摘要
研究目的：探討影響德國麻疹陰性婦女未來補施打意願與願付價格之相關因素。

資料來源：本研究運用臺北市衛生局「婦女補接種疫苗以防治先天性德國麻疹症候群胎兒之行為影響因素探討：以健康信念模式為框架」計畫之次級資料進行分析。該計畫係依據健康信念模式編製問卷，問卷中各構面之專家內容效度(Content Validity Index, CVI)值均為0.95以上，信度檢驗Cronbach's Alpha值均為0.7以上。該計畫針對民國101至102年臺北市婚後孕前健康檢查資料庫及民國99至101年臺北市立聯合醫院婦幼院區的孕產婦資料庫中，檢查德國麻疹抗體為陰性的婦女共139位進行問卷調查。本研究乃自該資料中選取產前檢查德國麻疹抗體為陰性的婦女且至調查時點仍未補接種者共99位為研究對象，在扣除研究變項缺失值的個案後，共88位做為探討影響未來是否願意補接種之研究樣本，89位婦女則做為分析影響未來補施打德國麻疹疫苗意願程度之研究樣本；此外，共89位個案則做為進行影響其疫苗願付價格相關因素分析之樣本。

方法：本研究除運用敘述統計外，亦運用相關係數與關連性強度檢定自變項與德國麻疹陰性婦女補接種德國麻疹之意願及願付價格之相關性及關係強度。此外，針對依變項之特性，本研究分別運用迴歸分析、順序羅吉斯模型(ordered logit model)，以及羅吉斯迴歸分析(logistic regression model)，探討在控制社會人口學變項、過去疾病狀況與疫苗使用狀況、先天性德國麻疹症候群與德國麻疹相關知識之情況下，影響德國麻疹陰性婦女未來補施打意願及願付價格之相關因素為何。

結果：在控制其他因素之下，自覺障礙性越低，未來補接種意願之可能性越高(OR=1.29; p=0.012)；自我效能越高，未來補接種意願的程度越高(p=0.013)；此外，願付價格的平均為NT$1,395.51，標準差為NT$1,154.08，而影響願付價格之重要因素為每月家戶收入(p<0.01)；若將願付價格分為三區間，則影響願付價格之重要因素為每月家戶收入(p=0.003)與全職工作(p<0.05)。

結論與建議：在未來補接種MMR疫苗意圖方面，受到重要他人不支持其施打MMR疫苗、較不擔心疫苗副作用、自覺障礙性低，以及德國麻疹抗體陰性婦女克服施打障礙的可能性，其未來補接種疫苗之意願越高；在願付價格方面，雖然健康信念模式與願付價格無顯著關係，但每月家戶收入為顯著因素。若願付價格分三區間，則受到德國麻疹抗體陰性婦女是否全職工作與每月家戶收入影響
建議未來衛生教育策略，應強化婦女克服他人不知持其施打疫苗之障礙，以及提供疫苗安全性、疫苗的費用等其他資訊，以提升未來補施打意願。若德國麻疹抗體陰性婦女未來需要額外自費補施打MMR疫苗，政府應該考慮財務的可近性以降低財務障礙，亦須為有全職工作者考量時間成本。

Abstract
Objective
To examine the factors associated with the intention and the willingness of women to pay for the Measles, Mumps and Rubella (MMR) vaccination.

Data Sources
We used data from the research called “A pilot study of implementing catch-up immunization program through pre-conceptional and prenatal screening to eliminate congenital rubella sundrome (CRS)” sponsored by the Taipei Department of Health. This study has designed a questionnaire based on the Health Belief Model, where the Content Validity Index (CVI) was above 0.95, and its internal consistency measure (Cronbach's Alpha) was greater than 0.7. There were 139 women whose antibodies were negative during their preconceptional check up program by the Taipei city government from 2012 to 2013 or their prenatal care in Taipei City Hospital, Fuyu Branch, from 2010 to year 2012, that were collected from this study, and we used 99 of these women who had never been vaccinated at the time of the survey. After deleting the cases with missing data, there were 88 and 89 women who were then used to analyze the factors associated with their intention of having a vaccination or not as well as their degrees of intentions respectively. In addition, there were 89 women who were used to analyze the factors associated with their willingness to pay (WTP).

