本論文研究運用健康信念理論作為研究架構基礎，目的在於研發一套能增進婦女乳癌篩檢認知的衛生教育指導課程。並探討此多媒體衛生教育課程介入後，對於研究對象的「乳癌知覺罹患性」、「乳癌知覺嚴重性」、「乳癌篩檢行動利益」、「乳癌篩檢行動障礙」、「乳癌篩檢行動線索」及「乳癌篩檢自我效能」改變結果。
本研究採準實驗設計，立意取樣，研究對象為45-69歲至三軍總醫院一般外科就診的女性病患，並將其分為實驗組及對照組，共計93名，實驗組47名婦女接受以健康信念模式(HBM)為依據之多媒體衛生教育介入，對照組46名婦女則僅給予財團法人癌症希望基金會乳癌防治手冊；實驗組及對照組均進行前、後測資料收集，以作為衛生教育課程介入對實驗組研究對象產生的成效分析。
研究結果發現，衛生教育介入後，實驗組研究對象，在後測「知覺罹患性」、「知覺嚴重性」、「知覺行動利益」、「知覺行動障礙」、「行動線索」及「自我效能」得分顯著高於對照組，且達到統計學上的顯著，代表乳癌多媒體衛生教育介入，對於實驗組對象產生增進的效果。
我們相信，此研究設計的多媒體衛生教育成效確實優於傳統單張式衛生教育方式。

The purpose of this study was to develop a health education program for women’s breast cancer screening and to explore the effect of preventive intervention on breast survey knowledge, attitude to perceived susceptibility, perceived seriousness, perceived benefits, perceived barriers, cues to action and self-efficacy in dealing with breast cancer screening.
A quasi-experimental design was utilized in Tri-Service General Hospital in Taipei. Purposive sampling was conducted. Ninety-three subjects were enrolled to two groups. The study group was enrolled forty-seven patients who took part multimedia health education program about breast cancer screening. The control group patients were only received the handout. Before the program, pretest was conducted to establish the baseline data to compare in the two groups. After this program, posttest was conducted to understand the effect of intervention.
The result of the study showed that after multimedia breast cancer preventive intervention. These patients in the study group, the knowledge to the breast cancer survey, attitude to perceived susceptibility, perceived seriousness, perceived benefits, perceived barriers, cues to action and self-efficacy in dealing with breast cancer screening were all better to the control group after compared all the data.
So we believed that the multimedia breast cancer screening health education program for women is a successful and effective program.

一、中文部分
刁翠美、周宜宏 (1998)。乳房超音波檢查近況。臨床醫學，42(6)， 440-454。
于家珩 (2003)。影響女性乳癌篩檢因素之分析-以某區域教學依遠門診民眾為例。未出版之碩士論文，中國醫藥學院醫務管理研究所，台中。
方淑華、李茹萍、章淑娟、王麗花、張惠冠 (2010)。花蓮地區婦女對乳癌疾病及篩檢知識之探討。志為護理，9(5)，80-89。
