臺灣博碩士論文加值系統

痛經是婦女常見的困擾之一，在現今醫療環境中，中醫有全民健保給付，讓婦女能求助中醫以調理身體來解決痛經的困擾，但病人遵從醫囑的程度成為有效治療的關鍵，因此，醫病互動會影響痛經婦女能否有效處理痛經。本研究運用Q方法(Q methodology)進行Q陳述句的擬定，建構意見母群，再從Q排列過程萃取最符合醫病互動看法之相關敘述，進行主觀的排序。研究對象為北區某兩家區域醫院接受中醫治療之痛經婦女，邀請60位受訪者對39句Q陳述句進行排列。
研究結果運用PQ method 2.35版軟體，進行量化統計分析，歸類受訪者人數為44人，解釋變異量56.67%，分為四種類型：「體質考量型」的受訪者認為中醫處理痛經問題是以體質調理為主、「醫師引導型」的受訪者認為不論採中西醫治療都需遵從醫師處置，將解決痛經的責任交給醫師、「耐心調理型」的受訪者認為中醫治療是因人而異調整，願意改變生活習慣並耐心等待療效產生、「療效要求型」的受訪者認為求較好療效，可選擇中西醫合併治療，若療效不如預期，則選擇更換醫師，觀察各類型對於求醫過程中醫病互動的看法。此研究有助於探索分析痛經婦女對醫病互動的主觀看法與內涵，以期待透過病人的觀點發現有助於醫病互動的契機。

Dysmenorrhea is one of the common problems of women, people here in Taiwan shared the scope of benefits in Chinese medicine by National Health Insurance, so many women turned to traditional Chinese medicine to solve the problem of dysmenorrhea in current society. As we know, the better compliance comes the more effective treatment. Therefore, the interaction between the patient and doctor would affect the women whether she could deal with dysmenorrhea effectively.
In this study, the Q methodology approach was adopted to explore women with dysmenorrheal views on physician-patient interaction. Extraction Q statements are generated from the representative sample about the concept of physician-patient interaction. A series of Q sorts were performed of rank the relevant descriptions obtained from the women with dysmenorrhea subjectively. The data collection was conducted on 60 women receiving Chinese medical remedies for women with dysmenorrhea at two regional teaching hospitals in northern Taiwan. The total arranged Q statements were 39 sentences.
The software of PQ method (2.35 version) was used for statistical analysis in this study. A total of 44 women were classified, which explained 56.67% of the variance: “body-constitution”- the respondents believe that the way to treat dysmenorrhea in Chinese medicine, “physicians-guided”- they think that obeying the doctors' orders is the priority, “well-cooperated”- the responders believe that the treatment should be individualized, and they are willing to change their lifestyle and wait patiently for the therapeutic effect, “therapeutic-effect”- women turn to another physician if they didn’t satisfied with the treatment outcome.
These findings portray the variety of viewpoints on physician-patient interaction existing among with the dysmenorrhea women in Chinese medicine clinics. The four identified categories may be useful in developing tailor-made continuing interaction strategies.

目錄
誌謝······················································i
中文摘要················································iii
英文摘要·················································iv
