看護学生に対する予防接種推奨の課題 : SD法によるイメージ調査からの検討

背景：看護学生に対して小児感染症とB型肝炎の免疫抗体価を検査し，免疫を持たない感染症について予防接種の指導を行った．しかし，予防接種が必要であると認識しながらも，実際に予防接種を受けるという行動に結びついた学生は少なかった．そこで，予防接種に対する態度を規定する要因を明らかにするためにイメージ調査を行い，予防接種を推奨する上での課題を明らかにした．
方法：看護学生１０４名を対象とした．集合質問紙調査法により予防接種の指導前後と長期休暇をはさんだ２ヵ月後に予防接種などに関するイメージ調査を行った．イメージ調査にはSD法（Semantic Differential Method）を用い，コンセプトは「予防注射」，「看護師」，「私」，「風疹」，「B型肝炎」の６つとした．
結果：予防注射に対するイメージについて指導前と指導後で比較すると「安い－高い」，「簡便な－面倒な」はマイナスの方向に有意に変化した（p＜０．０１）．「看護師」と「私」のイメージを比較すると，「健康な－病弱な」（p＜０．０１），「抵抗力がある－無防備な」（p＜０．０１）は「看護師」の方が有意にプラスイメージで，逆に「病気にならない－病気になる」（p＜０．０１），「安全な－危険な」は「私」の方が有意にプラスイメージであった．学生は看護師よりも病気にならず安全と感じ，同時に，看護師は学生よりも健康で抵抗力があるが病気になりやすいと矛盾した論理をもっていた．「私」についてのイメージは指導の前後で変化しなかった．
結論：接種率を向上させるためには，受診方法の改善や費用の助成等を行って，予防接種についてのハードルを低くし，環境面からアプローチする必要がある．また，学生は自分が免疫を持たないことを認知しながらも，自己の健康を過信し，自己矛盾を抱えていた．学生が自分自身の健康に対する意識を変え，自己矛盾に気づくよう教育することが今後の課題である．

Background : An investigation of immune antibody titer against pediatric infectious diseases and hepatitis B was conducted to nursing students. They were then instructed to vaccinate against communicable diseases they were not yet immunized against. Although they recognized the importance of vaccination, only few actually vaccinated themselves. Consequently, an image research was conducted to find factors determining the attitude toward vaccination. This has clarified issues in vaccination recommendation.
Methods : Group questionnaire surveys were conducted to the subjects of 104 nursing students before and after an instruction on vaccination and after 2 months sandwiching vacation. For an image research, the Semantic Differential Method was employed, setting five concepts of : Vaccination, Nurse, Self, Rubella, and Hepatitis B.
Results : In the comparison of images to vaccination before and after the instruction, the responses to the questions, “Cheap-Expensive” and “Simple-Complicating,” changed significantly in a negative direction, （p＜ 0.01）after the instruction. Between the concepts of “Nurse” and “Self,” the responses to “Healthy-Sickly” （p ＜0.01）and “Resistant-Vulnerable”,（p＜0.01）were positive in “Nurse”, whereas the responses to “Uneasily sickened-Easily sickened” （p＜0.01） and “Safe-Risky” were positive in “Self.” This represented a contradiction in the subjects’ logic : while the students thought they were uneasily sickened and felt safer than nurses, nurses were seen as healthier and more resistant then the students but easily sickened. Their images toward “Self” did not change from before to after the instruction.
Conclusion : The enhancement of vaccination rate requires an environmental approach to the barrier to vaccination, for example, by improving consultation methods and by financial support. Furthermore, the nursing students represented self- contradiction ; although they realized they lacked certain immunity, they were overconfident about their health. What remains to be seen is the education to enable them to change their attitude toward their own health and realize their self- contradiction.