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Objective This research aimed to examine the factors associated with the intention to use adult preventive health services in Taiwan. Design and sample Using Andersen's behavioral model, we employed a cross-sectional descriptive design to investigate 500 samples from four communities in southern Taiwan. Measures We used a self-reported survey to assess participants' intention to use adult preventive health services, and the predisposing, enabling, and need factors influencing their intention. Results Intention to use adult preventive health services was more significantly explained by predisposing and enabling factors than by need factors. In addition, a lack of fixed medical facilities (enabling factor) and Taiwanese origin (predisposing factor) were associated with decreased odds of intention to use adult preventive health services. An educational level of high school or below (predisposing factor), higher amounts of exercise (predisposing factor), and lower barriers to use preventive health services (predisposing factor) were associated with increased odds of intention to use adult preventive health services. Conclusion The findings can assist public health nurses in identifying high-risk groups with lower intentions of using adult preventive health services. Additionally, community-based health education program can be developed to increase people's intention to use adult preventive health services.

Introduction: Marital violence is a global women’s health issue. This study aimed to examine the factors influencing marital violence among Vietnamese immigrant women in Taiwan. Method: A cross-sectional research design was used. Snowball sampling was applied to recruit 250 Vietnamese women in southeast Taiwan. Data were collected through a survey from August 2015 to January 2016. The data were analyzed using a regression analysis. Results: This study found that 70.4% of Vietnamese women had experienced marital violence in the past year. Participants who did not depend on their husband’s income and held stronger views objecting to marital violence experienced a higher frequency of violence inflicted by their spouses. Conclusions/Implications: The study findings provide preliminary insight for nurses and a better understanding of the situation. They can be used not only to address the factors of marital violence affecting Vietnamese women in Taiwan but also to design marital violence–related interventions within a male-dominated culture.

Summary Purpose The purpose of this study was to understand the situation of diabetes patients receiving examinations for diabetes complications and to explore the factors influencing their intention to receive examinations for diabetes complications. Methods A cross-sectional study was performed that included 251 diabetes patients who visited outpatient clinics in Southern Taiwan. A survey using a self-administered questionnaire was conducted from October 2015 to January 2016. The questionnaire included items on demographic characteristics, perceived susceptibility to diabetes complications, perceived seriousness of diabetes complications, perceived benefits of taking action to receive diabetes complication examinations, perceived barriers to taking action to receive diabetes complication examinations, and the intention to receive diabetes complication examinations. The data were analyzed using regression analysis. Results The percentage of participants who received fundus, foot, and kidney examinations was 67.7%, 61.4%, and 73.3%, respectively. Every point increase on the perceived barriers to taking action to receive diabetes complication examinations scale increased the intention to receive a foot examination in the following year by 0.91 times ( p =.002), and every point increase on the perceived susceptibility to diabetes complications scale increased the intention to receive a kidney examination in the following year by 1.19 times ( p =.045). Conclusions Nurses should shoulder the responsibility to increase patients' intention to receive examination of diabetes complications. The results of this study can be used to promote nurses' care efficacy in preventing diabetes complications. They can also provide medical institutions with information to establish prevention and control policies for diabetes complications.

The aim of this study was to determine an appropriate frequency and location of binaural electrostimulation to ensure the treatment effect. Twenty-three healthy participants were recruited to receive 15 min of electrostimulation at two different frequencies (i.e., 1 vs. 25 Hz), and the same procedure was performed at two locations (tragus vs. earlobe). This study observed fluctuations in heart rate variability to reflect the autonomic activity. Repeated measures ANOVA was carried out to determine the differences. Results showed that the activities of parasympathetic and total power increased after stimulation in both tragus and earlobe trials. However, the effect of 25 Hz stimulation to increase total power was significantly higher than that of 1 Hz. No significant difference in stimulating the earlobes or tragus was observed. Therefore, binaural electrostimulation might be cardioprotective and useful as a complement to medical treatment.

