研究背景：近幾年，中外聯姻家庭增多。目前非本國籍母親所生嬰兒人數約佔國內嬰兒出生總人數的八分之一。內政部調查發現「提供幼兒健康檢查」是外籍配偶的最重要衛生需求，「兒童預防保健服務」是目前可滿足此項需求之主要衛生措施，目前國內並沒有外籍母親子女的兒童預防保健服務相關研究。
研究目的：探討外籍配偶子女與非外籍配偶子女的預防保健服務利用情形、需求情形，比較其差異，進一步透過Andersen醫療服務利用行為模式釐清母親國籍是否為影響兒童預防保健服務利用情形之獨立變項，並且瞭解非本國籍母親的子女預防保健服務利用情形的相關因素。
研究對象與工具：以台南市越南籍母親與大陸籍母親之子女為個案組，以居住於附近、相同性別且排行相近的本國籍母親子女為對照組，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利用情形，並且詢問傾向因素、使能因素與需要因素等變項資料。資料收集採面談方式，由兩位訓練過的訪員擔任。
統計方法：統計分析工具採用SAS 9.1套裝軟體，描述性統計方面以次數、百分比來描述各變項的分佈情形。分析性統計方面，以配對卡方檢定來比較外籍配偶子女與非外籍配偶子女兩個族群之相關變項的的差異，以邏輯斯迴歸分析（logistic regression）探討影響相關因素與兒童預防保健服務使用結果之間的關係。
研究結果：相較於本國籍母親所生子女，越南籍母親與大陸籍母親有使用次數較少的情形存在。越南籍組（11.8％）與大陸籍組（13.0％）均有超過一成的兒童未曾使用過兒童預防保健服務，但是，與其相配對的本國籍母親的子女完全沒有使用過兒童預防保健服務的比例均達不到一成（與越南籍配對：2.2％，與大陸籍配對：5.7%）。使用次數在四次（含）以上的「高程度使用」者，越南籍組有近三成（29.0％），與其配對的本國籍組相對較多，具有超過四成（43.0％），另外，大陸籍組僅有一成為「高程度使用」者（13.8％），而與其配對的本國籍組則高達四成（39.0％）。關於六次時程的使用狀況，三個族群皆以「第六次」的使用比例最低。民眾完全沒有使用過兒童預防保健服務的最主要原因是「不知道有這項服務」。關於民眾本身希望或實際獲得衛生資訊的管道，以具有醫療專業知識的「醫護人員」為主，醫護人員亦是讓民眾實際接受兒童預防保健服務的重要仲介者，高達八成的民眾是經由醫護人員的建議而接受兒童預防保健服務，只有二成的民眾會主動提出接受服務的要求。民眾對於兒童預防保健服務不滿意的原因以「醫護人員的檢查隨便」為主。民眾對於「身體檢查」、「問診項目」與「發展評估」三種服務類別的需求都很高，其中以「問診項目」的需求較低，另外，「問診項目」的需求以越南籍組較高。同時控制傾向因素、使能因素與需要因素之後，發現母親國籍對於使用次數而言是一個獨立的影響因素（在「越南籍組配對本國籍組」：OR=5.54，95%CI =1.63~18.86；在「大陸籍組配對本國籍組」：OR=3.73，95%CI =1.38~10.04）。另外，在「越南籍組配對本國籍組」這個族群中，傾向因素會影響母親國籍與使用次數之間的關係，在「大陸籍組配對本國籍組」這個族群中，使能因素會影響母親國籍與使用次數之間的關係。在越南籍組中，發現母親年齡與台灣本土語言能力是具有顯著意義的預測因素，在大陸籍組中，發現家庭經濟收支狀況與家庭型態是具有顯著意義的預測因素。
結論：比起一般本國籍母親的子女，越南籍與大陸籍母親子女之兒童預防保健服務的使用次數大多較為低落，對於年齡較大與語言能力較差的越南籍母親，以及對於家庭經濟為入不敷出狀況與小家庭的大陸籍母親之子女的兒童預防保健服務利用情形應該加強介入。醫護人員對於民眾使用兒童預防保健服務扮演了相當重要的角色，醫護人員既是主要訊息提供者，更是主導民眾使用兒童預防保健服務的仲介者，若要改善兒童預防保健服務的利用情形，可以從醫護人員著手，加強醫護人員對於民眾提供訊息、提供使用建議的動機，尤其是外籍配偶家庭較親近的衛生所醫護人員。