Methods
In addition to descriptive statistics, this study also used correlation analysis and other measures of association, to analyze the correlation and the strength of association between the independent variables and the two independent variables, intentions, and the WTP. Based on the nature of dependent variables, we used statistical methods such as regression model, ordered logit model, and logistic regression model, to analyze the factors associated with the intention and the WTP for an MMR vaccination after controlling for the socio-demographic variables, previous medical history, previous vaccinations, knowledge of rubella, and the congenital rubella syndrome.

Results
After controlling for other variables, and the lowering of their perceived barriers, the more likely they would be to have an MMR in the future (OR=1.29; p=0.012); the higher self-efficacy, the higher the degree of their intention of receiving an MMR (p=0.013). Moreover, the mean of willingness to pay for the MMR was NT$1,395.51, standard deviation was NT$1,154.08. The significant factor affecting the WTP was their monthly household income (p<0.01). If the WTP was categorized into three, then the significant factors included household income (p=0.003), and full-time workers status (p=0.01).

Conclusions and Recommendations
In terms of whether or not the women would receive an MMR vaccination, factors such as it was less likely that the women were affected by their significant others to not procure the vaccination, minor concerns about the possible side effects of the vaccination, lower barriers, and the more likely the women could overcome the barriers, then the higher the intention that they would have an MMR vaccination. In terms of the WTP, although the health belief model could not predict the WTP, other factors such as household monthly income were a significant factor. If the WTP was classified into three categories, monthly household income, and whether the women were full-time workers, could determine the amount of the WTP.
In conclusion, our study suggested that the program needs to empower women who would be able to overcome numerous barriers of not being vaccinated raised from their significant others who did not support their choice for a vaccination, and focus more on safety, vaccination expenses, and other information, in order to increase the intention to proceed with the vaccination. If having the vaccination were to cause women to be out of pocket, then the government should not only consider ways of reducing the financial accessibility for the lower socioeconomic groups, but also should consider the time costs of those who are employed.