Summary Purpose This study aimed to explore the factors associated with the intention to receive a Pap test among married immigrant women of Vietnamese origin living in Taiwan. Methods This was a cross-sectional community-based study. We enrolled 281 women aged 30 years and over in the study, from July 2013 to January 2014. The participants' characteristics, cervical cancer knowledge, Pap test knowledge, attitudes toward cervical cancer, barriers to receiving a Pap test, fatalism, and intention to receive a Pap test, were measured using self-report questionnaires. Hierarchical multiple regression analyses were performed to examine the variables associated with participants' intentions to receive a Pap test. Results Vietnamese women with low scores on the measures of cervical cancer knowledge and perceived barriers to receiving a Pap test were more willing to receive the test, as were those with high scores on the measures of Pap test knowledge and fatalism. Women who received a Pap test in the previous year were more willing to receive a Pap test within the next 3 years. Conclusions Preventive healthcare for immigrant women should be a focus of nurses. The development of culturally appropriate health education and strategies should enhance their knowledge of Pap tests and reduce perceived barriers to Pap test participation. This study's results can be a reference for nurses who work with immigrant women.

This paper aims to conduct and evaluate an educational intervention on preventing cervical cancer among married immigrant women of Vietnamese origin. The study design was a quasi-experimental method with two groups. In total, 260 married immigrant women of Vietnamese origin with national health insurance at least 30 years of age were recruited from November 2013 to January 2015 in southern Taiwan. The effects of the educational intervention, including cervical cancer and Papanicolaou test knowledge, attitudes towards cervical cancer, fatalism, barriers to receiving Papanicolaou tests, intention for receiving Papanicolaou tests within the next year, and intention for receiving Papanicolaou tests within the next 3 years, were evaluated. Repeated measures analyses of variance showed significant interactions between the intervention group and time for cervical cancer knowledge, knowledge of Papanicolaou test, attitudes towards cervical cancer, and intention for receiving a Papanicolaou test within the next 3 years; in addition, 71.4 % reported being satisfied or very satisfied with the intervention. The results of this study can provide information for governments to make appropriate health policies for screening behavior of cervical cancer, increase healthcare professionals' competencies towards Vietnamese women, and increase Papanicolaou test screening rates to decrease cervical cancer mortality. Effective interventions may require particular consideration of married immigrant women.

The aim of this study was to determine an appropriate range of negative pressure to ensure the treatment effect of cupping. Twenty healthy participants were enrolled to receive classic dry cupping treatments at three different pressure intensities (−100, −300, or −500 mmHg) for 10 min each. Heart rate variability (HRV) was measured before, during, and 10 min after cupping to assess changes in autonomic activity. Repeated measure ANOVA was used to analyze differences. Cupping at a pressure of −100 mmHg did not significantly change the HRV, but cupping at both −300 and −500 mmHg caused a significant improvement in HRV. The HRV responses did not differ significantly between cupping at −300 and at −500 mmHg, however. The significant increase in HRV occurred only during the recovery period after the cups were removed.

BackgroundThe study’s purpose was to examine the effectiveness of different reminder strategies on first-time free mammography screening among middle-aged women in Taiwan.MethodsA quasi-experimental design with random assignment was adopted to divide the participants into three Reminder Strategies groups (mail reminder, telephone reminder, and combined mail and telephone reminders) and one control group. This study recruited 240 eligible middle-aged women, and 205 of them completed the study. Upon the completion of data collection, mail reminders were provided to women of the first group; telephone reminders were provided to the second group; mail followed by telephone reminders were provided to the third group, and the usual postcards were provided to the control group 1 month after the interventions. Two follow-up assessments were conducted 1 and 3 months after the intervention to collect mammography-screening behaviors from all groups.ResultsThe findings showed that, compared to the control group, more participants in the intervention groups underwent mammography screening after receiving reminder interventions. Telephone contact as reminder was found to have the most significant influence among the interventions (OR = 5.0556; 95% CI = 2.0422–13.5722).ConclusionsGovernment and healthcare providers are recommended to consider adopting the telephone reminder strategy to encourage women to undergo their first-time mammography screening.

