研究目的:
了解南部四間國軍醫院醫療工作人員，在COVID-19流行期間，對於相關知識、預防COVID-19態度與接種COVID-19疫苗行為之關聯性。
方法：
本研究採橫斷性（cross-sectional）研究設計，論文架構採取知識、態度、行為模式。其中態度面向參考健康信念模式分為罹病性、嚴重性、利益性、障礙性四面項。依據國內外相關資料，以自擬結構式設計問卷，自2021年7月03日至2021年8月15日期間，採網路軟體 (Survey cake)蒐集研究問卷。共收集693份，扣掉無效問卷31份，有效問卷樣本數為662份。
結果:
在知識量表得分上，國軍屏東分院較國軍高雄總醫院高；工作年資16年(含)以上較1~5年者高；已婚、離婚/分居較喪偶者高；有運動習慣或定期接受流感疫苗者分數較高。在自覺罹病方面，無抽菸習慣或定期接種流感疫苗者分數較高。在自覺嚴重方面，醫師較護理師（士)高；已婚已生育子女較未婚/單身者高；有定期接受流感疫苗者高。自覺利益量表方面，男性或有運動習慣者有較高的分數。自覺障礙量表方面，國軍高雄總醫院較屏東分院高；大學(專)較研究所(含)以上分數高；護理師（士)或行政人員較醫師分數高；女性、無運動習慣、無定期接受流感疫苗者分數較高。在正向施打行為方面，有運動習慣、定期接受流感疫苗者分數較高。在反向施打行為方面，25-34歲較35-44歲者高；護理師較醫師高；未婚者較已婚已生育子女者分數高；女性、無運動習慣、無定期接受流感疫苗者分數較高。在量表之間相關性，知識量表總分和自覺罹病、自覺嚴重、自覺利益、正向施打疫苗行為總分呈現正相關，和自覺障礙、反向施打行為總分呈負相關。正向施打行為總分和自覺罹病、自覺嚴重、自覺利益總分呈現正相關，和自覺障礙總分呈負相關。反向行為總分和自覺障礙總分呈現正相關，和自覺利益總分呈現負相關。
結論:
醫院應定期舉辦院內相關教育課程，鼓勵各職類員工參與院外線上或實體課程，即時更新COVID-19正確資訊，以提昇其醫療照護和對民眾衛教能力。針對護理人員或年輕育齡員工，除需加強衛教工作以消除其對於疫苗保護力的疑慮，也要保障特定疫苗的施打，以增加其施打COVID-19疫苗之意願和行為。此外，鼓勵員工參與院內外的相關健康促進活動，如員工運動會和定期接種流感疫苗，以提升其預防COVID-19態度和施打疫苗行為。單位主管也需主動關心員工心理和其家庭問題，使醫療工作人員在長時間及壓力大的工作環境下，更有信心戰勝COVID-19。

Purposes:
To understand the relationship between the COVID-19 knowledge, COVID-19 prevention attitudes, and COVID-19 vaccination behaviors of the health care workers in the 4 armed forces general hospitals in southern Taiwan during the COVID-19 pandemic.

Methods:
This research is a cross-sectional study adopting the knowledge–attitude–behavior model, with the attitude dimension consisting of 4 subdimensions according to the health belief model, namely perceived susceptibility, perceived severity, perceived benefits, and perceived barriers. A self-developed structured questionnaire was designed according to relevant data worldwide; it was distributed and collected from July 3 to August 15, 2021 using SurveyCake. A total of 693 responses were gathered, and 31 invalid ones were excluded, leaving a total of 662 valid responses.

