positively related to the actual behavior for the following month (r＝0.874), that again proved that the needle-sharing actual behavior was highly prediction by needle-sharing behavior intention of respondents.onclusions: The Theory of Planned Behavior provided good prediction of needle-sharing behavior intention, and the perceived behavioral control was the main affecting variance. The frequency of needle sharing in last 10 times of drug injection significantly enhanced the explanations for the variance of needle-sharing intention in addition to the main variances of the theory model. 77.4％ of respondents showed that they would not share needles with other users next month. The needle-sharing behavior intention was positively related to the needle-sharing actual behavior, and from the behavior intention, the needle-sharing actual behavior was able to be predicted highly successfully.ecommendations:（1）Continuing to promote harm reduction program,（2）Strengthening case management and nursing quality,（3）Utilizing the unique and powerful drug addicts social net.目 錄試委員會審定書……………………………………………………………… i謝………………………………………………………………………………. ii文摘要………………………………………………………………………… iii文摘要…………………………………………………………………………. v一章 緒論 …..……………………………………………………………..….. 1一節 研究動機…..…..………………..…………………………………… 1二節 研究目的…..……..………..………………………………………… 5二章 文獻探討…..……………………………………………………..……… 6一節 藥物濫用與海洛因成癮………………….……...………………….. 6二節 共用針頭與愛滋病的相關性…………………..……………………. 12三節 共用針頭之相關變項及可能影響因素……………………..………. 17四節 理性行動理論、計劃行為理論與相關研究應用……………………. 20三章 研究方法…..……………………………………………………………... 27一節 研究架構……………………………………………………………... 27第二節 名詞界定……………………………………………………………... 28第三節 研究假設……………………………………………………..………. 29第四節 研究場所……………………………………..………………………. 30第五節 研究對象…………………………………………………………..…. 30第六節 研究工具…………………………………………………………..…. 31第七節 研究步驟…………………………………………………………..…. 42第八節 資料處理…………………………………………………..…………. 44第九節 倫理考量……………………………………………………..………. 50四章 研究結果…………………...…………………………………………….. 51第一節 研究對象背景描述………………………………………………...… 51第二節 共用針頭行為意圖及其影響因素……………….………………….. 57第三節 態度、主觀規範、自覺行為控制與其構成信念間之關係…………... 71第四節 不同程度之共用針頭行為意圖在各信念之差異比較…………...… 81第五節 共用針頭行為與實際共用針頭行為的關係…….………………….. 88第六節 其他發現……………………………………………...……………… 89五章 討論………………………………………………………………………. 92一節 研究對象背景描述………...………………………………………… 92第二節 共用針頭行為意圖及其影響因素………….……………………….. 96第三節 態度、主觀規範、自覺行為控制與其構成信念間之關係……...….. 100第四節 不同程度之共用針頭行為意圖在各信念之差異比較……………. 106第五節 共用針頭行為與實際共用針頭行為的關係………………………. 111六章 結論與建議……………………...……………………………………… 113第一節 結論………………..………...……………………………………… 113第二節 建議………………..………...……………………………………… 114第三節 研究限制…………..………...……………………………………… 116考文獻…..………………………………………………………………………. 117錄一 開放式訪談分析..…………………………..……………………………. 127錄二 正式問卷………………………………………….……………………… 131錄三 人體試驗委員會同意函…………………………………………………. 