背景：糖尿病視網膜病變是糖尿病人引起視力障礙甚至失明的主要原因之一，透過定期眼底檢查可早期發現及早期治療而減少視力的喪失，但是國內糖尿病人接受定期眼底檢查的比率偏低，因此必須進一步了解其原因。
目的：評估國內糖尿病人接受眼底檢查的順從性、探討影響眼底檢查的相關因素、及確認接受眼底檢查的預測因素。
資料來源及研究樣本：資料來源為「2009年國民健康訪問調查」面訪問卷，針對1040位年紀大於12歲以上的糖尿病人進行研究分析。
方法：本研究為橫斷性族群研究。以Andersen醫療服務利用行為模式為研究架構，將所有研究變項分成三大類因素：傾向因素、能力因素及需要因素。利用卡方檢定、獨立樣本t檢定及邏輯斯迴歸進行資料分析並調查研究變項與糖尿病人接受眼底檢查之間的關係。
結果：國內糖尿病人過去曾接受過眼底檢查的比例為45.2%。經邏輯斯迴歸分析，有自我驗血糖、有因糖尿病注意足保養、有參加糖尿病病友會、不是居住於鄉村、有視力問題或眼睛疾病、糖尿病罹病年數長、及使用胰島素控制血糖的糖尿病人較明顯可能會接受眼底檢查。而客家族群及住院次數較多的病人較明顯可能不會接受眼底檢查。
結論：國內糖尿病人曾經接受過眼底檢查的比例偏低。推動糖尿病人接受眼底檢查首先需重視的是教育糖尿病人有關糖尿病視網膜病變及眼底檢查的知識。對於無眼睛症狀、早期糖尿病、病情不嚴重及經常住院的糖尿病人更需積極轉介至眼科門診完成眼底檢查。最後也需設法解決國內偏鄉地區眼科資源不足的問題。

Background: Diabetic retinopathy is one of major causes of visual disturbance and blindness in the patients with diabetes. Early treatment for retinopathy could be achieved by early detection through eye examinations and reduce the patient’s visual loss. However, the rate of eye examinations was low in the patients with diabetes in Taiwan. It’s needed to further study about the reasons for poor compliance of eye examinations in the patients with diabetes.
Objectives: To estimate compliance of eye examinations in the patients with diabetes, to examine factors that affect compliance, and to determine reasons for compliance and non-compliance.
Data source and Sample size: Data were obtained from the 2009 Nation Health Interview Survey (NHIS) in Taiwan. A total of 1040 patients with diabetes 12 years of age or older were enrolled in this study.
Methods: A cross-sectional population study. The Andersen model was used as the analytic framework, and all variables were categorized into three factors: predisposing, need, and enabling factors. The chi-square test, independent-sample t test, and logistic regression were used to analyze the association between these variables and the use of eye examinations.
Results: Of all patients with diabetes, only 45.2% had an eye examination in the past years. By logistic regression, the probability of an eye examination among the patients with diabetes increased with checking sugar level themselves, taking care of their feet, having attended diabetes support group, not living in a rural area, having eye symptoms, having longer duration of diabetes, and taking insulin for sugar control. Hakka people and patients with frequent hospitalizations were less likely to use eye examinations.
Conclusion: The study results showed that the utilization rate of eye examinations was low. It’s important to improve the utilization of eye examinations through education about diabetic retinopathy and eye examination. We must aggressively transfer the patients with no any symptoms of eye, early stage of diabetes, mild degree of diabetes and frequent hospitalization to ophthalmology clinic for eye examinations. At last, it’s also needed to resolve the problems of insufficient resources of ophthalmology in a rural area.

論文審定書……………………………………………………………………………i
誌謝……………………………………………………………………………………ii
中文摘要………………………………………………………………………………iii
英文摘要………………………………………………………………………………iv
目錄……………………………………………………………………………………vi
圖次……………………………………………………………………………………viii
表次……………………………………………………………………………………ix
第一章　緒論…………………………………………………………………………1
　第一節　研究背景與動機…………………………………………………………1
　第二節　研究目的…………………………………………………………………6
第二章 文獻探討……………………………………………………………………...7
　第一節　糖尿病視網膜病變介紹…………………………………………………7
　第二節　國內糖尿病照護介紹…………………………………………………..14
　第三節　醫療服務利用行為模式………………………………………………..20
　第四節　影響糖尿病人接受眼底檢查因素探討………………………………..22
　第五節　小結……………………………………………………………………. 40
第三章 研究設計與方法…………………………………………………………....41
　第一節 研究架構………………………………………………………………....41
　第二節 研究假設………………………………………………………………....43
　第三節 資料來源與研究樣本…………………………………………………....44
　第四節 研究變項之操作型定義與測量方法…………………………………....47
　第五節 統計分析方法…………………………………………………………....54
第四章 研究結果…………………………………………………………………....56
　第一節　糖尿病樣本的特質描述………………………………………………..56
　第二節　糖尿病人接受眼底檢查情形與影響因素分析………………………..61
　第三節　國內糖尿病人接受眼底檢查的預測因素……………………………..69
第五章 研究討論…………………………………………………………………... 76
　第一節　糖尿病人接受眼底檢查情形討論……………………………………..76
　第二節　糖尿病人接受眼底檢查之影響因素探討…………………….……….77
第六章 研究結論、限制與建議…………………………………………………....84
　第一節　研究結論………………………………………………………………..84
　第二節　研究限制………………………………………………………………..85
　第三節　研究建議………………………………………………………………..87
第四節　研究貢獻………………………………………………………………....89
參考文獻……………………………………………………………………………..90
附錄……………………………………………………………………....…………100

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