This dissertation is composed of three research papers that deal with the topic of “accounting and innovation” and provide evidence for the area of innovation from two accounting perspectives, i.e., the external disclosure perspective and the internal management control system perspective. The disclosure perspective is addressed in the first paper. Using content analysis, it examines the innovation capital disclosure characteristics, i.e., disclosure quantity and quality, in intellectual capital statements of 51 European for-profit firms. Additionally, the relationship between innovation capital disclosure characteristics and industry, firm size, region of domicile, and disclosure guidelines adopted are analyzed. The second and third paper address the management control system perspective. The second paper contributes to the research on management control systems in product development by exploring the performance effects and the interplay of the levers of control, i.e., interactive, diagnostic, beliefs, and boundary control systems, based on data from a survey of 468 senior managers from the manufacturing industry. Therefore, I compare by structural equation modeling a base model of unrelated levers of control (additive model) with (a) a model of mutual association of levers of control (interdependence model), (b) a model of joint use of levers of control (interaction model), and (c) a combined model of mutual association and joint use of levers of control (combined interdependence/interaction model). The best fitting and most parsimonious model is analyzed in terms of the performance effects of the levers of control. Based on the sample of the second paper, the third paper contributes to the recent literature on the relationship between management control systems and innovation by considering how the four levers of control are used as “packages” in product development. I employ cluster analysis to determine how the levers of control are combined, depending on the type of strategy formation (i.e., intended or emergent) and the degree of innovativeness of the firm. Furthermore, I explore which of these combinations are equifinal in terms of product development and organizational performance.

本研究之目的在於瞭解國民小學學生網路使用行為與網路閱讀素養之關係，採問卷調查法收集研究資料，以全臺灣各縣市之國民小學高年級學生為研究母群，進行分層隨機抽樣，共取得有效樣本1182人。 研究工具採用「網路使用行為問卷」、「網路閱讀素養問卷」，並以t 檢定、Pearson積差相關、迴歸分析等方法進行研究資料分析，最後以結構方程式模型建立網路使用行為與網路閱讀素養模型，研究結果如下： 一、性別在資訊瀏覽與搜尋活動、線上遊戲活動方面達顯著差異。 二、性別在整體網路閱讀素養上無顯著差異。 三、年級在訊瀏覽與搜尋活動、社群活動方面達顯著差異，在線上遊戲上無顯著差 異。 四、年級在整體網路閱讀素養上達顯著差異，六年級優於五年級。 五、結構方程式模型檢定資訊瀏覽與搜尋活動、線上遊戲活動對國小學生網路閱 讀素養有顯著的影響。 六、資訊瀏覽與搜尋活動能正向預測網路閱讀素養，線上遊戲對網路閱讀素養有 負向影響，社群活動對網路閱讀素養無顯著影響。 最後，根據研究結果提出各項建議，以供教學實務上及未來參考。 / This research aims to reveal the relationship between internet usage behavior and internet reading literacy of elementary school students. This study used a questionnaire survey method to collect data. The subjects were collected from the elementary school students in 2011 by the stratified random sampling. The total valid samples were 1182. The research instruments used in this study included "Internet Usage Behavior Questionnaire", and "Internet Reading literacy Questionnaire ". Meanwhile, the collected data were analyzed by descriptive statistic, the t-test and Pearson correlation and regression analysis. Lastly, data were analyzed with Internet Usage Behavior and Internet Reading Literacy by structural equation modeling. The main findings were as follows: 1.There existed gender differences on information browsing and search activities and online game. 2.There existed no gender differences on internet reading literacy. 3.There existed grade differences on information browsing and search activities, community activities, and no grade differences on online game. 4.There existed grade differences on internet reading literacy with girls performed better than boys. 5.Structural equation modeling (SEM) showed that information browsing and search activities and online game activities had a remarkable influence on the internet reading literacy of elementary school students. 6.The study had found that information browsing and search activities have a positive effect upon internet reading literacy, and online game have a negative effect upon internet reading literacy. Community activities had no influence on the internet reading literacy. Finally, according to the findings, implications and suggestions for teaching and future researches were discussed and proposed.

¡@¡@At present, the essence situation of biotechnology industries in Taiwan lacks a market-oriented innovation system as sturdy as in advanced countries such as U.S.A., Canada, European Union, and Japan, et cetera. In the technology innovation processes including different gradations such as basic science, application research, technologies development and commercialization, all the R&D of biotechnology industries in Taiwan, ready for a innovation system, many strategies and projects with relation to R&D. However, in the commercialization gradation, having an unremarkable and approximate gap among biotechnology industries, venture capitals, authorities, academia, research institutes and corporations, with reciprocal effects to each other, that are inferior to these advanced countries. ¡@¡@The thesis research in estimating for the R&D performances of biotechnology industries in Taiwan, it makes use of the SPSS l0.0 and AMOS 5.0 for Windows to compute all raw data of sampling survey, after analyzing to demonstrate the structural equation modeling of estimating at the R&D performances of biotechnology industries of Taiwan, that the final result make sure of perfect goodness of fit for the model. The model could be transform into different structures to estimating at the R&D performances of all circles of biotechnology, to make up the gap between anticipated success and unexpected failure. ¡@¡@The conclusion reveals a special significance of business management, means that the R&D innovation system of biotechnology industries of Taiwan, should be operated in coordination with specific strategies and policies of the authorities, then certainty executing all science and technology projects to obtain the R&D performances in essence. In other words, the R&D innovation system of biotech industries of Taiwan still has many demands for investing more human resource, venture capital in R&D, having a well-arranged application for system resources, supplying the market with many well-appropriated laws and regulations, to communicating with international science and technology innovation systems in the world, et cetera. After accomplishing all as above, the R&D prospect of Taiwan¡¦s biotechnology industries will be well in the future.

