研究背景：口腔癌為我國十大癌症之一，男性發生率居高不下，與嚼檳、吸菸行為密切相關。雖然我國政府自2004年起推動口腔癌篩檢政策，針對高風險族群提供免費口腔黏膜檢查，但近年篩檢率持續下降，部分患者確診前兩年未曾篩檢。已有研究指出，個人知識、風險認知及心理障礙等皆可能影響篩檢參與意願，需進一步探討影響篩檢意圖的相關因素。
研究目的：本研究旨在透過問卷建構與資料蒐集，探討影響民眾接受口腔黏膜篩檢意圖之因素。研究目的包括：（一）建構用以衡量口腔黏膜篩檢意圖之問卷工具；（二）建立健康信念模式對篩檢意圖之解釋模型；（三）進一步納入癌症宿命論、癌症恐懼及知識等社會心理構面，建構擴充後的解釋模型；（四）檢驗模型中是否存在中介效果。
研究方法：本研究採橫斷式問卷調查設計，旨在建構影響民眾接受口腔黏膜篩檢意圖之問卷，並評估其相關影響因素。研究首先發展結構式問卷，內容涵蓋人口社會背景、口腔癌相關知識、健康信念模式六大構念（自覺嚴重性、自覺易感性、行動利益、行動障礙、自我效能、行動線索）、社會心理面向（癌症宿命論、癌症恐懼），以及作為主要結果變項的篩檢意圖。問卷通過人體試驗審查（IRB）後，進行匿名問卷施測與資料蒐集。在研究策略上，為確保量表具備良好信效度與結構穩定性，本研究首先以無吸菸與無嚼檳經驗之低風險組進行探索性因素分析（Exploratory Factor Analysis, EFA），以建立潛在構念之因素結構與題項歸屬。EFA分析前進行KMO與Bartlett球形檢定確認資料適用性，採用主成分分析法（PCA）進行因素萃取，並以Varimax轉軸，建構具建構效度之量表。接續以中低風險、中風險與高風險組（即具吸菸或嚼檳者）樣本進行驗證性因素分析（Confirmatory Factor Analysis, CFA）與結構方程模型（Structural Equation Modeling, SEM）分析，建構並比較三種理論模型：《模型一：健康信念模式模型》、《模型二：健康信念模式擴充模型》以及《模型三：健康信念模式擴充模型（含中介因子）》。SEM分析採用最大概似估計法（MLE），並以CFI、TLI、RMSEA、SRMR、AIC、BIC及R²等指標評估模型之適配度與解釋力，同時使用bootstrap法估計間接效應之信賴區間，以檢驗中介效果是否成立。最後使用路徑分析探討篩檢意圖的形成路徑與變項之間的關聯性。
研究結果：本研究共回收757份有效問卷，樣本以50–59歲男性為主（93.8%），教育程度以高中職最多（65.4%）。高風險組具較低教育與知識分數，癌症宿命論與行動障礙得分較高，顯示其面臨更多篩檢障礙與消極信念。量表經EFA與CFA驗證，具良好建構效度與內部一致性。結構方程模型分析結果顯示，《模型二：健康信念模式擴充模型》為最佳解釋模型（R²=53%、CFI=0.904、TLI=0.891、RMSEA=0.082），在理論與統計表現上均優於其他模型。模型中，行動線索（β=0.47, p<.001）為影響篩檢意圖最強的正向因子，其次為自我效能（β=0.15, p=0.01）與自覺易感性（β=0.08, p=0.03），癌症宿命論為負向影響因子（β=−0.11, p=0.02）。
結論：本研究針對高風險族群（嚼檳與吸菸者）進行口腔黏膜篩檢意圖之探討，結果顯示篩檢意圖受到多項因素影響，包括個人健康信念、自我效能、內外在誘因與癌症宿命觀等。高風險組具較高的行動障礙與宿命論傾向，知識與誘因接受度較低，導致其篩檢意圖與行動落差明顯。研究建構並驗證「健康信念模式擴充模型」，具良好適配度與最高解釋力（R²=53%），其中以「行動線索」、「自我效能」與「自覺易感性」為正向顯著因子，癌症宿命論則具負向影響。而「知識」與「自覺嚴重性」，在本研究中並未對篩檢意圖產生顯著影響，顯示單純傳遞口腔癌相關知識或強調疾病後果的嚴重性，可能無法有效促進高風險族群之篩檢行為。

Oral cancer is one of the top ten cancers in Taiwan, closely linked to betel quid chewing and smoking. Despite a free screening policy since 2004, participation remains low, particularly among high-risk individuals. This gap between eligibility and behavior highlights the importance of understanding psychological and cognitive factors that ifluence screening intention.
This study aimed to develop a psychometrically sound questionnaire to assess intention to undergo oral mucosal screening. Grounded in the Health Belief Model (HBM), the study integrated psychosocial constructs including cancer fatalism, cancer fear, and oral cancer knowledge. Structural Equation Modeling (SEM) was used to construct explanatory models.
A total of 757 valid responses were collected, mostly from males aged 50–59. SEM results showed that the Extended Health Belief Model (Model 2) had the best fit and explanatory power (R² = 53%, CFI = 0.904, TLI = 0.891, RMSEA = 0.082). “Cues to action” (β = 0.47, p < .001) emerged as the strongest positive predictor of screening intention, followed by “self-efficacy” (β = 0.15, p = .01) and “perceived susceptibility” (β = 0.08, p = .03). “Cancer fatalism” was a significant negative predictor (β = −0.11, p = .02).Overall, health beliefs and psychosocial factors played critical roles in shaping screening intention. While cues to action and self-efficacy facilitated intention, fatalistic beliefs and perceived barriers hindered it. Notably, knowledge and perceived severity showed no significant effect, suggesting that traditional education-based messaging alone may not be sufficient. Interventions should instead focus on enhancing motivation, addressing psychological resistance, and empowering high-risk groups to act.

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