參考文獻
一、 中文部分
Kenneth J Bart、林邱鳳英、劉定萍、郭旭崧（2010）。根除三麻一風計畫－「麻疹、先天性德國麻疹症候群及新生兒破傷風之消除作業」評估。疫情報導，26（5）。
王恩慈、巫坤彬、黃子玫、吳炳輝（2008）。臺灣小兒麻痺症防治現況與未來方向。疫情報導，24（2）。
朱瑞虹、林陳立、盧妍瑾、吳慧娜、祝春紅（2004）。影響新婚夫婦接受婚前健康檢查之相關因素。北市醫學雜誌，1（3），319-330。
何麗莉、陳秋美、趙偉翔、池宜倩、黃惠萍、周雅萍、劉士豪（2012）。 全國3歲以下嬰幼兒照顧者決定攜子女接種流感疫苗之影響因素探討，疫情報導，28（3）。
李尹暘、林曉佩、林君怡（2007）。自我效能理論之分析與應用。澄清醫護管理雜誌，3（2），46-51。
林陳立、施淑芳（2015）。婦女補接種疫苗以防治先天性德國麻疹症候群胎兒之行為影響因素探討：以健康信念模式為框架。臺北市衛生局。
林敬旺、蔡文正、曾盈甄（2011）。父母對於青少女接種人類乳突病毒疫苗接受度與影響因素探討。澄清醫護管理雜誌，7（2）。
邱皓政（2010）。量化研究與統計分析 : SPSS(PASW)資料分析範例解析。臺北市:五南圖書。
疾病管制署（2014）。傳染病統計資料查詢系統。出自：http://nidss.cdc.gov.tw/NIDSS_Report.aspx?dt=2&dc=1&disease=056&d=3&i=0&s=determined_cnt&RK=Y&Y1=2009&Y2=2014&MW1=&MW2=&Area=0&City=0&Town=0&Q=H。
疾病管制署（2014）。預防接種統計。取自http://www.cdc.gov.tw/submenu.aspx?treeid=d78de698c2e70a89&nowtreeid=7e0b8ae9b025d6b1
許淑雲、廖宏恩、洪百薰、林柏煌、高昆裕、王俊毅（2010）。國小低年級學童家長對其子女接種流感疫苗意向之轉變情形及其相關因素分析—以雲林縣學童家長為例。臺灣公共衛生雜誌，29（4）。
陳如欣、陳淑芳、劉定萍（2013）。成人接種麻疹－腮腺炎－德國麻疹（MMR）疫苗建議。疫情報導，29（8），109-114。
勞動部（2015）。生育福利站。取自http://www.mol.gov.tw/23323/23325/
黃坤傑（2006）。女性消費者對再生衛生紙的願付價格：條件估價法與聯合分析比較（未出版之碩士論文）。國立政治大學，臺北市。
溫麗芬、洪麗珍、張彩秀（2008）。青少女自費接種子宮頸癌疫苗意向之相關因素探討。臺灣公共衛生雜誌，27（2）。
臺北市政府衛生局 (2014)。防麻煩記得帶家中寶貝去接種疫苗。取自http://www.health.gov.tw/Portals/0/%E7%96%BE%E7%97%85%E7%AE%A1%E5%88%B6%E8%99%95/%E6%80%A5%E6%80%A7%E5%82%B3%E6%9F%93%E7%97%85%E8%82%A1/1030428%E7%97%B2%E7%96%B9%E3%80%81%E5%BE%B7%E9%BA%BB%E6%96%B0%E8%81%9E%E7%A8%BF.pdf.
潘豐泉、黃俊英、蘇惠甘（2012）。家長特質對自費子宮頸癌疫苗接種之行為意圖影響效果。寶建醫護與管理雜誌，10（2），1-13。
蔡淑芬、楊世仰、許麗卿、王聖帆（2003）。臺灣地區孕婦德國麻疹抗體盛行率調查。出自：http://www.cdc.gov.tw/uploads/files/b9c5361a-3281-4070-982e-80f276b86984.pdf
衛生福利部（2014）。民國101年門、住診合計就診率統計----按性別及年齡別分。出自：http://www.mohw.gov.tw/cht/DOS/Statistic.aspx?f_list_no=312&fod_list_no=4718
二、 英文部分
Bandura, A. (1977a). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84 (2), 191-215.
Bandura, A. (1977b). Social learning theory. Englewood Cliffs, NJ: Prentice Hall.
Blue, C. L., & Valley, J. M. (2002). Predictors of influenza vaccine. Acceptance among healthy adult workers. Official journal of the American Association of Occupational Health Nurses, 50(5), 227-233.
Brewer, N. T., Gottlieb, S. L., Reiter, P. L., McRee, A. L., Liddon, N., Markowitz, L., & Smith, J. S. (2011). Longitudinal predictors of human papillomavirus vaccine initiation among adolescent girls in a high-risk geographic area. Sexually Transmitted Infections, 38(3), 197-204.
Butraporn, P., Pach, A., Pack, R. P., Masngarmmeung, R., Maton, T., Sri-aroon, P., . . . Chaicumpa, W. (2004). The health belief model and factors relating to potential use of a vaccine for shigellosis in Kaeng Koi district, Saraburi province, Thailand. Journal of Health, Population and Nutrition, 22(2), 170-181.
Chen, M. F., Wang, R. H., Schneider, J. K., Tsai, C. T., Jiang, D. D. S., Hung, M. N., & Lin, L. J. (2011). Using the Health Belief Model to Understand Caregiver Factors Influencing Childhood Influenza Vaccinations. Journal of Community Health Nursing, 28, 29-40.
Choi, K. B., Mo, H. S., & Kim, J. S. (2013). Factors associated with the intention to recommend human papillomavirus vaccination among Korean school health teachers. Journal for Specialists in Pediatric Nursing, 18(4), 297-310.
Gil, J. M., et al. (2000). Market segmentation and willingness to pay for organic products in Spain. The International Food and Agribusiness Management Review 3(2), 207-226.
Hadisoemarto, P. F., & Castro, M. C. (2013). Public acceptance and willingness-to-pay for a future dengue vaccine: a community-based survey in Bandung, Indonesia. PLOS Neglected Tropical Diseases, 7(9), e2427.
Hanemann, W. M. (1984). Welfare Evaluations in Contingent Valuation Experiments with Discrete Responses. American Journal of Agricultural Economics. 66(3), 332.
Hertweck, S. P., LaJoie, A. S., Pinto, M. D., Flamini, L., Lynch, T., & Logsdon, M. C. (2013). Health care decision making by mothers for their adolescent daughters regarding the quadrivalent HPV vaccine. Journal of Pediatric & Adolescent Gynecology, 26(2), 96-101.