目錄·····················································vi
圖目錄·················································viii
表目錄···················································ix
第一章　緒論··············································1
第一節　研究背景與重要性······························1
第二節　研究目的······································4
第二章　文獻查證··········································5
第一節　中醫痛經治療··································5
第二節　就醫行為······································9
第三節　醫病互動與醫囑遵從性·························16
第四節　Ｑ方法·······································20
第三章　研究方法·········································23
第一節　研究設計·····································23
第二節　研究對象·····································24
第三節　研究流程·····································25
第四節　統計處理·····································33
第五節　研究倫理·····································36
第四章　研究結果分析與討論·······························37
第一節　研究分析過程·································37
第二節　受訪者基本資料分析···························42
第三節　各類型因素分析與詮釋·························44
第四節　四種類型之比較分析···························59
第五章　討論與建議·····································79
第一節　研究討論·····································79
第二節　研究建議·····································84
第六章 結論與限制·······································87
第一節　研究結論·····································87
第二節　研究限制·····································89
參考文獻·················································90
圖目錄
圖1醫病互動流程圖······································25
圖2特徵值大於1之陡坡圖································39
表目錄
表1國內外就醫行為相關研究······························13
表2接受中醫治療之痛經婦女對於醫病互動之Q陳述句········27
表3Q陳述句排列表格·····································30
表4因素特徵值與解釋變異量······························38
表5四種類型受訪者因素負荷表····························39
表6受訪者基本資料······································42
表7「體質考量型」(I)的理想化Q陳述句之因素排列表·······46
表8「體質考量型」(I)的最同意與最不同意之Q陳述句·······47
表9「醫師引導型」(II)的理想化Q陳述句之因素排列表·······50
表10「醫師引導型」(II)的最同意與最不同意之Q陳述句·······51
表11「耐心調理型」(III)的理想化Q陳述句之因素排列表······54
表12「耐心調理型」(III)的最同意與最不同意之Q陳述句······55
表13「療效要求型」(IV)的理想化Q陳述句之因素排列表·······57
表14「療效要求型」(IV)的最同意與最不同意之Q陳述句·······58
表15因素類型的分類對照表·······························60
表16四種類型受訪者的基本資料之綜合比較表···············63
表17四種類型受訪者的經期調查之綜合比較表···············65
表18四種類型最同意與最不同意Q陳述句之綜合比較表·······68
表19「體質考量型」(I)與其他類型之區別語句比較表·········71
表20「醫師引導型」(II)與其他類型之區別語句比較表·······73
表21「耐心調理型」(III)與其他類型之區別語句比較表·······76
表22「療效要求型」(IV)與其他類型之區別語句比較表·······78

參考文獻
一、中文部分
印會河，張伯訥(1997)‧中醫基礎理論‧台北:知音出版社，14(31)，260-4。
史麗珠、彭佩宜、高鳳聲、蘇靖鈞、鄭蕙君、李幸禧(2000)‧北部某大學學生的求醫行為：中西醫之選擇‧秀傳醫學雜誌，2(4)，151-159。
李卓倫、紀駿輝、賴俊雄(1995)‧時間、所得與中西醫療價格對中醫門診利用之影響‧中華公共衛生雜誌，14(6)，470-476。
李茹萍、邱豔芬(1998)‧結核病人之服藥遵從性‧護理雜誌，45(1)，63-68。 doi: 10.6224/JN.45.1.63
李俊霆(2005)‧因素數目決定法：特徵值大於一之再探‧臺灣大學。