In this research, it was mainly aimed to develop an acceptance model for processes, namely the process acceptance model (PAM). For this purpose, a questionnaire, comprising 3-part and 81-question, was developed to collect quantitative and qualitative data from people having relationships with certain process-focused models and/or standards (CMMI, ISO 15504, ISO 9001, ISO 27001, AQAP-160, AQAP-2110, and/or AS 9100). To revise and refine the questionnaire, expert reviews were ensured, and a pilot study was conducted with 60 usable responses. After reviews, refinements and piloting, the questionnaire was deployed to collect data and in-total 368 usable responses were collected from the people. Here, collected data were screened concerning incorrectly entered data, missing data, outliers and normality, and reliability and validity of the questionnaire were ensured. Partial least squares structural equation modeling (PLS SEM) was applied to develop the PAM. In this context, exploratory and confirmatory factor analyses were applied, and the initial model was estimated and evaluated. The initial model was modified as required by PLS SEM, and confirmatory factor analysis was repeated, and the modified final model was estimated and evaluated. Consequently, the PAM, with 18 factors and their statistically significant relationships, was developed. Furthermore, descriptive statistics and t-tests were applied to discover some interesting, meaningful, and important points to be taken into account regarding the acceptance of processes. Moreover, collected quantitative data were analyzed, and three additional factors were discovered regarding the acceptance of processes. Besides, a checklist to test and/or promote the acceptance of processes was established.

During the past decade, the environmental issue has been an important concern of public affairs because the problems generating from the physical environment are the main focus of local development. Generally, the most effective work of community development is to encourage people to participate in environmental improvement actions. For example, the literature has indicated that individual is the most important factor for environmental improvement actions. Thus, people who highly participate in the community affairs often have better performances on community improvement actions. Base on an efficient society and the budget of government downsizing, promoting community residents to actively participate in environmental improvement actions would help the community environment management to be more sustainable and indirectly leading the local development. Concerning community environment, the responsibility for the community, knowledge of environmental action, and the ability of self-control might be correlated with the community residents¡¦ participation behavior in environmental improvement actions. The purpose of study is to explore the relationships among sense of community, the knowledge of environmental action, environmental moral obligation, and participating environmental improvement actions. Four objectives are mainly specified: first, to develop a sense of community scale of Taiwanese population; second, to integrate theories to test a community participation behavior model in environmental improvement actions; third, to understand the influential factors of community residents participation in environmental improvement actions; finally, to compare and interpret community residents participation in environmental improvement behavior model and ¡§Theory of Planned Behavior¡¨. This study surveyed community residents who ever participated in ¡§urban community landscape renaissance project¡¨ supported by Construction and Planning Agency, and ¡§rural community landscape renaissance project¡¨ founded by Soil and Water Conservation Bureau. A total of 616 community residents were administrated a self-report questionnaire. Further analysis of the data based on comparing respondent¡¦s residence, respondents were grouped into to urban planning district group and non-urban planning district group. Structural Equation Modeling (SEM) method was then employed to test a conceptual model. There were nine domains proposed in the conceptual model. Five of nine domains adopted from planning behavioral theory included ¡§attitude¡¨, ¡§subjective norm¡¨, ¡§perceived behavioral control¡¨, ¡§behavioral intention¡¨ and ¡§behavior¡¨. One of nine domains, ¡§self-efficacy¡¨, was chosen from social cognition theory. Two of nine domains from environmental citizen behavioral model were ¡§knowledge of environmental action¡¨, ¡§environmental moral obligation¡¨. ¡§Sense of community¡¨ was referenced to the last domain. The findings provided support for eight hypotheses and two hypotheses were partial supported. The detailed descriptions of hypothesis-testing results were as below. Eight hypotheses supported, they included: (1) After residents reflected on the ¡§subjective norm¡¨, the ¡§attitude¡¨ toward participating environmental reform behaviors was remarkably promoted. (2) Resident¡¦s ¡§attitude¡¨ significantly influenced their ¡§behavioral intention¡¨ of participating environmental improvement behaviors. (3) Resident¡¦s ¡§perceived behavioral control¡¨ significantly impacted their ¡§behavioral intention¡¨ of participate in environmental improvement behaviors. (4) Resident¡¦s ¡§sense of community¡¨ significantly impacted their ¡§behavioral intention¡¨ of participating environmental improvement behaviors. (5) Resident¡¦s ¡§knowledge of environmental action¡¨ significantly impacted their ¡§self-efficacy¡¨. (6) Resident¡¦s ¡§self-efficacy¡¨ significantly effected their ¡§perceived behavioral control¡¨. (7) Resident¡¦s ¡§environmental moral obligation¡¨ significantly impacted their ¡§attitude¡¨ of participating environmental improvement behaviors. (8) Resident¡¦s ¡§behavioral intention¡¨ significantly impacted their participating environmental improvement ¡§behaviors¡¨. Two hypotheses were partial supported: (1) Only in non-urban planning district resident¡¦s ¡§subjective norm¡¨ significantly impacted their ¡§behavioral intention¡¨ of participating environmental improvement behaviors. (2) Only in urban planning district and all districts resident¡¦s ¡§perceived behavioral control¡¨ significantly impacted their ¡§attitude¡¨ of participating environmental improvement behaviors. Additionally, the findings confirmed that Italian Sense of Community Scale (ISCS) was an appropriate scale to measure Taiwanese population¡¦s sense of community. These findings provide researchers and practitioners for insight of resident¡¦s participation in environmental improvement, which is better than ¡§Theory of Planned Behavior¡¨.

