目的：
流行性感冒為世界各國重視的健康議題，推廣疫苗接種亦為疫情防治的重點工作，本研究以國軍醫院醫療工作者為主要研究對象，探討其預防流行性感冒之知識、態度與接種疫苗行為間關係。
方法：
本研究為橫斷性研究，採用問卷調查法，收案時間自2014年10月15日至2014年12月8日止。調查國軍醫院醫療工作者基本人口學變項、健康行為、接種經驗、對流感之知識與態度及接種行為，發放問卷計1,000份，有效問卷共計826份，以SPSS 18.0版本進行分析。
結果：
結果發現，年齡較長者、研究所以上學歷者、醫師、已婚者、有固定運動習慣者有較高的知識得分，達統計之顯著差異(p<0.05)，而經皮爾森績差相關發現，知識得分越高者，其態度越正向，亦達到統計上顯著(p<0.001)，再觀察邏輯斯迴歸結果得知，態度得分(OR=1.08；95%CI=1.05-1.10)與接種疫苗行為，達統計之顯著差異(p<0.001)，且過去接種經驗有無、接種後是否出現不適症狀等均為預測接種行為之因素。
結論：
研究結果顯示醫療工作者對流感的知識越正確，其態度表現越正向，而接種流感疫苗的行為則越高，反而過去不願意接種或接種後出現不適症狀者將明顯降低未來接種疫苗之行為意向，建議醫院應加強衛教宣導工作，並針對不願意接種之原因與接種後出現的不適症狀，妥適規劃輔導作為，排除醫療工作者的疑慮與不安，以落實防疫工作之責。

Introduction:
Influenza has been one of highly-concerned issues of public health around the world. Promoting influenza vaccination is considered an effective way to controlling the outbreak of influenza. The goal of our study is to investigate the association between military hospital health care workers’ (HCWs’) knowledge, the attitude of influenza prevention, and the behavior of influenza immunization.
Methods:
A cross-sectional study was conducted among health care workers in two military hospitals in southern Taiwan during the period starting from October to December 2014. Details of demography, health behaviors, past experiences of vaccination, knowledge, attitude and the behaviors on the prevention from influenza among participants were collected with a well-structured questionnaire. We distributed 1,000 questionaires to the prospective objects of study, and ended up 826 questionaires completed and returned. SPSS version 18.0 was adapted to assess associations of interest by multiple regressions.
Results:
Results has showed that elderly, those with graduate degree, physicians, the married, and those who exercise regularly had significantly higher knowledge scores (p<0.05). A positive correlation between knowledge scores of influenza and positive attitude of preventing influenza among HCWs was identidied (p<0.001). The odds ratio of attitude scores on influenza to vaccination was 1.08 (95%CI:1.05-1.10). Vaccination in the past years and absence of side effects to vaccination were the predictors of vaccination.
Conclusions:
Our research outcome confirms that HCWs who had higher scores in knowledge and more positive attitude on influenza were significantly more likely to receive the vaccine. Those who did not receive vaccination in the past year and who experienced side effects were more unwilling to be vaccinated this year. We suggested that health educational program and other polices should be focused on elucidate the effectiveness, importance and necessity of vaccine on HCWs.