The purpose of this study was to explore the factors associated with Pap testing among married immigrant women of Vietnamese origin residing in Taiwan, including demographics, knowledge of cervical cancer, knowledge of Pap tests, fatalism, attitudes toward cervical cancer, and barriers to receiving Pap tests. A cross-sectional correlational design was used. Data were collected from July 2012 to January 2013. Participants were recruited through snowball sampling in two communities in Southern Taiwan. A total of 451 married immigrant women of Vietnamese origin aged 30 years and over were invited to participate in the study and 427 participated. Data analysis included descriptive statistics and multivariate logistic regression. Participants with no children were significantly less likely to have received a Pap test (odds ratio = 0.278, 95% confidence interval [CI] = 0.135-0.569); each additional point of knowledge about Pap tests increased the likelihood of having a Pap test by 19% (odds ratio = 1.190, 95% CI = 1.093-1.297), and each additional point in barriers to receiving Pap tests decreased the chances of having received a Pap test (odds ratio = 0.714, 95% CI = 0.637-0.800). The results can provide governments with a reference for developing policies for cervical cancer prevention among married immigrant Vietnamese women.

Key wordsMarriage migrant women, health empowerment, participatory action researchAbstractPurpose: The aim of this study was to develop, implement, and evaluate a theory-based intervention designed to promote increased health empowerment for marriage migrant women in Taiwan. The rapid increase of international marriage immigration through matchmaking agencies has received great attention recently because of its impact on social and public health issues in the receiving countries.Design and Methods: A participatory action research (PAR) and in-depth interviews were adopted. Sixty-eight women participated in this study. Eight workshops of the health empowerment project were completed.Findings: Through a PAR-based project, participants received positive outcomes. Four outcome themes were identified: (a) increasing health literacy, (b) facilitating capacity to build social networks, (c) enhancing sense of selfworth, and (d) building psychological resilience.Conclusions: PAR was a helpful strategy that enabled disadvantaged migrant women to increase their health literacy, psychological and social health, and well-being.Clinical Relevance: The findings can be referenced by the government in making health-promoting policies for Southeast Asian immigrant women to increase their well-being. Community health nurses can apply PAR strategies to plan and design health promotion intervention for disadvantaged migrant women.The rapid increase of international marriage immigration through matchmaking agencies has received great attention recently because of its impact on social (e.g., demographic structure and culture) and public health (e.g., healthcare services) issues in the receiving countries. The U.S. Citizenship and Immigration Services (2013) reported that the "mail-order bride" business results in 4,000 to 6,000 marriages between U.S. men and foreign women each year. In Asian countries, an increasing number of women from Mainland China, Vietnam, Indonesia, the Philippines, Thailand, Malaysia, and Cambodia have migrated through international marriage to Taiwan, Singapore, Japan, South Korea, and Hong Kong (Hsia, 2010). In Taiwan, the immigration of Southeast Asian brides started in 1987 in rural areas of Taiwan (Yang & Wang, 2012). However, the number of undocumented international marriage immigrant women is often underestimated. According to Taiwan's Ministry of the Interior (2012), there has been an influx of 410,000 foreign spouses in Taiwan, including 140,000 from Southeast Asia and approximately 260,000 from Mainland China. The Ministry of the Interior (2012) reported that the overall immigrant population in Taiwan has grown dramatically, especially immigrants from Mainland China (318,390; 67.45%), Vietnam (87,274; 18.49%), Indonesia (27,648; 5.86%), Thailand (8,333; 1.77%), and the Philippines (7,468; 1.58%), making the influx of racial or ethnic immigrant minorities an increasingly challenging social and public health issue.For many women in developing countries, international marriage immigration has emerged as a way to escape poverty and achieve a better life by marrying men from more financially developed countries. For men in East Asia who experience difficulties finding a wife, matchmaking agencies can arrange a trip to allow men to locate a partner in a few days and return to their homeland with a new bride. The bridal candidates, however, are called by many derogatory terms, such as "mail-order brides" or "foreign brides," and are often treated with disrespect and derision in the receiving country (Choe, 2005).Health Care Among Immigrant Women in Transnational MarriagesThe growing number of immigrant women has become a significant global concern in the social and public health sectors. According to the United Nations' Committee on the Elimination of Discrimination Against Women (2009), immigrant women may not only be subject to sex discrimination in their receiving country but also face specific health challenges. …

