目的：陳凱姿（2006）研究指出外籍配偶子女的兒童預防保健服務使用率較本國籍子女低，其主要原因為外籍配偶家庭對於醫療訊息獲得不足以及忘記預防保健服務的時間。許多研究指出透過主動接觸的介入措施可以有效的增加健兒篩檢的使用率，而且大多主動接觸的介入是透過郵寄單張和電話訪視來進行，因此本研究希望設計一個郵寄單張和電話訪視的介入措施研究，並評估此介入措施對外籍配偶子女兒童預防保健服務使用率上的成效，並描述影響兒童預防保健服務利用的因素。

方法：2008年1月1日-2008年12月31日出生，現居地為台南市、母親原始國籍為大陸籍與越南籍的外籍母親子女，以家戶為介入單位，介入組為郵寄單張和電話提醒，對照組為郵寄單張，介入開始於2008年6月1日，分析的資料為2009年5月31日前所收集到的對象資料。總共有403個外籍配偶家庭，203個介入組、200個對照組，扣除拒訪8個、漏失追蹤（去大陸或越南81個、遷址無法聯繫32個）、生產後死亡1個，總計完訪問卷為281份，而其中2008年6月1日後出生的幼童有168人，為一歲前可完整追蹤四次使用的資料。成效評估會依據兒童健康手冊的紀錄，以問卷詢問兒童之預防保健服務力用情形，並且詢問傾向因素、使能因素、需要因素等變項資料。資料收集是以訓練過的訪員採面談方式進行。

結果：介入組（89.08%）和對照組（87.80%）有極高的比例認為主動接觸方式，有助於提醒他們帶幼童接受兒童預防保健服務，介入組的前三次預防保健服務使用率分別為（78.49%、73.04%、94.07%），對照組的前三次預防保健服務使用率分別（73.33%、71.00%、92.92%），不過介入組第四次的使用率顯著高於對照組（60.32% vs. 29.03%，P<0.001）。若只針對2008年6月1號出生的幼童使用情形來分析也得到類似的結果，介入組（89.87%）和對照組（85.42%）有極高的比例認為主動接觸方式，有助於提醒他們帶幼童接受兒童預防保健服務，介入組的前三次預防保健服務使用率分別為（78.49%、73.04%、94.07%），對照組的前三次預防保健服務使用率分別（73.33%、71.00%、92.92%），不過第四次的使用率雖然兩組相差將近40%（88.89 vs. 50.00%），但因樣本數太小仍未達統計上顯著差異（介入組9個、對照組4個）。影響兒童預防保健服務的使用因素為：幼童胎次（第一胎使用情形較好）、母親職業（薪資較穩定的職業使用情形較好）、母親國籍（大陸籍母親子女使用情形較好）、家庭型態（小家庭型態使用情形較差）。

結論：對照組（郵寄單張）和介入組（電話提醒、郵寄單張）在前三次兒童預防保健服務使用成效相當，因為幼童照護者多半是帶幼童接種預防注射時才順便接受兒童預防保健服務，一旦兒童預防保健服務時程內沒有預防接種項目搭配，如同第四次的兒童預防保健服務時程，則電話加郵寄的主動介入方式相較於僅郵件通知的介入方式，更可以有效提升兒童預防保健服務的使用成效。

Object: A study by Chen (2006) shows that both the Vietnam and Mainland China groups had lower rates of utilizing the well baby care visits than native group. A study by Chen (2006) shows that both the Vietnam and Mainland China groups had lower rates of utilizing the well baby care visits than native group. The main reasons are lack of medical information and forgetting of the service time. Many studies have indicated that the outreach interventions can increase well-child visits. The mailed pamphlet or the phone call was the most commonly used and effective method for the outreach interventions. The purpose of this study was to assess and compare the efficacy of two outreach interventions (the mailed pamphlet vs. the mailed pamphlet and the phone call) for the well baby care visits, and to delineate the factors associated the utilization of the well baby care visits.

Materials and method: The children born to the foreign mothers (Vietnam and Mainland China) between January 1, 2008 and December 31, 2008 in Tainan city were allocated randomly by families into the intervention group (by phone call and letter) and the control group (by letter only), starting on June 1, 2008. An interim analysis was performed on the data collected up to May 31, 2009. A total of 403 families were randomized either to the intervention group (n=203) or control group (n=200). After exclusion of refusals (n=8), losses to follow up (living abroad, n=81, and unable to contact, n=32), one premature death, 281 newborns were analyzed. Among these children with complete follow up data, 168 were newborns recruited after June 1, 2008. According to the child healthcare handbook, utilization of well baby care is determined. In addition, a structured questionnaire was used to obtain the predisposing factors, enabling factors, and need factors according to the Andersen’s Behavioral Model. Face to face interview was conducted by trained personnel.

Results: The interventions group (89.08%) and control group (87.80%) both highly agreed that the outreach interventions were important reminders to well baby care visits. The rates of utilization at the first visits before age of one year in the intervention group (78.49%, 73.04%, 94.07%, respectively) were comparable to those in the control group (73.33%, 71.00%, 92.92%, respectively). However, the intervention group had a significant higher percent of using the fourth well baby care visit than the control group (60.32% vs. 29.03%, P<0.001). Similar results were obtained for the subsample born after June 1, 2008. The interventions group (89.87%) and control group (85.42%) both highly agreed that the outreach interventions were important reminders to well baby care visits. The rates of utilization at the first visits before age of one year in the intervention group (78.49%, 73.04%, 94.07%, respectively) were comparable to those in the control group (73.33%, 71.00%, 92.92%, respectively). The rate at the fourth visit differed by nearly 40% between the intervention and control groups (88.89% vs. 50.00%), but the difference did not reach statistical significance due to small samples (n=9 for the intervention group and n=4 for the control group). Firstborns, babies born to mothers with stable income, and those born to mainlanders had higher utilization rates of well baby care visits before age of one year than the respective comparison groups, but those born in nuclear families had lower utilization rate than those born in the other family types.

Discussion and Conclusion: A reminder by letter only appeared to be as effective as that by both phone and letter at the first three visits, mainly because the primary caregivers used these visits for vaccination of their babies as well. However, the outreach intervention by phone and letter appeared to be much more effective than that by letter alone for the fourth visit.

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