目錄
口試委員會論文審定書 i
誌謝 ii
摘要 iii
Abstract iv
目錄 v
圖次 vii
表次 viii
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的與問題 3
第二章 文獻探討 4
第一節 流行性感冒 4
第二節 流感疫苗及其成效 7
第三節 醫療工作者與流感疫苗 9
第四節 國軍流感疫苗接種現況 11
第五節 影響接種流感疫苗之相關因素 13
第六節 態度與健康信念模式之應用 19
第三章 研究方法 21
第一節 研究架構與假設 21
第二節 研究對象與資料收集程序 23
第三節 問卷設計 24
第四節 問卷信效度分析 32
第五節 資料處理與分析方法 35
第四章 研究結果與分析 37
第一節 描述性統計分析 37
第二節 人口學特質與知識量表之相關性 47
第三節 人口學特質與態度量表之相關性 52
第四節 知識量表與態度量表之相關性 56
第五節 影響接種流感疫苗行為之分析 57
第六節 假設驗證 63
第五章 討論與建議 64
第一節 國軍醫院醫療工作者對於流感知識之相關性 64
第二節 國軍醫院醫療工作者對於流感態度之相關性 67
第三節 國軍醫院醫療工作者對於流感知識與態度 69
第四節 國軍醫院醫療工作者對接種流感疫苗行為之相關性 70
第五節 研究限制與未來研究 72
第六節 建議 73
參考文獻 74
一、中文文獻 74
二、英文文獻 76
附錄 81
一、人體試驗委員會核准函 81
二、研究問卷 82
三、專家學者名錄 86

一、中文文獻
王柏崴、黃禎貞、唐孝蘭、葉國樑、曾治乾（2009）。台北市國中學生綠色消費知識、態度、行為意圖及其相關因素研究~以某國中為例。科學教育學刊，17(3)，255-274。
江大雄(2006)。流行性感冒的全球大流行。疫情報導，22(3)，132-135。
行政院衛生福利部疾病管制署a(2014)。台灣流感速訊 2014年第20週。
行政院衛生福利部疾病管制署b(2013)。季節性流感防治手冊。
行政院衛生福利部疾病管制署c(2012)。認識流感疫苗 教學手冊。
行政院衛生福利部疾病管制署d(2014)。台灣流感速訊 2014年第41週。
吳肖琪（2001）。老人流感疫苗接種效益評估。行政院衛生署疾病管制局90年度委託研究計畫，DOH90-DC-1038。
吳明隆(2011)。SPSS 統計應用學習實務-問卷分析與應用統計。新北市：易習圖書。
吳美玲（2010）。影響醫院從業人員接種流感疫苗之因素探討。長榮大學職業安全與衛生學系碩士班碩士論文。
李慶玟、許麗齡、謝素英（2011）。護理人員對愛滋病照護知識需求評估之探討。護理雜誌，58(4)，47-57。
李曉雲（2006）。護理人員對肺結核知識、態度、行為及其影響因素探討－以某市立聯合醫院為例。（未出版之碩士論文）。臺北醫學大學，臺北市。
林倩伃、蕭靜怡、吳宗樹、朱育增、高全良、廖宜真、張卲聿、江百善、朱韻瑾、金傳春(2007)。人類流行性感冒的流行病學與偵測系統。疫情報導，23(5)，254-272。
國防部軍醫局(2013)。國軍特殊職務人員102年度流感疫苗接種作業規定。
郭秀娥、林惠賢、周心寧、康慧怡、張肇松、沈孟娟（2009）。醫療機構工作人員對流感與流感疫苗的認知、態度及接種流感疫苗行為之探討。感染控制雜誌，第19卷，69-80。
陳清文（2010）。應用健康信念模式-探討國軍衛生部隊官兵H1N1疫苗接種意願及其影響因素（碩士論文）。取自臺灣博碩士論文系統。
楊秋蘭(2007)。以健康信念模式探討老人族群接種流苗之因素(未出版碩士論文)。國立中山大學，高雄市。
楊瓊芳、莊淑婷、許玲女、劉彥芳、柯雅禎、郭憲文（2007）。中部某醫學中心護理人員接種流感疫苗後引發不適反應之研究。中台灣醫誌，12，44-50。
董振英、王全意、吳疆、徐敏、高婷、賀雄（2005）。北京市城區居民流感和流感疫苗知識、態度與行為調查。中華流行病學雜誌，26(2)，152。
廖琪玉(2007)。健康信念模式應用於醫護人員施打流感疫苗接種行為意向研究：以北部某醫學中心為例。國立臺北教育大學生命教育與健康促進研究所碩士論文。
廖琪玉、陳漢瑛(2007)。流感疫苗接種的健康信念與行為意向之研究﹣以北部某醫學中心醫護人員為例。健康促進暨衛生教育雜誌，27，1-19。
劉麗玲（2006）。探討影響老人接種流行性感冒疫苗之相關因素。長庚大學護理學研究所碩士論文。
衛生福利部傳染病防治諮詢會預防接種組流感疫苗工作小組(2013)。流感疫苗之接種建議。疫情報導，29(10)，145-147。
鄭惠方、吳佳蓉（2011）。台灣護理人員對新型流感知識及防護遵從性調查性研究。護理暨健康照護研究，7(2)，87-97。
蕭惠心、孫蕙芝、顏哲傑(2005)。醫療院所工作人員流感疫苗接種後不良反應評估問卷分析。疫情報導，21(8)，618-63。
謝顯森（2006）。流行性感冒與禽流感－歷史與現況。感染控制雜誌，16(2)，81-83。
蘇斌光、陳泥、施博文、鄭鈺陵、鄭伊秀、林盈伶、陳玉屏（2014）。護理人員對新型流感認知與其施打疫苗之行為。醫院，47(5)，35-49。
二、英文文獻
Amanda Banks Christini, B. S., Shutt, K. A., & Byers, K. E. (2007). Influenza vaccination rates and motivators among healthcare worker groups. Infection control and hospital epidemiology, 28(2), 171-177.
