臺灣博碩士論文加值系統

研究背景：台灣每13位老人就有1位是失智症病人，失智症在過去俗稱老年癡呆症，此詞彙有歧視含義，讓民眾產生排斥及反感，93.8%的失智症病人住在家中，受到社區民眾對於疾病烙印的觀感影響，導致失智症確診率僅54.1%，中年人因年齡漸增，除擔心自己邁向老年，也易擔心父母是否有罹患失智症的可能。

研究目的：國內外雖對於相關問題已逐漸探討，但與其他精神疾病相比，相關文獻仍較缺乏，因此本研究期透過問卷調查：瞭解台灣中年人社會人口學變項、失智症烙印、知識、態度、行為之分佈；探討台灣中年人不同社會人口學變項的失智症烙印、知識、態度、行為得分之差異及相關性；探討台灣中年人對失智症行為之預測因子。

研究方法：本研究採橫斷式相關性研究設計，以結構式問卷收集相關資料，以方便取樣於嘉義縣衛生所至社區進行3+1行動醫療篩檢時，向中年人發放並收回有效問卷366份，透過SPSS統計軟體進行分析。

研究結果：烙印方面，顯著變項以男性>女性、高中/高職以下>專科/大學以上、部分接觸經驗否>是，烙印總分與年齡呈正相關；知識方面，顯著變項以男性>女性、專科/大學以上>高中/高職以下、部分接觸經驗是>否，知識總分與年齡呈負相關；態度方面，態度總分與年齡呈負相關、與接觸經驗呈正相關；行為方面，顯著變項以專科/大學以上>高中/高職以下、未結過婚>曾結過婚，行為總分與年齡呈負相關、與接觸經驗呈正相關。經多元線性迴歸分析發現，行為預測因子為：婚姻狀況、居住鄉鎮、疾病總數、自覺未來罹患失智症的可能性、接觸經驗總分、烙印總分、知識總分、態度總分；經羅吉斯迴歸分析發現，行為預測因子為：教育程度、婚姻狀況、配偶母親情形、認為父母未來罹患失智症的可能性、接觸經驗總分、態度總分。

結論：失智症行為預測因子之顯著變項多數能與文獻及臨床實務情形進行應證，由上述可知，失智症行為與未來罹患失智症可能性、接觸經驗、烙印、知識、態度等具有一定相關性。

研究限制：本研究受限於時間及人力因素採方便取樣，故樣本的代表性及結果推論性可能會受到限制；採問卷調查法，故可能較無法得知受試者真正的質性想法；可能影響到中年人對於失智症烙印、知識、態度、行為之因素很多，本次研究未能探討所有可能影響的變項。

臨床貢獻：使用知識態度行為模型，瞭解知識差距、態度障礙及行為模式後，即可確立研究族群的需求、障礙及問題，研究結果發現，研究族群普遍對失智症的知識較不足、態度普通偏同意、行為落在同意，亦發現失智症知識、態度、行為分數具顯著相關性。進行教育介入後可顯著提升知識、態度、行為的分數，因此若提升研究族群的失智症知識分數，其態度及行為分數應可顯著提升，減少大眾對於失智症的烙印（刻板印象與負面情緒等），即可進一步提升失智者的就診率、降低醫療成本及照顧負荷。

建議：政策面，可依據研究結果規劃後續政策，如進行失智症烙印專門的衛教、增加與失智症病人的社會接觸、透過媒體傳遞公共健康意識、修改公共政策等。研究面，可依據研究結果設計介入型研究，如故事情境、教育影音、課程簡報、衛教單張等；也可應用至其他疾病或事物，如新冠肺炎、心理諮商、其他傳染性疾病等；目前仍較少針對高中以下族群相關的介入研究，也較少失智症大眾烙印相關的中文量表，未來亦可對此接續研究。臨床面，研究結果發現，教育程度越高、接觸經驗越多、年齡越低者，失智症知識、態度、行為分數較高、烙印分數則越低；而接觸經驗越多、失智症的烙印、知識、態度分數越高，也越能預測其會有更好的行為，因此在臨床與社區層面，未來可更著重於降低上述群體的烙印程度，透過增加其失智症知識，便可有效提升其正向態度，及幫助失智者的行為意願；也可藉由提升相關工作人員的失智症知識，讓其了解失智者需要的協助外，在遇到不了解失智症的民眾時，也有充足的知識可衛教之。