Results:
On the knowledge scale, the respondents from the Pingtung branch of Kaohsiung Armed Forces General Hospital scored higher than those from the main branch; those who had worked for no shorter than 16 years scored higher than those who had worked for 1–5 years; those who were married or divorced or separated scored higher than those who were widowed; those who had exercise habits or regularly received flu vaccinations scored higher. On perceived susceptibility, the respondents who had no smoking habits or regularly received flu vaccinations scored higher. On perceived severity, the doctors scored higher than the nursing professionals; the respondents who were married and had children scored higher than those who were single; those who regularly received flu vaccinations scored higher than those who did not. On perceived benefits, the respondents who were male or had exercise habits scored higher. On perceived barriers, the respondents from the main hospital scored higher than those from the Pingtung branch; those with college or university degrees scored higher than those with the master’s or doctor’s degrees; those who worked as nursing professionals or administrative personnel scored higher than doctors; those who were female or had no exercise habits or did not regularly receive flu vaccinations scored higher than the others. On positive vaccination behaviors, the respondents who had exercise habits or regularly received flu vaccinations scored higher than those who did not. On negative vaccination behaviors, the respondents who were aged 25–34 scored higher than the age group of 35–44 years; those who worked as nursing professionals scored higher than those who worked as doctors; those who were were single scored higher than those who married and had children; those who were female or did not have exercise habits or did not regularly receive flu vaccination scored higher. The total score on the knowledge scale was positively correlated with perceived susceptibility, perceived severity, perceived benefits, and positive vaccination behaviors but negatively correlated with perceived barriers and negative vaccination behaviors. The total score on positive vaccination behaviors was positively correlated with perceived susceptibility, perceived severity, and perceived benefits but negatively correlated with perceived barriers. The total score on negative vaccination behaviors was positively correlated with perceived barriers but negatively correlated with perceived benefits.
Conclusion:
Hospital authorities should regularly host relevant in-hospital courses, motivate all employees to participate in online or in-person courses outside their hospitals, and update correct information on COVID-19 on a real-time basis to improve hospitals’ capacity to provide medical care and educate people. Nursing professionals and young employees of childbearing age must reinforce their health education to mitigate their doubts about the protective power of vaccines; they must also have their reception of specific vaccines guaranteed to increase their COVID-19 vaccination intentions and behaviors. Employees must be encouraged to participate in relevant health promotion events inside and outside their hospitals, such as employee sports games and regular flu vaccinations, to promote their COVID-19 prevention attitudes and vaccination behaviors. Administrative personnel are required to actively pay attention to employees’ psychological and family problems to improve their confidence in combatting the COVID-19 pandemic in the long-term and stressful work environment.

口試委員論文審定書…………………………………………………………………i
致謝………………………………………………………………………………… ii
中文摘要…………………………………………………………………………… iii
Abstract………………………………………………………………………………v
圖次………………………………………………………………………………… ix
表次……………………………………………………………………………………x
第一章 緒論……………………………………………………………………… 1
第二章 文獻探討………………………………………………………………… 4
第三章 研究方法………………………………………………………………… 16
第四章: 研究結果與分析………………………………………………………… 25
第一節: 描述性性統計分析……………………………………………………25
第二節 基本人口學與知識量表相關性……………………………………….33
第三節 基本人口學與態度量表分項之相關………………………………….36
第四節 基本人口學與疫苗施打行為之相關性……………………………….47
第五節 量表間相關性………………………………………………………….53
第五章 討論……………………………………………………………………… 56
研究限制…………………………………………………………………………… 62
建議與結論………………………………………………………………………… 63
研究貢獻…………………………………………………………………………… 64
參考文獻…………………………………………………………………………… 65
附錄………………………………………………………………………………… 73

中文文獻

COVID-19 疫苗 孕婦諮詢要點. (2021, June 22). 台灣婦產科醫學會. https://www.taog.org.tw/news_contain_page.php?SN=184

陳鈺欣, 林巧雯, 王功錦, 賴珮芳, 柯靜芬, & 劉碧隆. (2020). 2020 年敦睦艦隊嚴重 特殊傳染性肺炎個案疫情調查. 疫情報導, 36(19), 311-315.

洪毓琪 . (2021, March 4). 首批AZ疫苗來了！全台31萬醫護僅37％能接種，誰能優先施打？. 遠見. https://www.gvm.com.tw/article/78233

鄭兆堅, 賴重宇, 王韵宜, & 李英俊. (2016). 南部兩間國軍醫院醫療工作者對預防流感之知識, 態度與接種疫苗行為之探討. 醫務管理期刊, 17(1), 46-62.

嚴重特殊傳染性肺炎. (2020, April 27). 衛生福利部疾病管制署a. https://www.cdc.gov.tw/Category/Page/vleOMKqwuEbIMgqaTeXG8A

新增12例COVID-19境外移入確定病例. (2021, November 27). 衛生福利部疾病管制署b. https://www.cdc.gov.tw/Bulletin/Detail/l5TWIq4FmR_R3yAuW40-iA?typeid=9

敦睦艦隊群聚調查結果出爐，疫情僅止於磐石艦. (2020, May 27). 衛生福利部疾病管制署c. https://www.cdc.gov.tw/Bulletin/Detail/ZcopDNy9TjfFRtgy8RJuTA?typeid=9

衛福部桃園醫院事件. (2021, March 31). 衛生福利部疾病管制署d. https://covid19.mohw.gov.tw/ch/cp-5122-58855-205.html

疫苗簡介. (2021, November 29). 衛生福利部疾病管制署e. https://www.cdc.gov.tw/Category/MPage/epjWGimoqASwhAN8X-5Nlw

