台灣老年人口比重將在 2018 年邁入高齡社會，但卻對老人健康促進與疾病預防相關研究甚少。本研究目的為利用2009年國民健康訪問調查（National Health Interview Survey），使用健康服務利用模式的概念架構分析台灣老人接受流感疫苗接種之相關因素間之關係。本研究樣本以個案的權值加權後得到全國六十五歲以上老人共計 2,372,653 位，男性佔 48.5%，平均年齡 74.54 歲，66.4%住在都會地區，74%為本省籍，32.7%不識字，61.6%有結婚，11.8%獨居，14.1%還在工作，66.1%是流行性感冒高風險群。六十五歲以上民眾仍有 49%未接種疫苗。雙變項分析以卡方檢定分析接受流感疫苗注射與人口社會學變項、身體健康狀況、醫療服務利用的關係，發現有接受肺炎鏈球菌疫苗預防注射、有使用過免費健康檢查、目前居住於宜花東地區、過去一年月收入較高、有使用癌症篩檢如糞便潛血及子宮頸抹片檢驗、有結婚、居住地都市化程度低、有運動習慣、族群為大陸省籍、有高血脂及心臟疾病及高血壓及腎臟病病史、現在不抽菸、有吃水果及蔬菜習慣、一個月內看過西醫門診、目前仍住照護機構、教育程度較高與接受流感疫苗接種呈現正相關。多變項分析以多元邏輯迴歸分析發現肺炎疫苗、利用老人健檢、過去一年月收入、醫療利用、婚姻、有運動習慣、心臟疾病七種變項與接受流行性感冒疫苗預防注射顯著相關。我國衛生政策提供65歲以上民眾免費流感疫苗預防接種但實際接受比率卻不理想，都市化程度較高之都會地區及有較多人口之北部地區反而較少接受流感疫苗預防接種，族群中比重最大的本省閩南人接種流感疫苗亦最低，但健康行為表現中使用各項醫療服務尤其是接受肺炎鏈球菌疫苗預防注射及曾經利用過免費健康檢查皆與接受流感疫苗接種呈現高度正相關，這將提供當局推動疫苗注射政策之參考。

Based on the proportion of its elderly population, Taiwan will become an aged society by 2018. However, research related to health promotion and disease prevention in the elderly is still relatively scarce. The aim of this study was to use data from the 2009 National Health Interview Survey and the conceptual framework for the use patterns of health services to analyze the relationship among the factors related to the receipt of influenza vaccinations among the elderly in Taiwan. After the weighting of cases, the total number of elderly individuals in Taiwan aged >65 years was 2,372,653. Males accounted for 48.5%; the mean age was 74.54 years; 66.4% lived in urban areas; 74% were native Taiwanese; 32.7% were illiterate; 61.6% were married; 11.8% lived alone; 14.1% were still working; and 66.1% were high-risk for influenza. Among them, 49% were still not vaccinated. Bivariate analyses were performed by using the χ2 test to analyze the relationship of receiving influenza vaccinations with sociodemographic variables, physical health status, and use of medical services. The results indicated that receipt of prophylactic Streptococcus pneumoniae vaccination; previous use of free health check-ups; currently living in the Yilan, Hualien, and Taitung counties; high monthly income in the past year; previous use of cancer screening (e.g., fecal occult blood and cervical smear tests); being married; living in areas with low urbanization; having an exercise habit; being a Mainland Chinese; having histories of hyperlipidemia, cardiovascular disease, hypertension, and renal diseases; currently not smoking; having the habit of eating fruits and vegetables; visiting a Western medicine clinic in the past month; currently living in care institutions; and high educational level all positively correlated with receipt of influenza vaccinations. Multivariate analysis with multiple logistic regression analysis showed that the following seven variables were significantly correlated with receipt of influenza vaccinations: pneumonia vaccination, use of geriatric health check-ups, monthly income in the past year, use of medical services, marriage, having an exercise habit, and cardiovascular disease. Taiwan’s health policy provides individuals aged ≥65 years with free prophylactic influenza vaccinations. However, the actual acceptance rate is still not ideal. Residents in northern regions, which have higher levels of urbanization and larger populations, were less likely to receive prophylactic influenza vaccinations. Native Min Nan people, the largest ethnic group, had the lowest rate of influenza vaccination. Among health behaviors, the use of various medical services, especially the receipt of prophylactic Streptococcus pneumoniae vaccination and previous use of free health check-ups, was highly positively correlated with receipt of influenza vaccinations. These findings can serve as a reference for the relevant authorities when promoting vaccination policies.

口試委員會論文審定書 ........................................................................................................ i
誌謝 ..................................................................................................................................ⅲ
中文摘要 ...........................................................................................................................ⅳ
英文摘要............................................................................................................................ⅴ
目錄 ................................................................................................................................. ⅶ
第一章 緒論........................................................................................................................ 1
第一節 研究背景與研究動機 ............................................................................................... 1
第二節 研究目的 ............................................................................................................... 2
第三節 研究流程與架構 ..................................................................................................... 2
第二章 文獻探討................................................................................................................ 4
第一節 流行性感冒及流感疫苗的相關研究 .......................................................................... 4
第二節 健康服務利用模式的相關研究 ................................................................................ 6
第三節 接受流感疫苗預防注射之相關因素的相關研究 ......................................................... 9
第四節 接受流感疫苗預防注射之相關因素的研究之限制 ..................................................... 21
第三章 研究方法............................................................................................................... 22
第一節 研究設計 ............................................................................................................. 22
第二節 研究架構 ............................................................................................................. 23
第三節 研究假設 ............................................................................................................. 28
第四節 資料來源 ............................................................................................................. 28
第五節 研究對象 ............................................................................................................. 30
第六節 資料處理 ............................................................................................................. 31
第七節 研究變項 ............................................................................................................. 32
第八節 統計方法 ............................................................................................................. 41
第四章 研究結果............................................................................................................... 43
第一節 樣本老人基本特質 ................................................................................................ 43
第二節 樣本老人接種率與影響因素雙變項分析 ................................................................... 45
第三節疫苗接種與影響因素之多元邏輯回歸分析（接種流感疫苗行為之重要預測因子）.......... 52
第五章 討論..................................................................................................................... 57
第一節 研究討論 ............................................................................................................ 57
第二節 研究討論 ............................................................................................................ 60
第六章 結論與建議............................................................................................................63
第一節 研究結論 ............................................................................................................ 63
第二節 管理意涵 ............................................................................................................ 63
第三節 研究建議 ............................................................................................................ 64
第四節 研究限制 ............................................................................................................ 64
第五節 未來研究建議 .................................................................................................... .65
參考文獻 ....................................................................................................................... 66

一、 中文
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