Background: In recent years, the number of cross national couples has increased. Children born to mothers of foreign nationality consist of nearly one-eighth among all live births. A survey in 2003 conducted by Ministry of Internal Affairs indicated that provision of physical examinations for infants and children is the health care need most wanted by the mothers of foreign nationality. Well baby care is currently available under the National Health Insurance Plan. However, utilization of well baby care visits by children born to mothers of foreign nationality is unclear.
Purpose: This study aims to investigate the utilization of well baby care visits by the children born to mothers of foreign nationality as compared to that by the children born to native mothers. We will delineate whether the nationality of the mothers is an independent predictor of utilization of well baby care visits by using the Behavioral Model of Health Services Utilization developed by Andersen. In addition, we will identify important predictors for the utilization in the children born to the mothers of foreign nationality.
Materials and method: A historical matched pair cohort where a child born to a foreign mother is matched by sex, birth order and area of residence to a child born to a native mother was assembled in Tainan city. 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 two trained personnel.
Statistics: We used the Statistical Analysis Software (SAS) for statistical computing. Frequency and percent were used to describe all the data. Chi square statistics for matched pairs was employed to compare the data between the foreign and native groups. Binary logistic regression for matched pair follow up data was used for relating these factors to utilization.
Results: Children born to the mothers from Vietnam and Mainland China had fewer well baby care visits. Both the Vietnam group (11.8%) and Mainland China group (13.0%) had more than ten percent never using the service. The matched native mother groups, however, had 2.2% and 5.7% respectively. The Vietnam group had nearly thirty percent (29.0%) using the service at least four times as compared to 43.0% in its matched group. The Mainland China group had 13.8% as compared to 39.0% in its matched group. The three groups all had the lowest utilization rates of the sixth visit. The reason for not using the well baby care visits was unaware of the service. The respondents reported that the main source of health information was medical staff. Over eighty percent of the respondents obtained the information of the well baby care visits from them. Only twenty percent of the respondents themselves requested for the service. They were dissatisfied with mainly the hap hazardous manner in physical examinations conducted by the medical staff. All the respondents expressed high demands for physical examinations, medical inquires and developmental assessment. The respondents had the lowest demand for the medical inquires among the three items. The Vietnam group had the highest demand for medical inquires as compared with the other two groups. Binary logistic regression revealed that the nationality of the mothers was an independent predictor for utilization of well baby care visits after adjusting for the predisposing factors, enabling factors, and need factors collected according to Andersen’s Behavioral Model (OR=5.54, 95%CI :1.63~18.86 for the Vietnam vs. native; OR=3.73, 95%CI :1.38~10.04 for the Mainland China vs. native). In the analysis of the Vietnam and Taiwan matched pairs, the predisposing factors were negatively confounded with the nationality. In the analysis of the Mainland China and Taiwan matched pairs, the enabling factors were negatively confounded with the nationality. In the Vietnam group, mother’s age was negatively associated with the utilization and the competence in mastering Chinese or Taiwanese or Hakka was positively associated with the utilization. In the Mainland China group, the family economics and family type were significant predictors of the utilization.
Conclusions: Both the Vietnam and Mainland China groups had lower rates of utilizing the well baby care visits. Among the Vietnam group, we shall assist the families of the Vietnam mothers who were older and had poor competence in Chinese or Taiwanese or Hakka. Among the Mainland China group, we shall assist the families of those mothers who had insufficient family economics and small families. Medical staff play an important role in dissemination of the medical information and more important as the service providers. In order to improve the utilization of well baby care visits, we must increase the motivation of the medical staff to provide the information and service, particularly those who worked in public health stations.