La présente thèse de doctorat porte sur la relation entre la santé psychologique au travail, les besoins fondamentaux et la compétence en emploi. En plus de valider un questionnaire de compétences en emploi (QCE), cette thèse propose que les compétences en emploi puissent prédire la santé psychologique au travail par la satisfaction des besoins fondamentaux dans le domaine de l’enseignement. Le premier article a pour objectif de présenter la conception et la validation de l’instrument de mesure des compétences en emploi dans le domaine de l’enseignement. Une première étape dans notre étude a permis l’identification de trois solutions factorielles possibles : structure à un seul facteur, structure à deux facteurs et structure à un facteur de deuxième ordre. Les matrices des corrélations des énoncés étaient fiables, se prêtaient bien à l’analyse factorielle exploratoire et présentaient de bonnes cohérences internes. La deuxième étape de notre étude a été de type confirmatif. Chacune des trois solutions factorielles proposées a été analysée, ce qui a permis l’identification du modèle le mieux ajusté compte tenu des seuils empiriques des indices retenus pour l’analyse par équations structurelles. L’étude réalisée sur un échantillon d’enseignants québécois démontre que nous pouvons conclure aux bonnes qualités psychométriques de l’instrument analysé. Les limites et les apports de cette étude seront aussi présentés. Le deuxième article examine les liens entre les compétences en emploi dans le domaine de l’enseignement, la santé psychologique au travail et la satisfaction des trois besoins fondamentaux (autonomie, compétence et affiliation). Un modèle de médiation est testé par des analyses de modélisation par équations structurelles. Dans ce modèle, on considère que la satisfaction des trois besoins fondamentaux (autonomie, compétence et affiliation sociale) agisse comme médiateur dans la relation entre les compétences en emploi et la santé psychologique au travail. Une relation de médiation partielle (Baron & Kenny, 1986) a été trouvée dans notre échantillon, en utilisant l’analyse de rééchantillonnage par « bootstrap », dans le cadre de la modélisation par équations structurelles. Les limites de la recherche, ainsi que des suggestions de recherches futures seront proposées. / This following thesis bears on relationship between psychological health, the basic needs and work competence. In addition to validating a questionnaire for work competencies (QCE), this thesis composed of two articles, proposes that the work competencies can predict psychological health in the workplace by meeting the basic needs, in the field of teaching. The first article aims to present the design and validation of the measurement instrument of work competencies in teaching. A first step in our study allowed the identification of three possible solutions factor: a single factor structure, two-factor structure and factor structure of the second order. The correlation matrix of the statements was reliable, lend them well to exploratory factor analysis and showed good internal consistency. The second step of our study was confirmatory type. All three possible solutions factor were analyzed, which allowed the identification of the best-fitting model given the empirical evidence threshold selected for the structural equation analysis. The study conducted on a sample of teachers in Quebec shows that we can conclude with good psychometric properties of the instrument analyzed. The limitations and contributions of this study are also presented. The second article examines the relation between work competencies, psychological health at work and the satisfaction of the basic needs (autonomy competence and affiliation). A mediation model is tested by analysis of structural equation modeling. In this model it is assumed that the satisfaction of the basic needs act as mediator in the relationship between work competencies and psychological health at work. A relationship of partial mediation (Baron & Kenny, 1986) was found in our sample, using the analysis of resampling by bootstrap in the context of structural equation modeling. The limitations of the research and suggestions for future research are proposed.

