癌症一直以來都是全世界關注的項目，更是多年來國內十大死因之首，根據2019年統計資料顯示，男性十大癌症中口腔癌為發生率為前三名，死亡率則為前五名，而30-69歲人口之篩檢利用率僅47.2％。因此本研究主要欲利用知識、態度、行為模式探討民眾分別對於口腔癌防治之知識、態度與行為之差異與三者之間的相關性。
本研究使用線上問卷調查的方式收集資料，共計回收250份問卷，篩選排除8份無效問卷後，有效問卷為242份，採用IBM SPSS Statistics 22作為資料分析之研究工具，分析方法包含描述性統計、因素分析、獨立樣本t檢定、單因子變異分析、皮爾森相關係數、多元線性迴歸分析。
研究結果顯示，知識方面，部分民眾尚未釐清對於口腔癌病徵之相關知識；態度方面，部分民眾雖具有吸菸或嚼食檳榔者，應定期接受口腔癌篩檢之觀念，但對於此項目卻不一定持認同態度；行為方面，部分民眾較不會主動向親友宣導口腔癌防治的資訊，執行意願較低。而在防治知識、態度、行為三者之間皆具有顯著正相關。

Cancer has always been a project of concern in the world, and it has been on the top of the ten causes of death in Taiwan for many years. According to 2019 statistics, the incidence of oral cancer in the top ten cancers in men is the top three, the mortality rate among the top five, and the screening usage rate of the population aged 30–69 is only 47.2%. Therefore, the purpose of this study is to use the knowledge, attitudes, and behavior model to explore the correlation between the differences in knowledge, attitudes, and behaviors toward oral cancer prevention among the public.
This study used an online questionnaire survey and collected 250 questionnaires. After screening and excluding 8 invalid questionnaires, the effective questionnaire was 242. IBM SPSS Statistics 22 was used as a research tool for data analysis, analytical methods included descriptive statistics, factor analysis, t-test, one way ANOVA, Pearson correlation coefficient, and multiple regression analysis.
The results of the study show that in terms of knowledge, some people have not yet clarified the relevant knowledge of the symptoms of oral cancer. In terms of attitude, although some people have the concept that smokers or who chew betel nuts should be screened regularly for oral cancer, they do not necessarily agree with this project. In terms of behavior, some people are less likely to take the initiative to promote oral cancer prevention and treatment information to relatives and friends, so their willingness to implement it is low. There is a significant positive correlation between prevention knowledge, attitudes, and behaviors.

論文審定書 i
誌謝 ii
摘要 iii
Abstract iv
目錄 v
圖次 vii
表次 vii
第壹章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 3
第三節 研究流程 3
第貳章 文獻探討 5
第一節 口腔癌與其危險因素 5
第二節 口腔癌篩檢 7
第三節 口腔癌防治之知識、態度與行為 8
第四節 重點文獻整理 11
第五節 文獻探討小結 14
第參章 研究方法 15
第一節 研究架構與假設 15
第二節 研究對象與資料來源 16
第三節 問卷設計 17
第四節 問卷信效度分析 21
第五節 資料處理與統計分析 23
第肆章 研究結果 25
第一節 描述性統計分析 25
第二節 問卷因素分析 34
第三節 推論性統計分析 38
第四節 研究假設與研究結果驗證彙整 56
第伍章 討論 57
第一節 研究樣本之人口學特性 57
第二節 研究結果討論 57
第陸章 結論與建議 67
第一節 研究結論 67
第二節 研究限制 68
第三節 研究貢獻 68
第四節 未來建議 69
參考文獻 70
附錄 78
附錄一 專家效度問卷 78
附錄二 正式問卷 84

李茹萍（2015）。癌症預防策略與癌症存活者之照護需求概論。源遠護理，9(2)，29-34。doi:10.6530/YYN/2015.5.05
周穆謙、林以容（2015）。癌症篩檢宣導海報之說服效果探討。資訊傳播研究，6(1)，1-27。doi:10.6144/JIC.2015.0601.01
邱南英 (2012)。吸菸的行為和心理因素、戒菸的心理障礙。血管醫學防治季刊(11)，2-3。doi:10.6527/pvm.2012.11.2
許志源、張彩秀 (2009)。社區中老年人口腔保健行為、口腔狀態與口腔相關生活品質之探討。Taiwan Journal of Oral Medicine Sciences，25(1)，49-63。 doi:10.7059/tjoms.200904.0049
曾光毅、曾嵩智（2011）。現階段口腔癌的預防與治療。家庭醫學與基層醫療，26(5)，215-224。doi:10.6965/FMPMC.201105.0215
黃振勳、郭生興、郭英雄（1994）。口腔癌在臺灣：文獻回顧。中華民國口腔顎面外科學會雜誌，5(1)，13-22。doi:10.7104/CJOMS.199403.0008