Andersen, R. M. (1995). "Revisiting the behavioral model and access to medical care: does it matter?" J Health Soc Behav 36(1): 1-10.

Bradley, R. H. and R. F. Corwyn (2002). "Socioeconomic status and child development." Annu Rev Psychol 53: 371-99.

Chen, L., W. S. Yang, et al. (2004). "Utilization of well-baby care visits provided by Taiwan's National Health Insurance Program." Soc Sci Med 59(8): 1647-59.

El-Mohandes, A. A., K. S. Katz, et al. (2003). "The effect of a parenting education program on the use of preventive pediatric health care services among low-income, minority mothers: a randomized, controlled study." Pediatrics 111(6 Pt 1): 1324-32.

Flinn, M. V. and B. G. England (1997). "Social economics of childhood glucocorticoid stress response and health." Am J Phys Anthropol 102(1): 33-53.

Gelberg, L., R. M. Andersen, et al. (2000). "The Behavioral Model for Vulnerable Populations: application to medical care use and outcomes for homeless people." Health Serv Res 34(6): 1273-302.

Jhanjee, I., D. Saxeena, et al. (2004). "Parents' health and demographic characteristics predict noncompliance with well-child visits." J Am Board Fam Pract 17(5): 324-31.

Likwang Chen, W.-S. Y., Shyh-Dye Lee, Hua-Chih Chang, Chen-Lin Yeh. (2004). "Utilization of well-baby care visits provided by Taiwan's National Health Insurance Program." Social Science & Medicine 59: 1647-1659.

Moore, T. and M. Kotelchuck (2004). "Predictors of Urban fathers' involvement in their child's health care." Pediatrics 113(3 Pt 1): 574-80.

Navarro-Rubio, M. D., A. J. Jovell, et al. (1995). "Socioeconomic status and preventive health-care use by children in Spain." Am J Prev Med 11(4): 256-62.

Newacheck, P. W., D. C. Hughes, et al. (1996). "Children's access to primary care: differences by race, income, and insurance status." Pediatrics 97(1): 26-32.

Oda, D. S., D. C. Heilbron, et al. (1995). "A preventive child health program: the effect of telephone and home visits by public health nurses." Am J Public Health 85(6): 854-5.

Ronsaville, D. S. and R. B. Hakim (2000). "Well child care in the United States: racial differences in compliance with guidelines." Am J Public Health 90(9): 1436-43.

Sanghavi, D. M. (2005). "Taking well-child care into the 21st century: a novel, effective method for improving parent knowledge using computerized tutorials." Arch Pediatr Adolesc Med 159(5): 482-5.

Schuster, M. A., D. L. Wood, et al. (1998). "Utilization of well-child care services for African-American infants in a low-income community: results of a randomized, controlled case management/home visitation intervention." Pediatrics 101(6): 999-1005.

Selby-Harrington, M., J. R. Sorenson, et al. (1995). "Increasing Medicaid child health screenings: the effectiveness of mailed pamphlets, phone calls, and home visits." Am J Public Health 85(10): 1412-7.

Shi, L. and G. D. Stevens (2005). "Disparities in access to care and satisfaction among U.S. children: the roles of race/ethnicity and poverty status." Public Health Rep 120(4): 431-41.

Victora, C. G., J. P. Vaughan, et al. (2000). "Explaining trends in inequities: evidence from Brazilian child health studies." Lancet 356(9235): 1093-8.

Vohr, B. R., L. L. Wright, et al. (2000). "Neurodevelopmental and functional outcomes of extremely low birth weight infants in the National Institute of Child Health and Human Development Neonatal Research Network, 1993-1994." Pediatrics 105(6): 1216-26.

White, E., A. Wilson, et al. (1995). "Growth screening and urban deprivation." J Med Screen 2(3): 140-4.

Williams, D. R. (1996). "Race/ethnicity and socioeconomic status: measurement and methodological issues." Int J Health Serv 26(3): 483-505.

Yang, Y. M. and H. H. Wang (2003). "Life and health concerns of Indonesian women in transnational marriages in Taiwan." J Nurs Res 11(3): 167-76.