Bautista, D., Vila, B., Usó, R., Téllez, M., & Zanón, V. (2006). Predisposing, reinforcing, and enabling factors influencing influenza vaccination acceptance among healthcare workers. Infection control and hospital epidemiology, 27(1), 73-77.
Bridges, C. B., Fukuda, K., Uyeki, T. M., Cox, N. J., & Singleton, J. A. (2002). Prevention and control of influenza. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports/Centers for Disease Control, 51(RR-3), 1-31.
Centers for Disease Control and Prevention (CDC. (2005). Interventions to increase influenza vaccination of health-care workers-California and Minnesota. MMWR. Morbidity and mortality weekly report, 54(8), 196.
Centers for Disease Control and Prevention (CDC. (2013). Prevention and control of seasonal influenza with vaccines. Recommendations of the Advisory Committee on Immunization Practices--United States, 2013-2014. MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports/Centers for Disease Control, 62(RR-07), 1.
Cox NJ, Subbarao K. (1999). Influenza. Lancet, 354, 1277–1282. doi: 10.1016/s0140-6736(99)01241-6
Elder, J. P. (1994). Motivating health behavior. New York: Delmar.
Habib, S., Rishpon, S., & Rubin, L. (2000). Influenza vaccination among healthcare workers. The Israel Medical Association journal: IMAJ, 2(12), 899-901.
Harbarth, S., Siegrist, C. A., Schira, J. C., Wunderli, W., & Pittet, D. (1998). Influenza immunization: improving compliance of healthcare workers. Infection Control and Hospital Epidemiology, 337-342.
Hannoun, C., Megas, F., & Piercy, J. (2004). Immunogenicity and protective efficacy of influenza vaccination. Virus research, 103(1), 133-138.
Joon Young Song, M. D., Cheong Won Park, M. D., Hye Won Jeong, M. D., Cheong, H. J., Kim, W. J., & Kim, S. R. (2006). Effect of a hospital campaign for influenza vaccination of healthcare workers. Infection control and hospital epidemiology, 27(6), 612-617.
Maltezou, H. C., Maragos, A., Katerelos, P., Paisi, A., Karageorgou, K., Papadimitriou, T., & Pierroutsakos, I. N. (2008). Influenza vaccination acceptance among health-care workers: a nationwide survey. Vaccine, 26(11), 1408-1410. doi:10.1016/j.vaccine.2008.01.049. Epub 2008 Feb 13.
Manuel, D. G., Henry, B., Hockin, J., & Naus, M. (2002). Health behavior associated with influenza vaccination among healthcare workers in long-term-care facilities. Infection control and hospital epidemiology, 23(10), 609-614.
Monto, A. S. (2008). Epidemiology of influenza. Vaccine, 26, 45-48.