142目錄2-1 計劃行為理論架構…………………………………………………………. 253-1 本研究之架構………………………………………………………………. 274-1 迴歸標準化殘差的直方圖（模式內三大變項）…………………………. 594-2 標準化殘差之常態機率分佈圖（模式內三大變項）……………………. 604-3 迴歸標準化殘差的直方圖（各子信念交乘積和）………………………. 624-4 標準化殘差之常態機率分佈圖（各子信念交乘積和）…………………. 624-5 迴歸標準化殘差的直方圖（模式內變項與外在變項）…………………. 684-6 標準化殘差之常態機率分佈圖（模式內變項與外在變項）…………….. 695-1 模式內變項統計資料………………………………………………..……. 112目錄3-1 受訪者之背景資料……….………………………………………………… 333-2 共用針頭之行為信念………………….…………………………………… 343-3 重要參考對象………………………………………………………………. 343-4 共用針頭之控制信念…………………...………………………………….. 343-5 問卷各分量表內部一致性信度分析………………………………………. 383-6 變項譯碼計分方式與代表意義（計劃行為理論模式內變項）……….…… 443-7 變項譯碼計分方式與代表意義（計劃行為理論模式外變項）…………..... 463-8 變項譯碼計分方式與代表意義（一個月之行為變項）……………………. 493-9 考驗各研究假設的統計方法………………...…………………………….. 504-1 社會人口學變項分佈情形….……………………………………..……….. 524-2 研究對象注射海洛因、共用針頭與美沙冬使用分佈情形..………………. 554-3 共用針頭行為意圖之描述性統計…………………………………………. 584-4 共用針頭行為意圖、態度、主觀規範與自覺行為控制之相關矩陣…….… 594-5 共用針頭行為意圖、態度、主觀規範與自覺行為控制之複迴歸……...….. 604-6 共用針頭行為意圖與各子信念交乘積和之相關矩陣…………………..... 614-7 共用針頭行為意圖與各子信念交乘積和之複迴歸（強迫進入法）………. 634-8 共用針頭行為意圖與外在變項的關係（皮爾森積差相關）………………. 644-9 共用針頭行為意圖與外在變項的關係（Independent-Samples T檢定）…... 654-10 共用針頭行為意圖與外在變項的關係（單因子變異數分析）………....... 664-11 共用針頭行為意圖與模式內變項、外在變項、共用針頭現況之複迴歸（強迫進入法）…………………………………………………………..…….. 704-12 共用針頭態度之描述性統計分析…...……………………………………. 724-13 共用針頭行為信念之描述性統計分析…...………………………………. 734-14 共用針頭結果評價之描述性統計分析…...………………………………. 734-15 共用針頭態度與行為信念、結果評價交乘積和之相關矩陣…...…..……. 744-16 共用針頭主觀規範之描述性統計分析…………………………………… 754-17 共用針頭規範信念之描述性統計分析…………………………………… 764-18 共用針頭依從動機之描述性統計分析…………………………………… 764-19 共用針頭主觀規範與規範信念、依從動機交乘積和之相關矩陣……….. 774-20 共用針頭自覺行為控制之描述性統計分析…...…………………………. 784-21 共用針頭控制信念之描述性統計分析…...………………………………. 794-22 共用針頭自覺力量之描述性統計分析…...………………………………. 804-23 共用針頭自覺行為控制與控制信念、自覺力量交乘積和之相關矩陣..… 814-24 高/低共用針頭行為意圖各信念之Wilks’ λ統計分析與同時信賴區間分析……………………………………………………….…………………. 834-25 高/低共用針頭行為意圖在行為信念之Wilks’ λ統計分析與同時信賴區間分析…………………………………………………….…………………. 844-26 高/低共用針頭行為意圖組在結果評價之Wilks’ λ統計分析與同時信賴區間分析………………………………………………….…………………. 844-27 高/低共用針頭行為意圖在規範信念之Wilks’ λ統計分析與同時信賴區間分析…………………………………………………….…………………. 854-28 高/低共用針頭行為意圖在依從動機之Wilks’ λ統計分析與同時信賴區間分析…………………………………………………….…………………. 864-29 高/低共用針頭行為意圖在控制信念之Wilks’ λ統計分析與同時信賴區間分析…………………………………………………….…………………. 874-30 高/低共用針頭行為意圖在自覺力量之Wilks’ λ統計分析與同時信賴區間分析…………………………………………………….…………………. 884-31 年齡與共用針頭現況之卡方檢定………………………...………………. 894-32 學歷與共用針頭現況之卡方檢定………………………...………………. 904-33 健康狀況與共用針頭現況之卡方檢定…………………...………………. 904-34 是否與他人聚集注射毒品與共用針頭現況之卡方檢定………………… 91application/pdf993415 bytesapplication/pdfen-US計劃行為理論男性藥物成癮者共用針頭意圖美沙冬門診海洛因毒癮藥癮注射藥癮者Theory of Planned BehaviorMale drug addictsNeedle-sharing behavior intentionMethadone clinicHeroinSubstance abuseDrug addictionInjection drug users[SDGs]SDG3http://ntur.lib.ntu.edu.tw/bitstream/246246/180337/1/ntu-97-R93426023-1.pdf