Background: Breast cancer is a major global health issue. Receiving regular breast cancer screenings aids in the early detection and treatment of breast cancer. Numerous factors influence whether a Vietnamese woman receives breast cancer screening. Purpose: The aims of this study were to understand current rates of breast cancer screening and explore the factors that influence intention to undergo breast cancer screening among Vietnamese women in transnational marriages. Methods: This was a cross-sectional, community-based study. Data were collected via snowball sampling. We enrolled 250 women aged 18 years and over from September to December 2015. Results: The percentage of participants who had received a breast self-examination, breast palpation, or breast ultrasound within the past year were 25.6%, 9.6%, and 21.2%, respectively. Moreover, only 6.8% of participants had received a mammography within the past 2 years. Participants with strong perceptions of breast cancer being a serious illness, who had fewer barriers to obtaining a breast cancer screening, or who had been advised by healthcare personnel to undergo screenings were more likely to report an intention to receive periodic breast self-examinations during the subsequent 1-year period. Participants who had lived in Taiwan for a longer period, had higher levels of perceived susceptibility to breast cancer, had prior experience with breast diseases, or had fewer barriers to obtaining a breast cancer screening were more likely to report an intention to receive a breast ultrasound during the subsequent 1-year period. Finally, participants who were older, perceived greater benefits from receiving breast cancer screening, and had not entered menopause were more likely to report an intention to receive a mammography during the following 2 years. Conclusions/Implications for Practice: Medical care personnel should promote breast cancer screening among Vietnamese women in transnational marriages. The results may be useful in promoting greater awareness among medical care personnel of breast cancer issues and efficacy in performing breast cancer screening for Vietnamese women in transnational marriages and provide references for the establishment of breast cancer prevention and control policies.

De Quervain's disease, carpal tunnel syndrome (CTS), and trigger finger (digit) are three common pathological conditions of the hand. They are considered overuse syndromes and occur predominantly in females. The prevalence rate and cause-specific risks of these three tendinopathies have not yet been clarified. Data from 41,871 cases listed in the Taiwan National Health Insurance Research Database (NHIRD) from 2010 to 2014 were analyzed. The prevalence rate of these 3 conditions by age, sex, and the risk factors of female-dominant diseases (e.g., osteoporosis, rheumatoid arthritis [RA], and tendinopathy), diabetes mellitus, and hormone antagonist treatment was evaluated. We found that 1.59% of the population developed CTS, 0.49% developed de Quervain's, and 1.07% developed trigger finger. Cases were more likely to develop the three hand tendinopathies if they were female, between 50 and 59 years old, and, according to a multivariate analysis, comorbid with RA, diabetes, using hormone antagonists. Our findings should provide an understanding of the risk factors associated with hand tendinopathy.

Objective The aim of this study is to clarify the conditions under which female medical personnel receive Pap tests and the influencing factors associated with not receiving Pap tests. Methods Data from the Taiwanese National Health Insurance Research Database (NHIRD) in Taiwan were analyzed. There were a total of 142,123 subjects: 5,196 physicians, 13,366 pharmacists, and 123,561 nurses. Results Of the subjects, 57.7% had received a Pap test in 2008–2010. Pap-test rates were highest for pharmacists (58.1%) and nurses (58.0%) and lowest for physicians (48.6%). After adjustment for age, having visited an obstetrics/gynecology clinic, gynecological disease, chronic disease, major illnesses, occupational diseases/injuries, and cancer, subjects were less likely to have received a Pap test if they were older, had visited an obstetric/gynecological clinic, or had gynecological diseases or major illnesses. Pharmacists and nurses who had occupational diseases/injuries and chronic diseases and nurses who had had cancer were less likely to have received a Pap test. Conclusion Hopefully, by highlighting the factors associated with lower likelihood of receiving Pap tests, the study findings will increase self-awareness among female medical personnel, improving their rate of Pap-test participation.

Background: An increasing number of survivors of intimate partner violence (IPV) have begun to seek help from hospital emergency departments. This study was conducted to develop a list of requisite clinical competencies for emergency nurses to provide adequate care for women experiencing IPV. Method: An e-mail survey using the Delphi technique was administered, involving three rounds of questionnaires from 30 participants. Participants were asked to score the importance of each item on a 4-point Likert scale. Results: The study identified three dimensions, comprising 38 items of competencies related to care for individuals experiencing IPV, including Knowledge (10 items), Attitudes (11 items), and Practice (17 items). Conclusion: The emergency department is where direct medical treatment and care is provided for those who have experienced IPV. The study findings can provide a reference for the development of in-service educational programs in hospitals and can guide future policy making. J Contin Educ Nurs . 2015;46(6):272–278.