Nichol, K. L., Lind, A., Margolis, K. L., Murdoch, M., McFadden, R., Hauge, M., ... & Drake, M. (1995). The effectiveness of vaccination against influenza in healthy, working adults. New England Journal of Medicine, 333(14), 889-893.
Norton, S. P., Scheifele, D. W., Bettinger, J. A., & West, R. M. (2008). Influenza vaccination in paediatric nurses: cross-sectional study of coverage, refusal, and factors in acceptance. Vaccine, 26(23), 2942-2948. doi:10.1016/j.vaccine.2008.03.033. Epub 2008 Apr 8.
Ofstead, C. L., Tucker, S. J., Beebe, T. J., & Poland, G. A. (2008). Influenza vaccination among registered nurses: information receipt, knowledge, and decision‐making at an institution with a multifaceted educational program. Infection Control and Hospital Epidemiology, 29(2), 99-106.
O'Reilly, F. W., Cran, G. W., & Stevens, A. B. (2005). Factors affecting influenza vaccine uptake among health care workers. Occupational Medicine, 55(6), 474-479.
O'Rorke, C., Bourke, W., Bedford, D., & Howell, F. (2002). Uptake of influenza vaccine by healthcare workers in an acute hospital in Ireland. Irish medical journal, 96(7), 207-209.
Qureshi, A. M., Hughes, N. J. M., Murphy, E., & Primrose, W. R. (2004). Factors influencing uptake of influenza vaccination among hospital-based health care workers. Occupational Medicine, 54(3), 197-201.
Rothberg, M. B., & Rose, D. N. (2005). Vaccination versus treatment of influenza in working adults: a cost-effectiveness analysis. The American journal of medicine, 118(1), 68-77.
Salgado, C. D., Farr, B. M., Hall, K. K., & Hayden, F. G. (2002). Influenza in the acute hospital setting. The Lancet infectious diseases, 2(3), 145-155.
Schrader, P. G., & Lawless, K. A. (2004). The knowledge, attitudes, & behaviors approach how to evaluate performance and learning in complex environments. Performance Improvement, 43(9), 8-15.
Seale, H., & MacIntyre, C. R. (2011). Seasonal influenza vaccination in Australian hospital health care workers: a review. Medical Journal of Australia, 195(6), 336-338.
Shrestha, S. S., Swerdlow, D. L., Borse, R. H., Prabhu, V. S., Finelli, L., Atkins, C. Y., ... & Meltzer, M. I. (2011). Estimating the burden of 2009 pandemic influenza A (H1N1) in the United States (April 2009–April 2010). Clinical Infectious Diseases, 52(suppl 1), 75-82. doi: 10.1093/cid/ciq012.
Swanson, J. C. (1972). Second thoughts on knowledge and attitude effects upon behavior. Journal of School Health, 42(6), 363-365.
Takayanagi, I. J., Cardoso, M. R. A., Costa, S. F., Araya, M. E. S., & Machado, C. M. (2007). Attitudes of health care workers to influenza vaccination: why are they not vaccinated?. American journal of infection control, 35(1), 56-61.
Talbot, T. R. (2008). Improving rates of influenza vaccination among healthcare workers: educate; motivate; mandate?. Infection control and hospital epidemiology, 29(2), 107-110.
Trivalle, C., Okenge, E., Hamon, B., Taillandier, J., & Falissard, B. (2006). Factors that influence influenza vaccination among healthcare workers in a French geriatric hospital. Infection control and hospital epidemiology, 27(11), 1278-1280.
Waltz, C. F., Strickland, O., & Lenz, E. R. (1991). Measurement in nursing research (Vol. 4). Philadelphia: FA Davis Company.
Wicker, S., Rabenau, H. F., Doerr, H. W., & Allwinn, R. (2009). Influenza vaccination compliance among health care workers in a German university hospital. Infection, 37(3), 197-202.
Wilde, J. A., McMillan, J. A., Serwint, J., Butta, J., O'Riordan, M. A., & Steinhoff, M. C. (1999). Effectiveness of influenza vaccine in health care professionals: a randomized trial. The Journal of the American Medical Association, 281(10), 908-913.