La recherche sur l’utilisation des connaissances issues de la recherche (CIR) est en pleine expansion. Plusieurs études ont montré que l’utilisation des CIR contribue à améliorer la réussite scolaire des élèves. Toutefois, il semble que les enseignants les utilisent très peu. Pour améliorer cette utilisation, il est nécessaire de développer un modèle explicatif de l’utilisation des connaissances issues de la recherche. Ce modèle permet de rendre compte des mécanismes menant à l’utilisation des connaissances issues de la recherche en milieu de pratique. Il permet également de mettre en évidence les facteurs les plus influents et l’agencement de ces différents facteurs dans le but de favoriser une meilleure utilisation des connaissances issues de la recherche. Ce dernier aspect constitue l’objectif principal de cette thèse pour le domaine spécifique de l’éducation. Pour ce faire, un questionnaire sur l’utilisation des connaissances issues de la recherche (QUC) est validé et un modèle est proposé. Le premier article de la thèse examine la fiabilité, la validité et la structure factorielle du QUC avec un échantillon francophone et anglophone d’un milieu défavorisé. Le QUC, composé de 43 items, mesure six dimensions, soit : l’utilisation des connaissances issues de la recherche, le contexte organisationnel, la stratégie de soutien, l’opinion des utilisateurs et leur expertise ainsi que la fréquence d’accès aux sources des connaissances issues de la recherche. Au total, 2270 enseignants ont complété le questionnaire. Les résultats des différentes analyses montrent que le QUC doit être réduit à 20 items regroupés en cinq facteurs : l’utilisation des connaissances issues de la recherche, l’opinion des utilisateurs, la stratégie de soutien, l’expertise des utilisateurs et les facteurs organisationnels. Le second article de cette thèse examine quel modèle permet de mieux expliquer l’utilisation des CIR. Pour ce faire, deux modèles sont testés avec le même échantillon que dans le premier article, soit un modèle de liens directs et un modèle avec médiation. Pour le premier modèle, un lien direct entre l’utilisation des connaissances issues de la recherche et les facteurs qui favorisent cette utilisation est postulé : l’expertise, l’opinion, la stratégie de soutien et le facteur organisationnel auront des liens directs avec l’utilisation des connaissances issues de la recherche. Le second modèle (modèle avec médiation) se base quant à lui sur les théories de l’action raisonnée et du comportement planifié et postule que le lien entre les facteurs et l’utilisation n’est pas direct; certains facteurs ont des effets directs et d’autres des effets indirects. Concrètement, ce second modèle postule que l’expertise et l’opinion agissent comme médiateurs entre, d’une part, les deux variables indépendantes (le facteur organisationnel et la stratégie de soutien), et, d’autre part, la variable dépendante (l’utilisation des connaissances issues de la recherche). Les résultats des analyses montrent que le modèle avec médiation permet de mieux comprendre l’utilisation des connaissances issues de la recherche. Cette étude a permis de valider un questionnaire sur l’utilisation des connaissances issues de la recherche et aboutit à la proposition d’un modèle qui permet d’expliquer l’utilisation des connaissances issues de la recherche spécialement conçu pour le domaine de l’éducation. Elle fournit des outils (un questionnaire validé et un modèle) qui permettent de mieux cerner le paradigme de l’utilisation des connaissances issues de la recherche, ce qui pourrait favoriser une plus grande utilisation des CIR par les intervenants scolaires. En effet, les résultats de cette recherche peuvent guider les décideurs dans l’implantation des programmes menant à l’utilisation des connaissances issues de la recherche qui s’adressent aux enseignants. Ces résultats indiquent sur quels facteurs agir en premier lieu afin d’améliorer l’utilisation des CIR chez les enseignants du secondaire dans les milieux défavorisés. Le présent modèle pourrait être utilisé dans d’autres milieux scolaires (par exemple les milieux non défavorisés ou les milieux scolaires primaires) après validation. / Research on knowledge transfer is growing rapidly. Numerous studies have shown that the use of research-based Knowledge (RBK) contributes to student academic success. However, it seems that teachers make little use of RBK. To improve RBI use, a model for explaining knowledge use needs to be developed. This model shows the mechanisms of knowledge transfer in the practice setting. It also helps to highlight the most influential factors and the arrangement of these different factors in order to promote a better use of RBK. This is the primary objective of the present thesis, specifically with regard to the field of education. To do so, a questionnaire on the use of research-based knowledge (QURBK) is validated and a model proposed. The first article in this thesis examines the reliability, validity and factor structure of the QURBI with a sample of French and English teachers in the disadvantaged sections of the population. The QURBK, which comprises 43 items, measures six dimensions: knowledge use, organizational factors, support strategies, user opinions, user expertise and frequency of access to knowledge sources. In all, 2270 teachers completed the questionnaire. The results of the various analyses indicate that the QURBK should be reduced to 20 items, grouped into five factors: knowledge use, user opinions, support strategies, user expertise and organizational factors. The second article in this thesis explores what model best explains RBK use. Two models are tested using the same sample considered in the first article. In the case of the first model, a direct link is postulated between knowledge use and factors that promote use: expertise, opinions, support strategies and organizational factors are thus directly linked to knowledge use. The second model, which is based on the theories of reasoned action and planned behaviour, postulates that the link between factors and use is not direct; certain factors have direct effects and others have indirect effects. Specifically, the model, named mediation model, suggests that expertise and opinion serve as mediators between the two independent variables (organizational factors, support strategies) on the one hand, and the dependent variable (knowledge use) on the other. Following analysis, it appears that the mediation model is helpful to better understanding of the use of research-based knowledge. This study was used to validate a questionnaire on the use of research-based Knowledge and allows the proposal of a model explaining RBK use, designed specifically for the field of education. As well, it provides tools (a validated questionnaire and a model) that could contribute to the greater use of research-based knowledge. As a matter of fact, the results of this research could be helpful to the decision makers in setting up knowledge transfer programs, which lead to better use of RBK, made for teachers. These results indicate on which factor one should act first in order to improve the use of RBI by secondary schools teachers in the disadvantaged sections of the population. After its validation, the present model could be used in other schools (for example in non-disadvantaged or in primary schools).