左如梅、李從業、蔣美蘭 (1997)。衛生教育活動對女性教師乳房自我檢查知識、態度和信念的影響。醫學研究，17(6)，344-360。
向肇英、賴裕和、吳志雄、陳美伶、黃采薇（2001）。探討衛生教育護理處置對乳癌婦女焦慮及術後疼痛改善之成效。新臺北護理期刊，3（1），91-102。
江育惠 (2006)。影響婦女參與乳房攝影檢查意圖相關因素之研究-以台北縣三芝鄉婦女為例。未發表之碩士論文，國立臺灣師範大學衛生教育學研究所，台北。
呂昌明 (1994)。「所謂健康信念模式」。健康教育，51，32-34。
李效梅、郭憲文、劉波兒 (1994)。「台中地區兩所專科女生對乳房自我檢查知識、態度、行為之研究」。弘光醫專學報，1-29。
李蘭、晏涵文、陳富莉、陸玓玲、吳文琪、江宜珍 (2010)。健康行為與健康教育。台北：巨流。
吳南宏、盧豐華、張翠珍、張瑩如、張智仁 (1995)。「乳房自我檢查衛生教育對婦女乳房自我檢查知識動機及技巧之影響」。中華衛誌，14（5），407-417。
何素梅、羅鳳嬌 （2002）。多媒體病房簡介之專案計劃。榮總護理，19（2），179-185。
余揚 （2004）。多媒體教學中媒體的選擇分析。旅遊職業教育與研究，37，20-22。
巫曉玲 （2004）。衛生教育光碟及單張對冠狀動脈心臟病患者飲食認知與自我效能之成效比較。未發表的碩士論文。慈濟大學護理學研究所，花蓮。
何子銘 (2008)。以健康信念模式探討風險知覺影響婦女執行乳房攝影篩檢之行為研究。未發表之碩士論文，銘傳大學風險管理學研究所，台北。
林麗鳳 (1989)。「台中市北屯區婦女對乳房自我檢查知識、態度及行為調查研究」。台中醫學學報，5，35-53。
林碧珠、林麗嬋、林金真 （1997）。成人教育理論與老人衛生教育。護理雜誌，44（2），81-86。
卓靜宜 (2005)。衛生教育介入對婦女篩檢行為及意向之影響。未出版之碩士論文，國立台北護理學院護理研究所，台北。
施秀慧 （2002）。護理指導對肝硬化患者知識及自我照顧行為之成效。未發表的碩士論文，慈濟大學護理研究所，花蓮。
洪博文、陳懿文 (2004)。乳癌篩檢。臺灣醫界，47(1)，25-29。
施良珠 （2004）。第三屆國際華夏內分泌會議~兩岸衛生教育交流心得。中華民國內分泌暨糖尿病學會會訊，17（3），26-27。
柯孟君 (2008)。乳癌病患確定診斷前健康行為與執行乳癌篩檢之相關性。未發表之碩士論文，中國醫藥大學醫務管理學研究所，台中。
張淑紅、黃璉華、李源德 （1996）。個別衛生教育介入高脂血個案知識、健康信念、自我效能、行為的影響。中華衛誌，15（3），188-195。
陳慧珠 (2007)。探討乳癌病患執行乳癌篩檢與疾病分期之相關性。未發表之碩士論文。中國醫藥大學醫務管理學研究所，台中。
黃鈴媚 (1999)。恐懼訴求與健康宣導活動：宣導訊息內容設計之研究。新聞學研究，61，99-135。
黃美凰 (2005)。電腦多媒體輔助學習對保母人員技能檢定成效之研究。未發表之碩士論文。國立屏東科技大學技術及職業教育研究所，屏東。
楊克平、程敏華、黃貞觀 (2005)。網路媒體衛生教育對脊髓損傷患者自我照顧能力之影響。榮總護理，22（2），178-190。
廖敏娟 (2004)。婦女接受乳房攝影之相關因素調查。未發表之碩士論文。高雄醫學大學公共衛生研究所，高雄。
董峻成 (2013)。運用訓練品質系統(TTQS)於乳房攝影檢查之改善成效。取自http://ttqs.wda.gov.tw/Expert_Column_Detail.aspx?Column_ID=b3c8fb7b87774913be7a5b90326f2a48
蔡蕙如 (2003)。大學女性教職員社會網絡與執行乳癌篩檢之關係研究。未發表之碩士論文。國立臺灣師範大學衛生教育研究所。台北市。
蔣婷婷、戴千淑、林碧珠 (2011)。以健康信念模式探討女性醫事人員乳癌篩檢行為及影響因素。榮總護理，28（2），130-138。
鄭伯壎 (2007)。組織臨床研究：旨趣與模式。應用心理研究，33，101-125。
衛生福利部國民健康署(2010a)-國家癌症五年防治計畫。取自 http://www.hpa.gov.tw/bhpmobile/file/ThemeDocFile/201009170913113706/%E5%9C%8B%E6%B0%91%E5%81%A5%E5%BA%B7%E5%B1%80-%E5%9C%8B%E5%AE%B6%E7%99%8C%E7%97%87%E9%98%B2%E6%B2%BB%E4%BA%94%E5%B9%B4%E8%A8%88%E7%95%AB
衛生福利部國民健康署 (2010b)。台灣地區主要癌症死亡原因。取自http://www.doh.gov.tw/CHT2006/DM/DM2_2.aspx?now_fod_list_no=12336&class_no=440&level_no=4.
衛生福利部國民健康署 (2013)。健康主題專區。取自 http://www.bhp.doh.gov.tw.