8. 孕婦及哺乳婦女. (2021, November 22). 衛生福利部疾病管制署f. https://www.cdc.gov.tw/Category/QAPage/aVLK2xpg8y3KYmkLK8X6iA
英文文獻

Alexander, P. A., & Jetton, T. L. (2000). Learning from text: A multidimensional and developmental perspective.
Allport, G. W. (1935). Attitudes: a handbook of social psychology. Worcester, 2
Al Sulayyim, H. J., Al-Noaemi, M. C., Rajab, S. M., Daghriri, H. A., Al Yami, S. M., Al-Rashah, A. S., ... & Al Salom, M. H. (2020). An assessment of healthcare workers knowledge about COVID-19. Open Journal of Epidemiology, 10(03), 220.
Biswas, N., Mustapha, T., Khubchandani, J., & Price, J. H.(2021). The Nature and Extent of COVID-19 Vaccination Hesitancy in Healthcare Workers. Journal of Community Health, 1-8.
Centers for Disease Control and Prevention. Overview, History, and How the Safety Process Works. (2020, September 9). https://www.cdc.gov/vaccinesafety/ensuringsafety/history/index.html
Costa, M. F. (2020). Health belief model for coronavirus infection risk determinants. Revista de Saúde Pública, 54.
Dror, A. A., Eisenbach, N., Taiber, S., Morozov, N. G., Mizrachi, M., Zigron, A., ... & Sela, E. (2020). Vaccine hesitancy: the next challenge in the fight against COVID-19. European journal of epidemiology, 35(8), 775-779.
Elbeshbishi, S. (2021). Nearly 40% of Marines decline COVID-19 vaccine, prompting some Democrats to urge Biden to set mandate for the military. USA Today. April, 10.
Fitzpatrick, M. (2006). The cutter incident: How America's first polio vaccine led to a growing vaccine crisis. Journal of the Royal Society of Medicine, 99(3), 156-156.
Gharpure, R., Guo, A., Bishnoi, C. K., Patel, U., Gifford, D., Tippins, A., ... & Link-Gelles, R. (2021). Early COVID-19 first-dose vaccination coverage among residents and staff members of skilled nursing facilities participating in the pharmacy partnership for long-term care program—United States, December 2020–January 2021. Morbidity and Mortality Weekly Report, 70(5), 178.
Grewal, V. S., Sharma, P. A., Rani, R., Jain, A., & Kotwal, A. (2021). Knowledge, attitude, practices, and behavior regarding COVID-19 among serving personnel of a large military garrison: a quick online cross-sectional survey. Medical Journal Armed Forces India, 77, S443-S449.
Liz hamel, ashley kirzinger, cailey muñana , & mollyann brodie. (2020, December 15). KFF COVID-19 Vaccine Monitor: December 2020. KFF. https://www.kff.org/coronavirus-covid-19/report/kff-covid-19-vaccine-monitor-december-2020/
Huynh, G., Nguyen, T. N. H., Vo, K. N., & Pham, L. A. (2020). Knowledge and attitude toward COVID-19 among healthcare workers at District 2 Hospital, Ho Chi Minh City. Asian Pacific Journal of Tropical Medicine, 13(6), 260
Kassie, B. A., Adane, A., Tilahun, Y. T., Kassahun, E. A., Ayele, A. S., & Belew, A. K. (2020). Knowledge and attitude towards COVID-19 and associated factors among health care providers in Northwest Ethiopia. PloS one, 15(8), e0238415.
Khader, Y., Al Nsour, M., Al-Batayneh, O. B., Saadeh, R., Bashier, H., Alfaqih, M., & Al-Azzam, S. (2020). Dentists’ awareness, perception, and attitude regarding COVID-19 and infection control: cross-sectional study among Jordanian dentists. JMIR public health and surveillance, 6(2), e18798
Khubchandani, J., Sharma, S., Price, J. H., Wiblishauser, M. J., Sharma, M., & Webb, F. J. (2021). COVID-19 vaccination hesitancy in the United States: a rapid national assessment. Journal of Community Health, 46(2), 270-277.
Kose, S., Mandiracioglu, A., Sahin, S., Kaynar, T., Karbus, O., & Ozbel, Y. (2021). Vaccine hesitancy of the COVID‐19 by health care personnel. International Journal of Clinical Practice, 75(5), e13917.
Krammer, F. (2020). SARS-CoV-2 vaccines in development. Nature, 586(7830), 516-527
Lang, M. A., Stahlman, S., Wells, N. Y., Fedgo, A. A., Patel, D. M., Chauhan, A., & Mancuso, J. D. (2021). Disparities in COVID-19 Vaccine Initiation and Completion Among Active Component Service Members and Health Care Personnel, 11 December 2020-12 March 2021. MSMR, 28(4), 2-9.
Ledda, C., Costantino, C., Cuccia, M., Maltezou, H. C., & Rapisarda, V. (2021). Attitudes of Healthcare Personnel towards Vaccinations before and during the COVID-19 Pandemic. International Journal of
Environmental Research and Public Health, 18(5), 2703.
Li, C. P. C., Theis, C. S. R., Kelly, M. D., Ocampo, L. C. T., Berglund, C. A., Morgan, M. D., ... & Burtson, M. K. (2021). Impact of an education intervention on COVID-19 vaccine hesitancy in a military base population. Military medicine.
Mahmud, I., Kabir, R., Rahman, M. A., Alradie-Mohamed, A., Vinnakota, D., & Al-Mohaimeed, A. (2021). The health belief model predicts intention to receive the covid-19 vaccine in saudi arabia: Results from a cross-sectional survey. Vaccines, 9(8), 864.
Mehrotra, S., Jambunathan, P., Jindal, M., Gupta, A., & Kapoor, K. (2021). A cross-sectional survey to assess the knowledge regarding coronavirus disease (COVID-19) among health care professionals. Medical Journal Armed Forces India, 77, S437-S442
Puspitasari, I. M., Yusuf, L., Sinuraya, R. K., Abdulah, R., & Koyama, H. (2020). Knowledge, attitude, and practice during the COVID-19 pandemic: A review. Journal of multidisciplinary healthcare, 13, 727
Rosenstock, I. M., Strecher, V. J., & Becker, M. H. (1988). Social learning theory and the health belief model. Health education quarterly, 15(2), 175-183.