李翠容、羅頌平(2010)‧痛經中西醫研究概況‧台灣中醫科學雜誌，1(5)，24-31。
呂萬安(2010)‧痛經的預防與治療‧中醫藥研究論叢，13(1)，101-109。
吳龍源、彭文煌、陳志芳、蔡魯、張照敏、蔡美霞、吳秀惠、楊萬清(2010)‧中醫門診痛經患者臨床中藥方劑用藥頻率與形態分析‧中醫藥研究論叢，13(2)，99-123。
林美玲、李敏玲(2008)‧運動對原發性痛經之影響‧大專體育，99，197-201。
林淑娟、賴盈潔、李韻雯、江梅鈴、許瑞芸、陳麗麗(2005)‧從中醫觀點探討痛經的自我照護方法‧長庚護理，16(1)，66-72。
林孟寰(2010)‧高階文官管理核心能力Q方法論研究‧Unpublished 未發表‧銘傳大學，台北市。
林綽絹、陳麗麗(2002)‧從傳統中醫觀點論「症狀護理」‧護理雜誌，49(5)，15-21。doi: 10.6224/JN.49.5.15
林芸芸(1992)‧中、西醫醫療利用型態的文獻回顧與實證研析‧中華家雜誌，2(1)，1-13。
卓忠毅(2010)‧以Q方法探討教師對於數位學習關鍵成功因素之主觀看法‧(碩士論文未發表)，淡江大學，新北市。
周碧玲、林佳靜(2012)‧醫病關係對癌症病人服藥遵從性與症狀控制的影響‧護理雜誌，59(1)，10-14。 doi: 10.6224/JN.59.1.10
洪媺惠、賴裕和、張明揚(2007)‧續發性經痛婦女的經痛經驗與希望之相關探討‧長庚護理，18(2)，147-155。
洪微惠、洪毓珮、楊育書、黃頌儼、傅元聰、蔡欣潔、吳宏乾(2007)‧痛經的中醫治療文獻探討‧台灣中醫醫學雜誌，5(2)，56-68。
紀櫻珍、紀琍琍、吳振龍、黃松元（2006）‧醫學倫理與醫病關係‧醫學雜誌，3(12)，1-11。 doi: 10.6200/TCMJ.2006.3.12.01
高瑞青(2007)‧痛經之中醫藥療法，台灣中醫臨床醫學雜誌，13(1)，37-40。
高銘偵、鐘瑩慧、楊淑齡(2013)‧中藥藥物穴位外敷治療痛經之療效初探‧中醫藥雜誌，24(1)，85-96。
孫嘉玲、黃美瑜、宋梅生、王秀香(2005)‧痛經的芳香療法‧護理雜誌，52(4)，59-64。 doi: 10.6224/JN.52.4.59
孫嘉玲、黃美瑜、宋梅生、王秀香(2005)‧精油按摩對原發性痛經緩解效果之先驅研究‧實證護理，1(3)，195-201。doi: 10.6225/JEBN.1.3.195
陳重光、黃雅珮、方焄蓮、黃雅瑜(2013)‧女性痛經影響因素與舒緩方法之研究-以南部某專科學校為例‧護理雜誌，60(3)，40-50。doi: 10.6224/JN.60.3.40
陳素蟬、司徙儀(2004)‧原發性痛經中醫治療近況‧中醫婦科醫學雜誌，(4)，6-10。
陳緋娜、李珮端、謝慶良、林正介、江秀梅、林香汶、蔡文正、侯鈺琪、洪寶蓮(2008)‧台灣中部民眾就醫及用藥概況調查-以某醫學中心門診病患為例‧中西整合醫學雜誌，10(2)，1-14。
陳慧芳、賴建璋、楊榮季(2009)‧經痛的中醫療法‧繼續教育，25(1)，148-152。
康健壽、李金鳳、陳介甫、周碧瑟（1995）‧單複向求診行為的相關因素之探討‧中華醫誌，6(3)，175-186。
連義隆等著(1999)‧痛經與經前症候群，生殖內分泌及不孕症概要，健康出版社，台北，pp.105-114。
章殷超、溫在弘、賴美淑(2009)‧利用地理資訊系統探討肝癌病患就醫地理可近性與醫院選擇間之相關因素‧台灣衛誌，28(6)，517-529。
曾文俊(2002)‧綜合療法治經痛‧傳統醫學雜誌，13，96-99。
莊曜愷(2009)‧服務品質、醫院形象與民眾就醫行為對忠誠度的影響‧寶建醫護與管理，7(2)，18-29。
張振宇(2003)‧針灸配合耳穴貼壓治療痛經40例‧河南中醫，23(4)，51。
張珣(1983)‧台灣和人的醫療體系與醫療行為-一個台灣北部農村的醫學人類學研究‧中央研究院民族學研究所集刊，56，29-58。
張家蓓(2011)‧論經痛的中醫治療‧北市中醫會刊，17(1)，93-99。
張苙雲(1998)‧「逛醫師」的邏輯:求醫歷程的分析‧台灣社會學刊，21，59-87。
黃垣禎(2004)‧子宮內膜異位與痛經的探討‧中國中醫臨床醫學雜誌，10(2)，165-168。
湯振青、林靜川、蘇世斌(2010)‧原發性經痛診斷與治療‧家庭醫學與基層醫療，25(6)，237-242。
楊淑珍(2004)‧痛經‧中國中醫臨床醫學雜誌，10(1)，15-19。
葉宏明、楊美鳳、林為森(2013)‧類風濕性關節炎病患就醫行為調查‧秀傳醫學雜誌，12(1)，10-18。
廖瑞琪(2011)‧醫病關係＝關懷關係‧應用倫理評論，50，127-152。
蔡文正、龔佩珍(2003)‧民眾對基層診所評價與就醫選擇影響因素‧台灣衛誌，2(3)，181-193。
蔡文正(2007)‧民眾對中醫藥的認知度、信賴度、使用度及其相關因素之探討，中醫藥年報，27(4)，153-224。
蔡慈儀、蔡憶文、郭耿南(2010)‧醫療照顧體系中的健康溝通‧台灣醫學，14(6)，607-615。
鄭乃華、王琇宜、施涵琇、蘇靜怡、盧姝蓉、歐明秋(2010)‧芳香精油按摩對於緩解痛經之成效評估‧美容科技學刊，7(1)，71-87。
鄭集誠(2005)‧小兒營養不良‧台灣中醫臨床醫學雜誌，11(1)，27-31。
賴世偉、賴明每、黃金財(1990)‧經痛病人評估‧基層醫學，14(8)，144-146。
魏佳俐、林君穎、陳秀蘭、楊行義、蔡英傑（2009）．中草藥複方精油MA3B緩解經痛之研究．傳統醫學雜誌，20(1），133－141。
顏如娟、許明暉(2007)‧從資訊揭露與醫病雙方共同決策談醫病關係的演化‧北市醫學雜誌，4(8)，1-7。 doi: 10.6200/TCMJ.2007.4.8.01
衛生福利部國民健康署 (2012)‧BMI測試‧取自http://health99.hpa.gov.tw/OnlinkHealth/Onlink_BMI.aspx
Aday, L. L., &; Andersen, R. (1974). A framework for the study of access to medical care. Health Services Research, 9(3), 208-220.