Intimate relationships function not in isolation, but within a broader social network and social environment, in which the opinions and actions of close network members can play a role in how a relationship develops. The current study investigated how perceiving support for one’s relationship (including same-sex and mixed-sex relationships) from friends and family is associated with not only relationship well-being, but also the mental and physical health of the individuals within the relationship. After establishing that social support specifically for a relationship was indeed a separate and unique construct as compared to more general social support for an individual, the study tested a hypothesized model using structural equation modeling, finding evidence for a model in which the association between support for a relationship and the health outcomes for an individual is fully mediated by relationship well-being. Relationship type (i.e., same-sex versus mixed-sex) was not a significant moderator, indicating that regardless of relationship type, individuals who perceive more support for their relationship are also more likely to report greater relationship satisfaction and better mental and physical health. Furthermore, participants provided data up to three times over a period of three years, allowing for an examination of how social support for a relationship functions as a predictor of relationship well-being and health outcomes over time. Perceived social support for a relationship at Time 1 was found to be a significant predictor of the rate of relationship dissolution over the course of the study as well as relational and health outcomes at later points in time. With respect to the source of support for the relationship, evidence was found that support from parents and friends both have associations with relationship outcomes, but these findings were inconsistent across analyses with support from parents having stronger associations in some analyses and support from friends having stronger associations in others. Reasons for these discrepancies are discussed, as well as theoretical implications concerning the role that perceived social support for relationships plays in the prediction of relationship well-being and mental and physical health. / Thesis (Ph.D, Psychology) -- Queen's University, 2012-05-29 21:04:59.381

Peu de femmes atteignent la recommandation internationale d’un allaitement exclusif d’une durée minimale de 6 mois malgré ses nombreux bienfaits pour l’enfant et pour la mère. Une raison fréquemment mentionnée pour la cessation précoce de l’allaitement ou l’introduction de préparations commerciales pour nourrissons est l’insuffisance de lait. L’origine de cette perception maternelle demeure toujours inexpliquée bien que sa prévalence dans les écrits soit bien documentée. L’insuffisance lactée relève-t-elle de pratiques d’allaitement qui contreviennent au processus physiologique de la lactation ou relève-t-elle d’un manque de confiance maternelle dans sa capacité d’allaiter? Une meilleure compréhension des déterminants de la perception d’insuffisance lactée (PIL) s’avère primordiale, un manque d’interventions infirmières permettant de prévenir, dépister et soutenir les femmes allaitant percevant une insuffisance lactée ayant été identifié. Cette étude visait à déterminer l’apport explicatif de variables biologiques et psychosociales de 252 femmes primipares allaitant sur une PIL. Une modélisation de facteurs associés à la PIL a été développée à l’aide de l’approche synthèse théorique comportant les variables suivantes: les événements entourant la naissance, les capacités infantiles et maternelles, la supplémentation, le sentiment maternel d’efficacité en allaitement, la PIL et les pratiques d’allaitement. Afin de mieux comprendre comment se développe et évolue la PIL, un devis prédictif confirmatif longitudinal a été privilégié de la naissance à la 6e semaine postnatale. Au T1, soit le premier 24 heures suivant la naissance, les participantes ont complété un questionnaire concernant leur intention d’initier et de maintenir un allaitement exclusif pour une durée de 6 mois. Au T2, soit la 3e journée postpartum, les femmes complétaient un 2e questionnaire regroupant les différentes mesures utilisées pour l’étude des variables de la modélisation PIL, incluant le prélèvement d’un échantillon de lait maternel. À la 2e semaine, soit le T3, les femmes complétaient un questionnaire similaire à celui du T2, lequel était envoyé par la poste. Finalement, au T4, soit à la 6e semaine, une entrevue téléphonique semi-dirigée concernant les pratiques d’allaitement a été réalisée. La vérification des hypothèses s’est faite principalement à l’aide de tests de corrélations de Pearson, d’analyses de régressions et d’équations structurelles. Les résultats indiquent une influence simultanée des capacités infantiles et du sentiment maternel d’efficacité en allaitement sur la PIL au T2 et au T3; le sentiment maternel d’efficacité en allaitement exerçant de surcroit un effet médiateur entre les capacités infantiles et la perception d’insuffisance lactée au T2 et au T3. Au T2, la fréquence des tétées est associée à une diminution du taux de Na+ du lait maternel, marqueur biologique de l’établissement de la lactogenèse II. Des interventions ciblant le développement d’un sentiment maternel élevé d’efficacité en allaitement devraient être privilégiées. / Few mothers achieved the international recommendation of 6 months exclusive breastfeeding even though it’s numerous benefits both for mother and baby. Perceived insufficient milk (PIM) is a frequent reason reported by mother for stopping breastfeeding or introducing commercial milk products, especially in the first 6 weeks. Although consensus about its prevalence exists in the literature, the origin of this perception is still unexplained. Does PIM result from breastfeeding mismanagement which interferes with lactation physiologic processes or does it results from a lack of maternal confidence? This critical gap in the knowledge of determinants of PIM limits nursing intervention development. The aim of this study is to determine the relative contribution of biological and psychological variables on PIM among a group mother’s 1st time breastfeeding. To allow a comprehensive understanding of the evolution of PIM, a predictive confirmative longitudinal design was implemented from birth to 6th week postnatal. PIM model was developed through theory synthesis and include the following key variables: birth events, infant capacities, maternal capacities, supplementation, breastfeeding self-efficacy, perceived insufficient milk and breastfeeding practices. This study’s sample consisted of 252 breastfeeding 1st time mothers that were contacted at 4 points in time. At T1, the first 24 hours following birth, the participants completed a questionnaire related to their intention to initiate and maintain 6 months exclusive breastfeeding. At T2 of the study, on the 3rd day postpartum, the women completed a 2nd questionnaire regrouping the different measures used for the PIM model key variables and hand-expressed breast milk sample. On the 2nd week, T3, the women completed a questionnaire comparable to the one at T2, which was sent by mail. Lastly, the 4th study time, at the 6th week, a semi-directed telephone interview was done regarding their breastfeeding practices. Statistical analyses included Pearson correlations, ascendant logistic regressions and SEM. The results suggest a simultaneous influence of infant capacities and breastfeeding self-efficacy on PIM on T2 and T3; breastfeeding self-efficacy exerting a mediating effect in between infant capacities and PIM at both T2 and T3. At T2, breastfeeding frequency was associated with a fall in Na+ breastmilk, indicating establishment of lactogenesis II. Interventions towards increasing breastfeeding self-efficacy should be developed.