Background: In Taiwan, for every 13 elderly individuals, there is one dementia patient. Dementia was previously commonly referred to as senile dementia, a term carrying discriminatory connotations, which led to public rejection and aversion. 93.8% of dementia patients live at home, influenced by the stigma of the disease within the community, resulting in a diagnosis rate of only 54.1%. Middle-aged individuals, as they age, not only worry about their aging but also the possibility of their parents who have dementia.

Objectives: Although relevant issues have been gradually explored domestically and internationally, compared to other mental illnesses, there is still a lack of relevant literature. Therefore, this study aims to use a questionnaire survey to understand the distribution of demographic variables, stigma, knowledge, attitudes, and behaviors of middle-aged individuals in Taiwan regarding dementia; explore the differences and correlations of stigma, knowledge, attitudes, and behaviors of middle-aged individuals with different demographic variables in Taiwan; investigate the predictive factors of middle-aged individuals' behaviors towards dementia.

Methods: This study adopts a cross-sectional correlational research design, collecting relevant data through structured questionnaires. Convenient sampling was conducted in Chiayi County, from health centers to communities, during a 3+1 mobile medical screening. 366 valid questionnaires were collected and analyzed using SPSS statistical software.

Results: Regarding stigma, significant variables include male > female, high school/vocational school or below > junior college/university and above, and partial contact experience <no. The total stigma score is positively correlated with age. For knowledge, significant variables include male > female, junior college/university and above > high school/vocational school or below, and partial contact experience > no. The total knowledge score is negatively correlated with age. For attitudes, the total attitude score is negatively correlated with age and positively correlated with contact experience. For behaviors, significant variables include junior college/university and above > high school/vocational school or below, and never married > previously married. The total behavior score is negatively correlated with age and positively correlated with contact experience. Multiple linear regression analysis identified predictive factors for behavior: marital status, township of residence, total number of diseases, perceived likelihood of future dementia, total contact experience score, total stigma score, total knowledge score, and total attitude score. Logistic regression analysis identified predictive factors for behavior: education level, marital status, spouse's mother's condition, perceived likelihood of parents' future dementia, total contact experience score, and total attitude score.

Conclusion: Many significant predictive variables for dementia behavior can be verified through literature and clinical practice. From the above, it can be seen that dementia behavior is correlated with the likelihood of future dementia, contact experience, stigma, knowledge, attitudes, etc.

Limitations: This study is limited by time and staffing factors, using convenient sampling, which may limit the representativeness of the sample and the inferential results. Using a questionnaire survey method, it may not be easy to know the participants' true qualitative thoughts. Many factors may affect middle-aged individuals' stigma, knowledge, attitudes, and behaviors toward dementia, which were not explored in this study.

Contributions: By using the knowledge-attitude-behavior model, understanding knowledge gaps, attitude barriers, and behavior patterns, the needs, barriers, and problems of the research population can be established. The research found that the research population generally lacks knowledge about dementia, has moderately positive attitudes, and falls into agreement regarding behaviors. It was also found that dementia knowledge, attitude, and behavior scores are significantly correlated. After educational intervention, knowledge, attitude, and behavior scores can be significantly improved. Therefore, if the dementia knowledge scores of the research population are increased, their attitude and behavior scores should also significantly improve, reducing the stigma of dementia（stereotypes and negative emotions, etc.）, further increasing the dementia diagnosis rate, and reducing medical costs, and caregiving burden.