The aim of this study was to develop, implement, and evaluate a theory-based intervention designed to promote increased health empowerment for marriage migrant women in Taiwan. The rapid increase of international marriage immigration through matchmaking agencies has received great attention recently because of its impact on social and public health issues in the receiving countries.A participatory action research (PAR) and in-depth interviews were adopted. Sixty-eight women participated in this study. Eight workshops of the health empowerment project were completed.Through a PAR-based project, participants received positive outcomes. Four outcome themes were identified: (a) increasing health literacy, (b) facilitating capacity to build social networks, (c) enhancing sense of self-worth, and (d) building psychological resilience.PAR was a helpful strategy that enabled disadvantaged migrant women to increase their health literacy, psychological and social health, and well-being.The findings can be referenced by the government in making health-promoting policies for Southeast Asian immigrant women to increase their well-being. Community health nurses can apply PAR strategies to plan and design health promotion intervention for disadvantaged migrant women.

Aim To assess and understand the barriers faced by Vietnamese marital immigrant women who do not regularly undergo cervical screenings in Southeast Taiwan. Background Studies have shown a low uptake rate of preventive medical services among immigrants. As immigrant women may not be aware of the healthcare delivery system in their host country, their uptake of and access to healthcare services might be limited. Design A qualitative, descriptive inquiry design was adopted. Methods This qualitative study employed semi-structured, individual, in-depth interviews of 17 Vietnamese immigrant women. Data were collected from February–July 2011 and analysed using content analysis. Findings The barriers to receiving cervical screening were lack of health literacy, lack of female healthcare providers, negative perceptions of cervical screening and personal reasons. Conclusion The results might serve as a reference for government entities and healthcare providers in Taiwan to improve cervical screening rates; this should help enhance the effectiveness of healthcare services for Vietnamese immigrant women. The findings can also provide a reference for making appropriate healthcare policies for immigrant women in other countries.

Bone grafting is a commonly used orthopedic surgical procedure that will provide bone formation in bone defects or regions of defective bone healing. A major complication following bone grafting is a postoperative recipient graft site infection that is associated with substantial mortality and increased use of medical resources. The purpose of the study was to identify the risk factors associated with infection after bone-grafting surgery. Data from 1,303,347 patients listed in the Taiwan National Health Insurance Research Database (NHIRD) and admitted to hospitals from 1997 through 2012 who underwent primary bone grafting (mean age: 46.57 years old; mean length of hospital stay: 8.04 days) were analyzed. The incidence of infection by age, hospital stay, gender, income, chronic disease (tuberculosis [TB]; diabetes mellitus [DM]; acquired immunodeficiency syndrome [AIDS]), fracture complications (nonunion; delayed union fracture), types of graft and hospital was evaluated. Three percent of the patients developed a postoperative recipient graft site infection. Multivariable analysis revealed that patients were more likely to develop a post bone-grafting surgery infection if they were older, had a longer hospital stay, were male, had a lower income, or had comorbid TB, DM, or AIDS. Patients were more likely to develop an infection if they had a nonunion, an alloplast graft, or treated in a local clinic. Our findings should provide a clinically relevant reference for surgeons who perform bone grafting. Patients should be informed of the potential risks.

This paper reports on the effects of health education intervention on the smoking knowledge, attitudes, decision-making capabilities, and intentions not to smoke of eighth-grade students. The study selected one intervention and two control groups. The intervention group received six-hour's health education. Data were collected before and immediately after and two months after the intervention to examine the immediate and later effects of the intervention. Data were analyzed with a repeated measures analysis of variance. Results indicated that while health education could significantly enhance students' smoking knowledge, it did not significantly change the students' nonsmoking attitudes, decision-making capabilities, or intention not to smoke. The findings suggest that school health nurses can design and provide health education activities to increase junior high school students' smoking knowledge and smoking frequency.