衛生福利部國民健康署（2014a）。100年癌症登記年報。取自http://www.hpa.gov.tw/BHPNet/Portal/File/PressFile/201404151012192334/2011%e7%99%8c%e7%99%bb%e8%a8%98%e8%80%85%e6%9c%83%e7%b0%a1%e5%a0%b1.pdf
衛生福利部國民健康署（2014b）。102年全國主要癌症死因。取自http://health99.hpa.gov.tw/Article/ArticleDetail.aspx?TopIcNo=846&DS=1-life
衛生福利部國民健康署 (2015):歷年45-69歲婦女最近兩年內接受乳癌篩檢率。取自http://data.hpa.gov.tw/dataset/143070580718/resource/c3a2c286-bc26-447f-8049-444fe696878a
衛生福利部國民健康署（2017）。102年癌症登記年報。取自http://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=269&pid=5191
大數聚(2015)。乳癌篩檢不想去，十大理由講不完。取自 http://group.dailyview.tw/2015/09/24/%E5%A5%BD%E5%AE%B3%E7%BE%9E%EF%BC%81%E4%B9%B3%E7%99%8C%E7%AF%A9%E6%AA%A2%E4%B8%8D%E6%83%B3%E5%8E%BB%EF%BC%8C%E5%8D%81%E5%A4%A7%E7%90%86%E7%94%B1%E8%AC%9B%E4%B8%8D%E5%AE%8C%EF%BC%81/
鍾昀臻 （2005）。運用互動式影音光碟衛生教育改善末期腎病患者決策、不確定感及生活品質之成效。未發表的碩士論文，輔英科技大學護理學研究所，高雄。
羅雪、陳品玲、陳靜敏、李從業、謝家明 (2001)。乳癌高危險群婦女執行乳房自我檢查之健康信念與行為。護理雜誌，48(6)，59-68。
羅惠敏、徐南麗、李麗蘭、林哲先 （2005）。多媒體影音光碟衛生教育介入對婦女行子宮切除手術醫療決策之成效。慈濟護理雜誌，4(3)，64-73。
顧艶秋,林鎂喻 (2013)。探討南部某醫學中心門診婦女民眾接受「乳癌篩檢」的影響因素。高雄護理雜誌，30(3)，36-47.
二、英文部分
Abbaszadeh, Haghdoost, Taebi, & Kohan. (2007). The Relationship Between Women’s Health Beliefs and Their Participation in Screening Mammography. Asian Pacific Journal of Cancer Prevention, 8, 471-475.
Adelson, Irwig, & Turnbull. (1992). Evaluating the impact of a promotional campaign for screening mammography: women's knowledge and sources of awareness. Australian Journal of Public Health, 16(1), 72-78.
American Cancer Society (2014). Breast Cancer Screening Reminder. Retrieved from http://www.cancer.org/healthy/toolsandcalculators/remind-me
Atkins, Burgess, Forbes, Linsell, Omar, Ramirez, & Tucker. (2011). A promoting early presentation intervention increases breast cancer awareness in older women after 2 years: a randomised controlled trial. British Journal of Cancer, 105(1), 18-21.
Avci, I. A., & Kurt, H. (2008). Health Beliefs and Mammography Rates of Turkish Women Living in Rural Areas. Journal of Nursing Scholarship, 40(2), 170-175.
Baines, Miller, Wall, McFarlane, Simor, Jong, … Ouimet-Oliva. (1986). Sensitivity and specificity of first screen mammography in the canadian National Breast Screening Study: a preliminary report from five centers. Radiology, 160, 295-298.
Bandura, A. (1977). Self-efficacy: toward a unifying theory of behavioral change. Psychological Review, 84, 191-215.
Becker, Drachman & Kirscht. (1974). A new approach to explaining sick-role behavior in low-income populations. American Journal of Public Health, 64(3), 205-216.
Caris-Verhallen, W. M., KerKstra, A., Bensing, J. M., & Grypdonck, M. H. (2000). Effect of video interaction analysis training on nurse-patient communication in the care of the elderly. Patient Education & counseling, 39(1), 91-103.
Chelf, J. H., Agre, P., Axelrod, A., Cheney, L., Cole, D. D., … Weaver, C. (2001). Cancer-related patient education: an overview of the last decade of evaluation and research. Oncology Nursing Forum, 28 (7), 1139-1147.