由於醫療服務具高度專業性，故醫療照護市場長期存在資訊不對等的問題。隨著消費者利益保護及病人權利運動的興起、民眾被要求在自己的健康上承擔更多的責任，積極參與健康決策、新資訊科技的發明，使得醫院醫療與服務品質資訊的收集更容易且成本更低廉，因此，歐美各國近年來積極建立健康照護市場的品質資訊，發展醫院品質報告卡，提供民眾就醫選擇所需的資訊，期望能達成保障民眾的醫療權益，同時促使醫院提升醫療與服務品質，及增進醫療照護市場運作效率的目標。 台灣自1995年起實施全民健康保險制度，醫院與中央健康保險局的特約率達90%以上，民眾享有極大的自由選擇就醫地點及醫院，然而到目前為止，仍然欠缺足夠的醫院醫療與服務品質資訊提供給民眾做為選擇醫院的參考。其次，相關研究的結果顯示，台灣民眾對於就醫選擇資訊的提供有高度的興趣，且對民眾就醫選擇決策亦有重大的影響。 目標：本研究旨在由民眾觀點篩選醫院醫療與服務品質報告卡的指標項目，及採用創新擴散理論(innovation diffusion theory)，以結構方程模式(structural equation model)探討住院病人對醫院醫療與服務品質報告卡創新特性的知覺、態度及使用意願。 方法：本研究首先以推動社會福利、關心民眾健康權益及病人團體的30位專家為研究對象，進行二回合的德菲法(Delphi method )問卷調查篩選醫院醫療與服務品質報告卡的指標項目。其次以台北縣市不同層級及權屬別的八家醫院內、外科共500位住院病人為研究對象進行面訪問卷調查，探討住院病人創新接受度、對醫院醫療與服務品質報告卡創新特性的認知、態度及使用意願，並以結構方程模式進行研究假說與架構的驗證。 結果：1.由民眾觀點所選出屬於高適用性且高重視度的指標項目計有院內感染率、手術傷口感染率、住院病人對醫師病情解說內容的滿意度、門診病人對醫師服務態度的滿意度等九項；2.只有17.2%的住院病人在填問卷前有聽過醫院醫療與服務品質報告卡這個名詞；3.有80.2%的住院病人認為醫院醫療與服務品質報告卡對選擇醫院是非常有價值或有價值的；4.住院病人對服務品質指標的瞭解程度相對地高於對醫療品質指標的瞭解程度；5.對呈現方式的瞭解程度由高至而低排序，依序為星號、百分比、長條圖；6.影響「住院病人是否看懂醫院醫療與服務品質資訊」的因素，在控制其他變項的影響後發現，教育程度愈高者、年齡愈輕者、個人平均月收入較高者，較看懂醫院醫療與服務品質報告卡範例中指標資訊；7.創新特性中，「相容性」及「結果展示性」對「對醫院醫療與服務品質報告卡的態度」具有正向的顯著影響；8.「知覺有用性」、「對醫院醫療與服務品質報告卡的態度」及「創新接受度」對「使用醫院醫療與服務品質報告卡的意願」具有正向的顯著影響；9.影響住院病人「對醫院醫療與服務品質報告卡的態度」最主要因素為「相容性」，且達到統計上的顯著水準；10.影響住院病人「使用醫院醫療與服務品質報告卡的意願」的最主要因素為「對醫院醫療與服務品質報告卡的態度」，且達到統計上的顯著水準；11.最後要特別強調的是，本研究的新發現為「知覺有用性」、「知覺易用性」、「相容性」、「結果展示性」、「創新接受度」，兩兩之間具有統計上之顯著相關，這是本研究與以往相關研究結果的最大不同發現。 結論：住院病人認為醫院醫療與服務品質報告卡對選擇醫院是有價值的，因此，建議行政院衛生署可考慮主導，整合醫院評鑑、全民健康保險申報及病人滿意度調查的資料，分區分醫院等級，評比其在高適用性且高重視度的九項指標項目之表現，以星號及百分比的形式呈現，再以小手冊及網際網路查詢的方式對外公佈，並加強對民眾的宣導教育，讓民眾可以將品質資訊運用在就醫選擇決策上，使民眾成為明智的醫療服務消費者及醫療與服務品質的共同監督者，以提升醫療體系的運作效能。 / There exists information asymmetry between providers and consumers in healthcare market due to the highly specialized knowledge in this market. Consumers were asked to bear more responsibility on their own health and to participate in the formulation of healthcare strategies and the inventions of new technology as the uprising in the movement of consumer right protection. These would result in the reduction in costs related to the medical services and information collection. Therefore, western countries have aggressively established the medical information system and developed hospital report cards in order to protect consumers’ right, to improve quality of medical services, and to increase the efficiency of healthcare market by providing service information to consumers. Taiwan initiated the National Health Insurance since 1995 with the facility contract rate reaching over 90%. This provides consumers great access to healthcare institutions. However, few service data have been provided to consumers as a reference for the choice of providers to date. In addition, previous studies showed that consumers were interested in obtaining available service information and these information have a great influence on consumers’ decision of providers. Objectives: The purposes of this study were to select indicators of hospital report cards from public’s perspective and to adopt the innovation diffusion theory and structural equation modeling to explore inpatients’ perception characteristics of innovation, attitudes toward, and willingness to use hospital report card. Materials and Methods: Firstly, we selected 30 subjects who were experts in social welfare or consumer right to participate in two rounds of Delphi investigation to select appropriate indicators of hospital report card. Secondly, we