楊明仁、鍾奇諺、郭千綺、何啟功、何內一郎 (1996)。工作性質與工作場所次文化對個人飲酒行為之影響－一項探索性前驅研究。The Kaohsiung Journal of Medical Sciences，12(6)，339-347。doi:10.6452/kjms.199606.0339
謝錦琳（2007）。民眾對口腔癌知識、防治態度及預防行為的研究。秀傳醫學雜誌，7(1&2)，21-32。
羅英毓、王森德、李芸霏、蘇千田（2010）。口腔癌危險因子與癌前病變。家庭醫學與基層醫療，25(8)，310-317。doi:10.6965/FMPMC.201008.0310
衛生福利部國民健康署(2022)。口腔癌防治。2022年3月，取自https://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=613&pid=1118。
衛生福利部國民健康署(2022)。108年癌症登記報告。2022年5月，取自https://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=269&pid=14913。
台灣癌症登記中心(2020)。存活分析。2022年5月，取自https://twcr.tw/?page_id=1804。
衛生福利部國民健康署(2021)。108年健康促進統計年報。2022年6月，取自https://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=268&pid=14567。
衛生福利部心理及口腔健康司(2017)。106-110年國民口腔健康促進計畫。2022年6月，取自https://dep.mohw.gov.tw/domhaoh/cp-486-1917-107.html。
衛生福利部國民健康署(2021)。國人吸菸行為調查結果。2022年8月，取自https://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=1718&pid=9913。
南投縣政府衛生局(2019)。定期口腔檢查的好處。2022年8月，取自https://www.kingnet.com.tw/news/single?newId=35234。
中華民國內政部戶政司全球資訊網(2022)。人口統計資料。2022年9月，取自https://www.ris.gov.tw/app/portal/346。
Brocklehurst, P., Kujan, O., O'Malley, L. A., Ogden, G., Shepherd, S., & Glenny, A. M. (2013). Screening programmes for the early detection and prevention of oral cancer. Cochrane Database Syst Rev, 2013(11), Cd004150. doi:10.1002/14651858.CD004150.pub4
Brown, L. M., Check, D. P., & Devesa, S. S. (2011). Oropharyngeal cancer incidence trends: diminishing racial disparities. Cancer Causes Control, 22(5), 753-763. doi:10.1007/s10552-011-9748-1
Chakraborty, D., Natarajan, C., & Mukherjee, A. (2019). Advances in oral cancer detection. Adv Clin Chem, 91, 181-200. doi:10.1016/bs.acc.2019.03.006
Chaurasia, A., Alam, S. I., & Singh, N. (2021). Oral cancer diagnostics: An overview. Natl J Maxillofac Surg, 12(3), 324-332. doi:10.4103/njms.NJMS_130_20
Chuang, S. L., Su, W. W., Chen, S. L., Yen, A. M., Wang, C. P., Fann, J. C., Chiu, S. Y., Lee, Y. C., Chiu, H. M., Chang, D. C., Jou, Y. Y., Wu, C. Y., Chen, H. H., Chen, M. K., & Chiou, S. T. (2017). Population-based screening program for reducing oral cancer mortality in 2,334,299 Taiwanese cigarette smokers and/or betel quid chewers. Cancer, 123(9), 1597–1609. https://doi.org/10.1002/cncr.30517
Croucher, R., Islam, S. S., & Nunn, H. (2011). Campaign awareness and oral cancer knowledge in UK resident adult Bangladeshi: a cross-sectional study. Br J Cancer, 105(7), 925-930. doi:10.1038/bjc.2011.317
Davis, L. L. (1992). Instrument review: Getting the most from a panel of experts. Applied Nursing Research, 5(4), 194-197. doi:https://doi.org/10.1016/S0897-1897(05)80008-4
Dhanuthai, K., Rojanawatsirivej, S., Thosaporn, W., Kintarak, S., Subarnbhesaj, A., Darling, M., Kryshtalskyj, E., Chiang, C. P., Shin, H. I., Choi, S. Y., Lee, S. S., & Aminishakib, P. (2018). Oral cancer: A multicenter study. Medicina oral, patologia oral y cirugia bucal, 23(1), e23–e29. https://doi.org/10.4317/medoral.21999