Champion, V. L. (1985). Use of the health belief model in determining frequency of breast self-examination. Research In Nursing & Health, 8(4), 373-379.
Champion, V. L. (1988). Attitudinal variables related to intention, frequency and proficiency of breast self-examination in women 35 and over. Research In Nursing & Health, 11, 283-291.
Champion, V. L. (1991). The relationship of selected variables to breast cancer detection behaviors in women 35 and older. Oncology Nursing Forum, 18(4), 733-739.
Champion, V. L., & Skinner, C. S. (2008). The Health Belief Model. In K. Glanz, B. K. Rimer & K. Viswanath (Eds.), Health Behavior and Health Education: Theory, Research, and Practice. (4th ed., pp 45- 66).San Francisco : Jossey-Bass Publish.
Champion, V. L., Millon-Underwood, S., Monahan, P. O., Paskett, E. D., Russell, K. M., … Zhao, Q. (2010). Randomized trial of a lay health advisor and computer intervention to increase mammography screening in African American women. Cancer Epidemiology Biomarkers Prevention, 19(1), 201-210.
Chan, S. S., Chow, D. M., Cheng, K. K., Cheung, P. S., Fung, W. Y., … Wong, D. C. (2007) Using a community-based outreach program to improve breast health awareness among women in Hong Kong. Public Health Nursing, 24(3), 265-273.
Chou, Y. H., Tiu, C. M., Lee, S. S., Chen, C. M., & Chang, T. (1992). Imaging of breasts in symptomatic patients: a comparison of ultrasonic and X-Ray mammography. Journal of Ultrasound in Medicine of the R.O.C., 9, 1-10.
Cohen, J. (Ed.) (1988). Statistical Power Analysis for the Behavioral Sciences (2nd ed.). New Jersey: Lawrence Erlbaum Associates, Publishers Hillsdale.
Cunnigham, M. A., ＆ Baker, D. (1986). How to teach patients better and faster. RN, 49(9), 50-52.
Epstein, S. A., Lin, T. H., Audrain, J., Stefanek, M., Rimer, B., & Lerman, C. (1997). Excessive breast self-examination among first-degree relatives of newly diagnosed breast cancer patients. High-Risk Breast Cancer Consortium. Psychosomatics, 38(3), 253-261.
Freiberg, R., Holmes, T., & Sucher, K. (2004). The effectiveness of a video on hemodialysis as a teaching tool for medical nutrition therapy students. Journal of the American Dietetic Association, 104(1), 38-45.
Garrett, B. M., & Callear, D. (2001). The value of intelligent multimedia simulation for teaching clinical decision-making skills. Nursing Education Today, 21(5), 382-390.
Gaskey, N. J. (1987). Evaluation of the effect of a pre-operation-anesthesia videotape. Journal of the American Association of Nurse Anesthestists, 55(4), 341-345.
Goold, P. C., Bustard, S., Ferguson, E., Carlin, E. M., Neal, K., & Bowman, C. A. (2006). Pilot study in the development of an interactive multimedia learning environment for sexual health interventions : a focus group approach. Health Education Research, 21(1), 15-25.
Gordon, P. B., & Goldenberg, S. L. (1995). Malignant breast masses detected only by ultrasound. A retrospective review. Cancer, 76, 626-630.
Green, L., & Kreuter, M. (1991). Health promotion planning: An educational and environmental approach. 2nd edition. Mountain View, CA: Mayfield Publishing Company.
Harding, M. M. (2014). Incidence of Distress and Associated Factors in Women Undergoing Breast Diagnostic Evaluation. Western Journal of Nursing Research, 36(4), 475-494.
Hong, W. H., Jung, E., Kim, M. H., Kye, S. Y., Park, K., & Park, H. G. (2011). Community-based intervention to promote breast cancer awareness and screening: The Korean experience. BMC Public Health, 11, 468.
Hosseini, H., & Hosseini, N. (2008). Epidemology and prevention of fall injuries among the elderly. Journal of Hospital Topics, 86(3), 15-20.
Humphrey, L. L., Helfand, M., Chan, B. K., & Woolf, S. H. (2002). Breast cancer screening: a summary of the evidence for the U.S. Preventive Services Task Force. Annals of Internal Medicine, 137, 344-346.
Jackson, S. L., Hislop, T. G., Teh, C., Yasui, Y., Tu, S. P., Kuniyuki, A., & Taylor, V. M. (2003). Screening mammography among Chinese Canadian women. Canadian Journal of Public Health, 94 (4), 275-280.