Sallam, M. (2021). COVID-19 vaccine hesitancy worldwide: a concise systematic review of vaccine acceptance rates. Vaccines, 9(2), 160.
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.
Shereen, M. A., Khan, S., Kazmi, A., Bashir, N., & Siddique, R. (2020). COVID-19 infection: Origin, transmission, and characteristics of human coronaviruses. Journal of advanced research, 24, 91–98. https://doi.org/10.1016/j.jare.2020.03.005
Slama, H., El Kefi, H., Taamallah, K., Stambouli, N., Baffoun, A., Samoud, W., ... & Gharsallah, H. (2021). Immediate Psychological Responses, Stress Factors, and Coping Behaviors in Military Health-Care Professionals During the COVID-19 Pandemic in Tunisia. Frontiers in psychiatry, 12, 734.
The History of Vaccine, an Educational Resource By The College Of Philadelphia (2010.October 12). Vaccine Development, Testing, and Regulation. https://www.historyofvaccines.org/content/articles/vaccine-development-testing-and-regulation
Wong, M. C., Wong, E. L., Huang, J., Cheung, A. W., Law, K., Chong, M. K., ... & Chan, P. K. (2021). Acceptance of the COVID-19 vaccine based on the health belief model: A population-based survey in Hong Kong. Vaccine, 39(7), 1148-1156.)
World Health Organization. Advice for the Public: Coronavirus Disease (COVID-19). (2021, October 1). https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public
World Health Organization. 10 Vaccines Granted Emergency Use Listing (EUL) by WHO. (2021, December10). https://covid19.trackvaccines.org/agency/who/
Yesse, M., Muze, M., Kedir, S., Argaw, B., Dengo, M., Nesre, T., ... & Ayelign, H. (2021). Assessment of knowledge, attitude and practice toward COVID-19 and associated factors among health care workers in Silte Zone, Southern Ethiopia. PloS one, 16(10), e0257058.
Zambrano, L. D., Ellington, S., Strid, P., Galang, R. R., Oduyebo, T., Tong, V. T.,& Zapata, L.(2020). Update: characteristics of symptomatic women of reproductive age with laboratory-confirmed SARS-CoV-2 infection by pregnancy status—United States, January 22–October 3, 2020. Morbidity and Mortality Weekly Report, 69(44), 1641.
Zhang, M., Zhou, M., Tang, F., Wang, Y., Nie, H., Zhang, L., & You, G. (2020). Knowledge, attitude, and practice regarding COVID-19 among healthcare workers in Henan, China. Journal of Hospital Infection, 105(2), 183-187.
Zhong, B. L., Luo, W., Li, H. M., Zhang, Q. Q., Liu, X. G., Li, W. T., & Li, Y. (2020). Knowledge, attitudes, and practices towards COVID-19 among Chinese residents during the rapid rise period of the COVID-19 outbreak: a quick online cross-sectional survey. International journal of biological sciences, 16(10), 1745.