Di Giuseppe, G., Pelullo, C. P., Mitidieri, M., Lioi, G., & Pavia, M. (2020). Cancer Prevention: Knowledge, Attitudes and Lifestyle Cancer-Related Behaviors among Adolescents in Italy. International journal of environmental research and public health, 17(22), 8294. https://doi.org/10.3390/ijerph17228294
Ghani, W., Razak, I. A., Doss, J. G., Yang, Y. H., Rahman, Z., Ismail, S. M., Abraham, M. T., Wan Mustafa, W. M., Tay, K. K., & Zain, R. B. (2019). Multi-ethnic variations in the practice of oral cancer risk habits in a developing country. Oral diseases, 25(2), 447–455. https://doi.org/10.1111/odi.12995
Huang, C.-C., Ou, C.-Y., Lee, W.-T., Hsiao, J.-R., Tsai, S.-T., & Wang, J.-D. (2015). Life expectancy and expected years of life lost to oral cancer in Taiwan: A nation-wide analysis of 22,024 cases followed for 10 years. Oral Oncology, 51(4), 349-354. doi:https://doi.org/10.1016/j.oraloncology.2015.01.001
Huang, C. C., Lin, C. N., Chung, C. H., Hwang, J. S., Tsai, S. T., & Wang, J. D. (2019). Cost-effectiveness analysis of the oral cancer screening program in Taiwan. Oral Oncol, 89, 59-65. doi:10.1016/j.oraloncology.2018.12.011
Hulin, C., Netemeyer, R., & Cudeck, R. (2001). Can a Reliability Coefficient Be Too High? Journal of Consumer Psychology, 10(1/2), 55-58. Retrieved from http://www.jstor.org/stable/1480474
Hung, L. C., Kung, P. T., Lung, C. H., Tsai, M. H., Liu, S. A., Chiu, L. T., Huang, K. H., & Tsai, W. C. (2020). Assessment of the Risk of Oral Cancer Incidence in A High-Risk Population and Establishment of A Predictive Model for Oral Cancer Incidence Using A Population-Based Cohort in Taiwan. International journal of environmental research and public health, 17(2), 665. https://doi.org/10.3390/ijerph17020665
IARC. (2004). Tobacco smoke and involuntary smoking. IARC Monogr Eval Carcinog Risks Hum, 83, 1-1438.
Irani, S. (2020). New Insights into Oral Cancer-Risk Factors and Prevention: A Review of Literature. Int J Prev Med, 11, 202. doi:10.4103/ijpvm.IJPVM_403_18
Kaiser, H. F., & Rice, J. (1974). Little Jiffy, Mark Iv. Educational and Psychological Measurement, 34(1), 111-117. doi:10.1177/001316447403400115
Karadeniz, H., & Cetinkaya, F. (2020). Knowledge levels and attitudes of adult individuals about cancer and its risk factors. Nigerian journal of clinical practice, 23(11), 1607-1614. https://doi.org/10.4103/njcp.njcp_434_19
Lambert, R., Sauvaget, C., de Camargo Cancela, M., & Sankaranarayanan, R. (2011). Epidemiology of cancer from the oral cavity and oropharynx. Eur J Gastroenterol Hepatol, 23(8), 633-641. doi:10.1097/MEG.0b013e3283484795
Li, H.-W., Huang, C.-H., Chou, C., & Wang, T.-F. (2020). Knowledge, attitudes, practice and related factors of oral cancer prevention among public health nurses in Taiwan. European Journal of Cancer Care, 29(5), e13262. doi:https://doi.org/10.1111/ecc.13262
Mariño, R., Hopcraft, M., Ghanim, A., Tham, R., Khew, C.-W., & Stevenson, C. (2016). Oral health-related knowledge, attitudes and self-efficacy of Australian rural older adults. Gerodontology, 33(4), 530-538. doi:https://doi.org/10.1111/ger.12202
Mason, R. D., Lind, D. A., & Marchal, W. G. (1983). Statistics: An introduction. New York: Harcourt Brace Jovanovich.