purposely ask for the permission from eight hospitals representing different accreditation levels and ownerships to allow us to select 500 medical and surgical inpatients to conduct a face-to-face interview regarding their innovativeness, perception characteristics of innovation, attitudes toward, and willingness to use hospital report cards. Finally, we used structural equation modeling (SEM) to test research hypotheses by way of. Results: We found that (1) from publics’ perspective the most applicable and important indicators include nosocomial infection rate, postoperative infection rate, inpatient’s satisfaction toward physician’s explanation, and outpatient’s satisfaction toward physician’s service attitudes; (2) only 17.2% of surveyed sample heard the term “hospital report card” before; (3) a total of 80.2% of inpatients considered hospital report cards to be very valuable or valuable for the selection of providers; (4) inpatients understood more in service indicators than clinic indicators; (5) the order of inpatients’ preference in presentation of hospital report cards was to use stars, percentages, and bar charts; (6) those who had higher education and higher monthly incomes, and were younger were more likely to understand the information provided by hospital report cards after adjusting for other factors; (7) among inpatients’ characteristics of innovation toward hospital report card, ”compatibility” and “result demonstrability” had significant positive influence on ”inpatients’ attitude toward hospital report card”; (8)”perceived usefulness”, “inpatients’ attitude toward hospital report card”, and “inpatients’ innovativeness” had significant positive influence on ”inpatients’ willingness to use hospital report card”；(9)”compatibility” had significant positive influence on “inpatients’ attitude toward hospital report card”；(10)“inpatients’ attitude toward hospital report card” had significant positive influence on ”inpatients’ willingness to use hospital report card”；(11)finally it is worth emphasize that this study had a new finding that ”perceived usefulness”, “perceived ease to use ”, “compatibility”, “result demonstrability ”,and “inpatients’ innovativeness” had significant positive correlation between each other. Conclusions: We concluded that inpatients considered hospital report cards to be valuable for the selection of hospitals. Therefore, it is recommended that hospital report cards be initiated by the Department of Health by integrating the information from hospital accreditation, medical claims data from the National Health Insurance, and survey of patient satisfactions. The rankings of hospital shown on report cards can be presented in stars or percentages, and these pieces of information can be released through booklet or Internet. In addition, consumers should be educated to use hospital information in order to monitor hospital performance and improve the efficiency of healthcare delivery system. / 目 錄 誌謝……………………………………………………………… Ⅰ 摘要……………………………………………………………… Ⅲ Abstract………………………………………………………… Ⅴ 目錄……………………………………………………………… Ⅶ 表目錄……………………………………………………………… Ⅹ 圖目錄……………………………………………………………… Ⅻ 第一章 前言……………………………………………………… 1 第一節 研究背景與動機………………………………… 1 第二節 研究目的與研究問題…………………………… 5 第三節 研究的重要性與預期貢獻……………………… 6 第二章 文獻探討………………………………………………… 8 第一節 醫院品質報告卡的沿革……………………………… 8 第二節 醫院品質報告卡的指標項目………………………… 15 第三節 醫院品質報告卡的影響與推行障礙………………… 27 第四節 醫療品質指標系統及品質報告卡的發展步驟……… 32 第五節 創新擴散理論………………………………………… 37 第六節 結構方程模式………………………………………… 43 第七節 國內外相關實證研究之結果………………………… 48 第八節 綜合討論……………………………………………… 76 第三章 以德菲法篩選醫院醫療與服務品質報告卡之指標項目. 