Aziato, L., Dedey, F., &; Clegg-Lamptey, J. N. (2014). The
experience of dysmenorrhoea among Ghanaian senior high and
university students: pain characteristics and effects.
Reproductive Health, 11(1),1-8. doi: 10.1186/1742-4755-11-58
Baker, R., Thompson, C., &; Mannion, R. (2006). Q methodology in health economics. Journal of Health Services Research and Policy, 11(1),38-45. doi: 10.1258/135581906775094217
Bertoni, J. M., Busby, L. C., Crespo, A., Dixon, D., Dutton,L. L., &; Ennis, G. (2001). Professional guide to signs &;symptoms (3rd ed.). Springhouse, PA: Springhouse.
Bornstein, H. B., Marcus, D., &; Cassidy, W. (2011). Choosing a doctor: an exploratory study of factors influencing patients’ choice of a primary care doctor. Journal of Evaluation in Clinical Practice, 6(3), 255-262. doi: 10.1046/j.1365-2753.2000.00256.x
Burkhart PV, S. E. (2003). Adherence to long-term therapies:
Evidence for action. Journal of Nursing Scholarship, 35(3), 207.
Burnett, MA., Antao, V., Black, A., Feldman, K., Grenville, A., Lea, R., Robert, M. et al. (2005). “Prevalence of primary dysmenorrhea in Canada,” Journal of Obstetrics and
Gynaecology Canada, 27(8), 765–770.
Chiou, M. H., &; Wang, H. H. (2008). Predictors of Dysmenorrhea and Self-Care Behavior Among Vocational Nursing School Female Students. Journal of Nursing Research, 16(1),17-25. doi: 10.1097/01.JNR.0000387286.30688.5b
Chung, S. D., Liu, S. P., Lin, H. C., &; Kang, J. H. (2014). Association of dysmenorrhea with interstitial cystitis/bladder pain syndrome: a case-control study. Acta Obstetricia Et Gynecologica Scandinavica , 93(9), 921–925. doi: 10.1111/aogs.12437
Coco, A. S. (1999). Primary dysmenorrheal. American Family
Physician, 60,489-496.
Coogan, J., &; Herrington, N. (2011). Q methodology: An overview. Research in Secondary Teacher Education, 1(2), 24-28.
Daryl, M., &; Ralph, H. (1977). Improving patient compliance. Medical Clinics of North American, 61(4), 879-889.
Dawood, M. Y. (2006). Primary dysmenorrhea: advances in
pathogenesis and management. Obstetrics &; Gynecology,
108(2), 428-441. doi: 10.1097/01.AOG.0000230214.26638.0c
Ezekiel, L., &; Linda. (1992). Four models of the physician-patient relationship. Journal of the American Medical Association, 267(16), 1-13.
Ghodsi, Z., Asltoghiri, M., (2014). The Effect of Fennel on Pain Quality, Symptoms, and Menstrual Duration in Primary Dysmenorrhea. Journal of Pediatric and Adolescent Gynecology, 27(5), 283-286. doi: 10.1016/j.jpag.2013.12.003
Harlow, S. D., &; Park, M. (1996). A longitudinal study of risk factors for the occurrence, duration and severity of menstrual cramps in a cohort of college women. Birth Journal of Obstetrics and Gynaecology, 103,1134-1142. doi: 10.1111/j.1471-0528.1996.tb09597.x
Harlow, S. D., &; Ephross, S. A. (1995). Epidemiology of menstruation and Its relevance to women's health. Epidemiologic Revviews, 17(2), 265-286.
Haynes, B. R., Taylor, W. R. &; Sackett, D. L. (1979). Compliance in Health Care. Baltimore, MD: Johns Hopkins Univ. Press.