Hou, Z., Jie, C., Yue, D., Fang, H., Meng, Q., & Zhang, Y. (2014). Determinants of willingness to pay for self-paid vaccines in China. Vaccine, 32(35), 4471-4477.
Johnston, S. S., Rousculp, M. D., Palmer, L. A., Chu, B. C., Mahadevia, P. J., & Nichol, K. L. (2010). Employees' willingness to pay to prevent influenza. American Journal of Managed Care, 16(8), e205-214.
Lau, J. T., Mo, P. K., Cai, Y. S., Tsui, H. Y., & Choi, K. C. (2013). Coverage and parental perceptions of influenza vaccination among parents of children aged 6 to 23 months in Hong Kong. BMC Public Health, 13, 1026.
Liao, Q., Cowling, B. J., Lam, W. W., & Fielding, R. (2011). Factors affecting intention to receive and self-reported receipt of 2009 pandemic (H1N1) vaccine in Hong Kong: a longitudinal study. PLoS One, 6(3), e17713.
Lin, C. C., Yang, C. Y., Shih, C. T., Chen, B. H., & Huang, Y. L. (2010). Rubella seroepidemiology and catch-up immunization among pregnant women in Taiwan: comparison between women born in Taiwan and immigrants from six countries in Asia. The American Journal of Tropical Medicine and Hygiene, 82(1), 40-44.
Lin, C. C., Yang, C. Y., Shih, Y. L., Hsu, H. W., Yang, T. H., Cheng, Y. W., . . . Huang, Y. L. (2011). Rubella seroepidemiology and estimations of the catch-up immunisation rate and persistence of antibody titers in pregnant women in Taiwan. An International Journal of Obstetrics and Gynaecology, 118(6), 706-712.
McLean, H. Q., Fiebelkorn, A. P., Temte, J. L., & Wallace, G. S. (2013). Prevention of measles, rubella, congenital rubella syndrome, and mumps, 2013: summary recommendations of the Advisory Committee on Immunization Practices (ACIP). Morbidity and Mortality Weekly Report, 62(Rr-04), 1-34.
Modlin, J. F., Herrmann, K., Brandling-Bennett, A. D., Eddins, D. L., & Hayden, G. F. (1976). Risk of congenital abnormality after inadvertent rubella vaccination of pregnant women. The New England Journal of Medicine, 294(18), 972-974.
Myers, L. B., & Goodwin, R. (2011). Determinants of adults' intention to vaccinate against pandemic swine flu. BMC Public Health, 11(1), 15.
Roberto, A. J., Krieger, J. L., Katz, M. L., Goei, R., Jain, P.. (2011). "Predicting pediatricians' communication with parents about the human papillomavirus (hpv) vaccine: an application of the theory of reasoned action. Journal of Health Communication. 26(4),303-312.
Shahrabani, S., Benzion, U., & Yom Din, G. (2009). Factors affecting nurses' decision to get the flu vaccine. The European Journal of Health Economics, 10(2), 227-231.
Simons-Morton, B. G., McLeroy, K. R., & Wendel, M. L. (2012). Behavior theory in health promotion practice and research. Burlington, MA: Jones & Bartlett Learning.
Su, S. B., & Guo, H. R. (2002). Seroprevalence of rubella among women of childbearing age in Taiwan after nationwide vaccination. The American Journal of Tropical Medicine and Hygiene, 67(5), 549-553.
Teitler-Regev, S., Shahrabani, S., & Benzion, U. (2011). Factors Affecting Intention among Students to Be Vaccinated against A/H1N1 Influenza: A Health Belief Model Approach. Advances in Preventive Medicine, 2011.
Tseng, H. F., Chang, C. K., Tan, H. F., Yang, S. E., & Chang, H. W. (2006). Seroepidemiology study of rubella antibodies among pregnant women from seven Asian countries: evaluation of the rubella vaccination program in Taiwan. Vaccine, 24, 29-30.
Wang, M., Liao, C., Yang, S., Zhao, W., Liu, M., & Shi, P. (2012). Are people willing to buy natural disaster insurance in China? Risk awareness, insurance acceptance, and willingness to pay. Risk Analysis, 32(10), 1717-1740.
Wertenbroch, K. and B. Skiera (2002). Measuring Consumers' Willingness to Pay at the Point of Purchase. Journal of Marketing Research, 39(2), 228-241.