Yu, S. M., H. A. Bellamy, et al. (2002). "Factors that influence receipt of recommended preventive pediatric health and dental care." Pediatrics 110(6): e73.

Yu, S. M., Z. J. Huang, et al. (2005). "Parental awareness of health and community resources among immigrant families." Matern Child Health J 9(1): 27-34.

Yu, S. M., Z. J. Huang, et al. (2006). "Parental English proficiency and children's health services access." Am J Public Health 96(8): 1449-55.

中華民國職業資訊查詢系統 "http://www2.evta.gov.tw/odict/index.htm."

內政統計資訊服務網 "http://www.moi.gov.tw/stat/index.asp."

內政部戶政司 "http://www.ris.gov.tw/docs/f4a-2.html."

王秀紅、楊詠梅 (2002). "東南亞跨國婚姻婦女的健康." 護理雜誌 49(2): 35-41.

行政院 (2005). "民國92年產婦國籍別暨醫療院所之出生通報案數統計表." 行政院衛生署國民健康局.

李淑君、陳麗美、高森永、譚開元 (1999). "全民健康保險兒童預防保健服務利用情形及其相關因素之調查研究." 中華職業醫學雜誌 6(3): 185-212.

李麗君 (2004). "利用R.M.Andersen模式探討越南籍婦女產前健康照護服務利用情形及滿意度." 國立陽明大學臨床護理研究所碩士論文.

周培萱、王秀香、蔣亞萍、林昀蓉、康金玟、李威青 (2006). "東南亞跨國婚姻婦女孕產期之生活經驗." 實證護理 2(4): 311-321.

季瑋珠、賴佳君 (2001). "全民健保預防保健服務使用率之分析." 台灣衛誌 20(1): 43-51.

紀櫻珍、古智愷、吳振隆、黃富源 (2005). "兒科醫師對兒童預防保健認知、態度與參與醫院之探討." 北市醫學雜誌 2(12): 1107-1116.

夏曉鵑 (2002). "流離尋岸-資本國際化下的「外籍新娘」現象." 台灣社會研究叢刊-09.

張慈桂 (2004). "家庭社會經濟地位與學齡前兒童健康關聯之探討." 國立陽明大學公共衛生研究所博士論文.

陳延芳、陳姿伶、陳妙青、林金玉 (1998). "台灣地區嬰兒地用兒童預防保健服務之調查研究." 公共衛生 25(2): 121-137.

陳怡沁 (1998). "小兒科專科醫師與家醫科專科醫師對於「全民健保兒童預防保健服務」的態度、認知與執業情形之研究調查." 國防醫學院 公共衛生研究所碩士論文.

陳欽賢、朱子斌、劉彩卿 (2006). "全民健康保險制度下兒童預防保健服務之利用." 醫務管理期刊 7(1): 107-121.

陳麗光、盧鴻興、張華志 (2004). "1996-2001年之全民健康保險兒童預防保健服務利用率." 台灣衛誌 23(1): 37-44.

黃月桂、林勤豐 (1999). "全民健保兒童健檢服務施行初期評估." 中華衛誌 18(2): 116-122.

葉郁菁 (2004). "澎湖離島地區東南亞女性外籍配偶暨子女生活狀況與福利需求調查." 兒童及少年福利期刊(6): 55-86.

葉鶯鶯、湯允一 (1999). "健保資訊的接觸管道對全民健保預防保健服務利用之影響." 新聞學研究 61: 73-98.

劉秀琪 (2004). "苗栗地區台灣、外籍、大陸育齡婦女育嬰知識、育嬰態度、社會支持與嬰兒生長發育狀況之探討." 國立台北護理學院護理研究所碩士論文.

劉彩卿、吳佩璟 (2001). "全民健保下病患在各醫療層級間的就醫選擇-台北市小兒科病患為例." 醫務管理期刊 2(2): 87-108.

蔡佳憓 (2005). "台南地區本地籍與越南籍初產婦在產後自我照顧及新生兒照護執行狀況的分析與比較." 陽明大學 臨床護理研究所 碩士論文.