Huang, C. M., Wu, H. L., Huang, S. H., Chien, L. Y., &; Guo, J. L.(2013).Transtheoretical model-based passive smoking prevention programme among pregnant women and mothers of young children.European Journal Public Health, 23(5), 777-782. doi: 10.1093/eurpub/cks177
Hung, J. Y., Chiou, C. J., &; Chang, H. I. (2012). Relationships between medical beliefs of superiority of Chinese or western medicine, medical behaviours and glycaemic control in diabetic outpatients in Taiwan. Health and Social Care in the Community, 20(1), 80-86. doi:
10.1111/j.1365-2524.2011.01019.x
Kaba, R., Sooriakumaran, P. (2007). The evolution of the doctor-patient relationship. International Journal of Surgery, 5(7), 57-65. doi: 10.1016/j.ijsu.2006.01.005
Kleinman, A., Eisenbger, L., &; Good, B. (1978). Culture, illness and care: Clinical lessons from anthropological and cross-cultural research. Annals of Internal Medicine, 88, 251-258.
Kotler, P. (1987). Principles of Marketing, 3rd ed., Englewood Cliffs, New Jersey : Prentice-Hall.
Kwok. C., &; Sullivan, G. (2007). Health seeking behaviours
among Chinese-Australian women: implications for health
promotion Programmes. Social Science &; Medicine, 60,
1467-1478. doi: 10.1177/1363459307077552
Lynn, M. R. (1986). Determination and quantification of content validity. Nursing Research, 35(6), 382-385. doi:
10.1097/00006199-198611000-00017
McEvoy, M., Chang, J., &; Coupey, S. M. (2004). Common menstrual disorders in adolescence: Nursing interventions. The American Journal of Maternal/Child Nursing, 29(1), 41-49. doi: 10.1097/00005721-200401000-00011
Mead, N., &; Bower, P. (2000). Patient-centredness: a conceptual framework and review of the empirical literature. Social Science Medicine, 51, 1087-1100. doi: 10.1016/S0277-9536(00)00098-8
Morrow, C., &; Naumburg, E. H. (2009). Dysmenorrhea. Primary Care Clinics in Office Practice, 36(1), 19-32. doi: 10.1016/j.pop.2008.10.004
Osterberg, L., &; Blaschke, T. (2005). Adherence to medication. New England Journal of Medicine, 353(5), 487－497. doi: 10.1056/NEJMra050100
Pfister- Minogue, K. (1993). Enhancing patien t compliance: A guide for nurses. Geriatric Nursing, 14, 124-132. doi: 10.1016/S0197-4572(06)80128-X
Petit dit Dariel, O., Wharrad, H., &; Windle, R. (2010). Developing Q-methodology to explore staff views toward the use of technology in nurse education. Nursing Research, 18(1), 58-71. doi: 10.7748/nr2010.10.18.1.58.c8048
Prabakaran, R., Seymour, S., Moles, D. R., Cunningham, S. J. (2012). Motivation for orthodontic treatment investigated with Q-methodology: atients’ and parents’ perspectives. Am J Orthod Dentofacial Orthop, 142(2), 213-220.doi: 10.1016/j.ajodo.2012.03.026
Sandman, L., Granger, B. B., Ekman, I., &; Munthe, C. (2011). Adherence, Shared Decision-Making and Patient Autonomy. Medicine, Health Care and Philosophy, 14, 1-44.
Schlinger, M. J. (1969). Cues on Q-technique. Journal of Advertising Research, 9(3), 53-60.
Simons, J. (2013). An introduction to Q methodology. Nursing Research, 20(3), 28-32. doi: 10.7748/nr2013.01.20.3.28.c9494
Smith, R. P. (1996). Menstrual discomfort. Hospital Medicine, 32(3), 47-48.
Stephenson, W. (1953). The Study of Behavior: Q-Technique and Its Methodology: Chicago: The University of Chicago Press.
Szasz, T. S., &; Hollender, M. H. (1956). A contribution to the philosophy of medicine : the basic models of the doctor-patient relationship. A. M. A. Archives of internal medicine, 97(5), 585-592. doi: 10.1001/archinte.1956.00250230079008
Vermair, J. H., Hoogstraten, J., van Loveren, C., Poorterman, J. H., &; van Exel, N. J. (2010). Attitudes towards oral health among parents of 6-year-old children at risk of developing caries. Community Dent Oral Epidemiol, 38(6), 507-520. doi: 10.1111/j.1600-0528.2010.00558.x
Wolf, L. L. (1999). Dysmenorrhea. Journal of theAmerican Academy of Nurse Practitioners, 11(3), 125-133. doi: 10.1111/j.1745-7599.1999.tb00549.x