Mehrotra, R., & Gupta, D. K. (2011). Exciting new advances in oral cancer diagnosis: avenues to early detection. Head Neck Oncol, 3, 33. doi:10.1186/1758-3284-3-33
Meshkani, Z., Moradi, N., Aboutorabi, A., Noman, S., Motlagh, A. G., & Langarizadeh, M. (2022). Systematic review of women's knowledge, attitude, and practice towards breast cancer. Journal of education and health promotion, 11, 171. https://doi.org/10.4103/jehp.jehp_634_21
Montero, P. H., & Patel, S. G. (2015). Cancer of the oral cavity. Surg Oncol Clin N Am, 24(3), 491-508. doi:10.1016/j.soc.2015.03.006
Nagao, T., & Warnakulasuriya, S. (2020). Screening for oral cancer: Future prospects, research and policy development for Asia. Oral Oncol, 105, 104632. doi:10.1016/j.oraloncology.2020.104632
Rivera, C. (2015). Essentials of oral cancer. Int J Clin Exp Pathol, 8(9), 11884-11894.
Rubio, D. M., Berg-Weger, M., Tebb, S. S., Lee, E. S., & Rauch, S. (2003). Objectifying content validity: Conducting a content validity study in social work research. Social Work Research, 27(2), 94-104. doi:10.1093/swr/27.2.94
Sankaranarayanan, R., Ramadas, K., Amarasinghe, H., Subramanian, S., & Johnson, N. (2015). Oral Cancer: Prevention, Early Detection, and Treatment. In H. Gelband (Eds.) et. al., Cancer: Disease Control Priorities, Third Edition (Volume 3). The International Bank for Reconstruction and Development / The World Bank.
Sankaranarayanan, R., Ramadas, K., Thomas, G., Muwonge, R., Thara, S., Mathew, B., & Rajan, B. (2005). Effect of screening on oral cancer mortality in Kerala, India: a cluster-randomised controlled trial. Lancet, 365(9475), 1927-1933. doi:10.1016/s0140-6736(05)66658-5
Saraswat, N., Everett, B., Pillay, R., Prabhu, N., Villarosa, A., & George, A. (2022). Knowledge, Attitudes and Practices of Indian Immigrants in Australia towards Oral Cancer and Their Perceived Role of General Practitioners: A Cross-Sectional Study. Int J Environ Res Public Health, 19(14). doi:10.3390/ijerph19148596
Saraswat, N., Pillay, R., Everett, B., & George, A. (2020). Knowledge, attitudes and practices of South Asian immigrants in developed countries regarding oral cancer: an integrative review. BMC Cancer, 20(1), 477. doi:10.1186/s12885-020-06944-9
Schwartz, N. E. (1975). Nutritional knowledge, attitudes, and practices of high school graduates1. Journal of the American Dietetic Association, 66(1), 28-31. doi:https://doi.org/10.1016/S0002-8223(21)14396-2
Sturgis, E. M. (2004). A review of social and behavioral efforts at oral cancer preventions in India. Head & Neck, 26(11), 937-944. doi:https://doi.org/10.1002/hed.20075
Subramanian, S., Sankaranarayanan, R., Bapat, B., Somanathan, T., Thomas, G., Mathew, B., Vinoda, J., & Ramadas, K. (2009). Cost-effectiveness of oral cancer screening: results from a cluster randomized controlled trial in India. Bulletin of the World Health Organization, 87(3), 200–206. https://doi.org/10.2471/blt.08.053231
Ursachi, G., Horodnic, I. A., & Zait, A. (2015). How Reliable are Measurement Scales? External Factors with Indirect Influence on Reliability Estimators. Procedia Economics and Finance, 20, 679-686. doi:https://doi.org/10.1016/S2212-5671(15)00123-9
Warnakulasuriya, S., Fennell, N., Diz, P., Seoane, J., Rapidis, A., & LDV Lifelong Learning Programme (2015). An appraisal of oral cancer and pre-cancer screening programmes in Europe: a systematic review. Journal of oral pathology & medicine : official publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology, 44(8), 559–570. https://doi.org/10.1111/jop.12267
Warnakulasuriya, S., & Kerr, A. R. (2021). Oral Cancer Screening: Past, Present, and Future. J Dent Res, 100(12), 1313-1320. doi:10.1177/00220345211014795
Weber, J. C., & Lamb, D. R. (1970). Statistics and research in physical education. Saint Louis: C.V. Mosby Co.
Wong, T., & Wiesenfeld, D. (2018). Oral Cancer. Aust Dent J, 63 Suppl 1, S91-s99. doi:10.1111/adj.12594
Yang, Y.-H., Warnakulasuriya, S., Yang, H.-F., Lin, L.-J., & Wang, Y.-W. (2020). Public health measures to reduce areca nut and betel quid use for control of oral cancer in Taiwan. Oral Oncology, 108, 104915. doi:https://doi.org/10.1016/j.oraloncology.2020.104915