Suggestions: On a policy level, subsequent policies can be planned and based on the research results, such as conducting specialized health education on dementia stigma, increasing social contact with dementia patients, delivering public health awareness through media, and modifying public policies. In terms of research, intervention studies can be designed and based on the research results, such as storytelling, educational videos, course presentations, health education brochures, etc. It can also be applied to other diseases or issues, such as COVID-19, psychological counseling, other infectious diseases, etc. Currently, there are fewer intervention studies targeting populations below high school and fewer Chinese scales related to the stigma of dementia, which can be explored in future research. From a clinical perspective, the research found that the higher the education level, the more contact experience, and the younger the age, the higher the dementia knowledge, attitude, and behavior scores, and the lower the stigma score. Moreover, the more contact experience, stigma, knowledge, and attitude scores, the better the prediction of better behavior. Therefore, at the clinical and community levels, future efforts can focus more on reducing the degree of stigma among the above groups. By increasing their knowledge of dementia, positive attitudes can be effectively enhanced, and the willingness of dementia patients to behave can be assisted. Additionally, by enhancing the dementia knowledge of relevant personnel, they can not only understand the assistance needed by dementia patients but also have enough knowledge to educate the public when encountering individuals who do not understand dementia.

目錄
中文摘要 I
ABSTRACT III
目錄 VI
表目錄 VIII
圖目錄 X

第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 2
第三節 研究問題 2
第四節 研究假設 3
第五節 名詞界定 3

第二章 文獻探討 6
第一節 失智症概述 6
第二節 失智症烙印之相關文獻探討 12
第三節 失智症知識、態度、行為之相關文獻探討 24

第三章 研究方法 32
第一節 研究設計與架構 32
第二節 研究對象及場所 32
第三節 研究工具 33
第四節 研究步驟 36
第五節 倫理考量 38
第六節 資料處理與分析 39

第四章 研究結果 41
第一節 台灣中年人社會人口學變項、失智症烙印、知識、態度、行為之分佈情形 41
第二節 台灣中年人社會人口學變項與失智症烙印之分析 50
第三節 台灣中年人社會人口學變項與失智症知識、態度、行為之分析 54
第四節 台灣中年人失智症行為預測因子之分析 63

第五章 討論 66
第一節 台灣中年人社會人口學變項、失智症烙印、知識、態度、行為之分佈情形 66
第二節 台灣中年人社會人口學變項與失智症烙印之分析 72
第三節 台灣中年人社會人口學變項與失智症知識、態度、行為之分析 72
第四節 台灣中年人失智症行為預測因子之分析 74

第六章 結論與建議 76
第一節 結論 76
第二節 研究限制、臨床貢獻與建議 77

參考文獻 80
中文部分 80
西文部分 84

附錄 90
附錄一 問卷 90
附錄二 人體試驗同意審查證明書 95
附錄三 衛生局同意函 105
附錄四 專家效度審查委員名單 107


表目錄
表2-1 國內外失智症盛行率比較 8
表2-2 失智症每五歲盛行率 8
表2-3 失智症嚴重程度 8
表2-4 失智症失能程度 8
表2-5 長照資源布建情形 10
表2-6 長照服務涵蓋率 10
表2-7 失智照護資源數 10
表2-8 使用烙印進行研究之相關疾病（1995-2001年） 13
表2-9 使用烙印進行研究之傳染性疾病（1998-2021年） 14
表2-10 使用烙印進行研究之非傳染性疾病（2004-2017年） 14
表2-11 其他疾病烙印相關研究整理 15
表2-12 質性失智症烙印相關研究整理 18
表2-13 失智症烙印相關研究整理 21
表2-14 失智症知識態度行為相關研究整理 26
表3-1 量表信效度分析 34
表3-2 資料處理與分析表 39
表4-1 台灣中年人社會人口學變項之分佈情形 42
表4-2 台灣中年人失智症烙印之分佈情形 46
表4-3 失智症知識之分佈情形 47
表4-4 台灣中年人失智症態度之分佈情形 48
表4-5 台灣中年人失智症行為之分佈情形 49
表4-6 台灣中年人社會人口學變項與失智症烙印總分之分析 50
表4-7 台灣中年人社會人口學變項與失智症知識、態度、行為之分析 56
表4-8 台灣中年人失智症行為預測因子之多元線性迴歸分析 64
表4-9 台灣中年人失智症行為預測因子之羅吉斯迴歸分析 65
 

圖目錄
圖2-1 臨床失智評量表（CDR） 7
圖2-2 「癡呆」、「失智」、「阿茲海默」報導名詞流變 11
圖3-1 研究架構圖 32
圖3-2 G* power 33
圖3-3 研究流程圖 38

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