Kash, K. M., Holland, J. C., Halper, M. S., & Miller, D. G. (1992). Psychological distress and surveillance behaviors of women with a family history of breast cancer. Journal National Cancer Institute, 84, 24-30
Lewin, R. J. P., Furze, G., Robinson, J., Griffith, K., Wisemon, S., Pye, M., & Boyle, R. (2002). A randomized controlled trial of a self-management plan for patients with newly diagnosed angina. British Journal of General Practice, 5(2), 194-201.
Lim, C. C., Devi, M. K., & Ang, E. (2011). Anxiety in women with breast cancer undergoing treatment: a systematic review. International Journal of Evidence-Based Healthcare, 9(3), 215-235.
Loving, V. A., DeMartini, W. B., Eby, P. R., Gutierrez, R. L., Peacock, S., & Lehman, C. D. (2010). Targeted ultrasound in women younger than 30 years with focal breast signs or symptoms: outcomes analyses and management implications. American Journal of Roentgenology, 195, 1472-1477.
Lukwago, S. N., Kreuter, M. W., Holt, C. L., Steger-May, K., Bucholtz, D. C. ＆ Skinner, C. S. (2003). Sociocultural correlates of breast cancer knowledge and screening in urban African American women. American Journal of Public Health, 93(8), 1271-1274.
Matthews, C. E., Shu, X. O., Jin, F., Dai, Q., Hebert, J. R., … Zheng, W. (2001). Lifetime physical activity and breast cancer risk in the Shanghai Breast Cancer Study. British Journal of Cancer, 84(7), 994-1001.
McIlfatrick, S., Taggart, L., & Truesdale-Kennedy, M. (2011). The role of community nurses and residential staff in supporting women with intellectual disability to access breast screening services. Journal of Intellectual Disability Research, 55(1), 41-52.
Miller, A. (1985). When is the time ripe for teaching? American Journal of Nursing, 85(7), 801-804.
National Cancer Institute (2010). Lifetime Probability of Breast Cancer in American Women. Retrieved from http://www.nci.nih.gov/cancer information/
Nystrom, L., Wall, S., Rutqvist, L. E., Lindgren, A., Lindqvist, M., Ryden, S., … Larsson, L.-S. (1993). Breast cancer screening with mammography: overview of Swedish randomised trials. Lancet, 341, 973-978.
Reis, J., Riley, W., Lokman, L., & Bear, J. (2000). Interactive multimedia prevention alcohol education : A technology application in high education. Journal of Drug Education, 30(4), 399-421.
Rosenstock, I. M., Strecher, V., & Becker, J. (1988). Social learning theory and the health belief model. Health Education Quarterly, 15, 175-183.
Siskind, V., Schofield, F., Rice, D., & Bain, C. (1989). Breast cancer and breastfeeding: results from an Australian case-control study. The American Journal of Epidemiol, 130(2), 229-236.
Sorensen, J., Hertz, A., ＆ Gudex, C. (2004). Evaluation of a Danish teaching program in breast self-examination. Cancer Nursing, 28(2), 141-147.
Wang, W. L., Hsu, S. D., Wan, J. H., Huang, L. C., & Hsu, W. L. (2014). Survey of breast cancer mammography screening behaviors in Eastern Taiwan based on a health belief model. The Kaohsiung Journal of Medical Science, 30(8), 422-427.
World Health Organization. (2014). Breast cancer: prevention and control. Retrieved from http://www.who.int/cancer/detection/breastcancer/en/
Wydra, E. W. (2001). The effectiveness of a self-care management interactive multimedia module. Oncology Nursing Forum, 28 (9), 1399-1406.
Yang, P. S., Yang, T. L., Liu, C. L., Wu, C. W., & Shen, C. Y. (1997). A case-control study of breast cancer in Taiwan-a low-incidence area. British Journal of Cancer, 75, 752-756.
Yen, A. M. F., Tsau, H. S., Fann, J. C. Y., Chen, S. L. S., Chiu, S. Y. H., Lee, Y. Chia., … Chiou, S. T. (2016). Population-Based Breast Cancer Screening With Risk-Based and Universal Mammography Screening Compared With Clinical Breast Examination. JAMA Oncology, 2(7), 915-921.