79 壹、研究方法……………………………………………………… 79 第一節 研究設計與流程………………………………………… 79 第二節 研究對象………………………………………………… 79 第三節 研究工具………………………………………………… 81 第四節 資料處理與分析………………………………………… 95 貳、研究結果……………………………………………………… 95 第一節 問卷回收情形…………………………………………… 95 第二節 描述性統計分析………………………………………… 96 第三節 第一回合與第二回合問卷調查結果差異分析…………105 參、討論……………………………………………………………106 第一節 重要研究結果討論………………………………………106 第二節 研究限制…………………………………………………108 第四章 住院病人對醫院醫療與服務品質報告卡的認知、態度 與使用意願……………………………………………… 110 壹、研究方法………………………………………………………110 第一節 研究架構、目的與假說…………………………………110 第二節 研究對象…………………………………………………118 第三節 研究變項之操作型定義…………………………………121 第四節 研究工具…………………………………………………124 第五節 資料處理與分析…………………………………………126 貳、研究結果………………………………………………………128 第一節 問卷信度及效度的檢定…………………………………129 第二節 樣本基本特質與研究變項的統計分析…………………130 第三節 研究假說與架構的驗證…………………………………170 參、討論……………………………………………………………178 第一節 重要研究結果討論………………………………………178 第二節 研究限制…………………………………………………187 第五章 結論與建議………………………………………………188 第一節 結論………………………………………………………188 第二節 建議………………………………………………………191 參考文獻……………………………………………………………194 附錄…………………………………………………………………209 附錄一、德菲法問卷專家效度名單………………………………209 附錄二、德菲法問卷專家名單……………………………………210 附錄三、醫院品質報告卡指標項目適用性及重要性評分問卷 212 附錄四、醫院品質報告卡指標項目適用性及重要性評分問卷 (第二回合) ………………………………………………224 附錄五、住院病人對「醫院醫療與服務品質報告卡」的認知、 態度與使用意願之研究問卷專家效度名單……………246 附錄六、住院病人對「醫院醫療與服務品質報告卡」的認知、 態度與使用意願之研究…………………………………247 附錄七、醫院醫療與服務品質報告卡的範例……………………254 表目錄 表2-1品質報告卡的種類及指標項目…………………………… 20 表2-2台灣有關醫療品質指標的實證研究……………………… 50 表2-3台灣用來評估醫院醫療品質的指標彙總表……………… 56 表2-4有關民眾(病人)選擇醫院(醫師)考量因素的實證研究… 58 表2-5台灣有關醫院品質報告卡及民眾就醫選擇資訊需求的相 關研究 ……………………………………………………… 66 表3-1本研究初步選取醫院醫療與服務品質指標的來源或依據…84 表3-2本研究所採用醫院醫療與服務品質指標的操作型定義……87 表3-3問卷發放及回收情形…………………………………………96 表3-4德菲法專家問卷分析結果……………………………………99 表3-5適用性前十名指標項目及其平均值 ………………………103 表3-6重視度前十名指標項目及其平均值 ………………………104 表3-7適用性與重視度交叉分析矩陣表 …………………………104 表3-8高適用性且高重視度指標項目 ……………………………105 表3-9Wilcoxon Signed Ranks Test 檢定結果………………… 109 表4-1研究對象分配表—依層級別、權屬別及性別分 …………120 表4-2預試問卷各成份信度結果 …………………………………125 表4-3有效樣本分佈情形—依醫院別 ……………………………131 表4-4樣本個人基本特質與就醫選擇資訊搜尋及需求狀況 ……133 表4-5對醫院醫療與服務品質報告卡的認知 ……………………137 表4-6對醫院醫療與服務品質報告卡之指標及呈現方式的瞭解 程度…… ……………………………………………………139 表4-7醫院醫療與服務品質報告卡創新特性之描述性分析 ……140 表4-8醫院醫療與服務品質報告卡的態度及使用意願之描述性 分析………………………………………………………… 144 表4-9創新接受度量表之描述性分析 ……………………………145 表4-10住院病人自覺醫院醫療與服務品質報告卡對選擇醫院有 無價值影響因素的雙變項分析……………………………147 表4-11病人自覺品質報告卡對選擇醫院有無價值影響因素之複 迴歸分析……………………………………………………149 表4-12住院前有無先探聽醫院醫療與服務品質資訊影響因素的 雙變項分析…………………………………………………151 表4-13住院前有無探聽醫院醫療與服務品質資訊影響因素之複 迴歸分析……………………………………………………153 表4-14住院病人是否看懂醫院醫療與服務品質資訊影響因素的 雙變項分析…………………………………………………155 表4-15住院病人是否看懂品質資訊影響因素之複迴歸分析……157 表4-16住院病人是否需要醫院醫療與服務品質報告卡影響因素 的雙變項分析………………………………………………159 表4-17住院病人是否需要醫院品質報告卡影響因素之複迴歸分 析……………………………………………………………161 表4-18住院病人會不會參考醫院醫療與服務品質報告卡影響因 素的雙變項分析 …………………………………………163 表4-19住院病人會不會參考醫院品質報告卡影響因素之複迴歸 分析…………………………………………………………165 表4-20住院病人是否會更換就醫醫院影響因素的雙變項分析…167 表4-21住院病人會不會更換到其他的醫院看病影響因素之複迴 歸分析…… ………………………………………………169 表4-22住院病人創新接受度、對醫院醫療與服務品質報告卡創 新特性之知覺、態度與使用意願理論架構因果模式之配 適度檢定結果………………………………………………171 表4-23整體模式之多元相關平方(SMC) …………………………171 表4-24外因潛在變項與其測量變項關係之標準化係數之檢定…173 表4-25內因潛在變項與其測量變項關係之標準化係數之檢定…174 表4-26潛在變項間之因果關係的標準化係數之檢定……………174 表4-27外因潛在變項間相關係數之檢定…………………………175 表4-28研究模式的間接、直接與整體效果………………………175 表4-29研究假說檢定結果…………………………………………176 圖目錄 圖2-1Rogers的創新--決策過程典範………………………………41 圖3-1德菲法研究流程………………………………………………80 圖4-1研究架構 ……………………………………………………111 圖4-2本研究之結構方程模式關係路徑圖 ………………………177