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研究生:陳怡伶
研究生(外文):Elan, Yi-Ling Chen
論文名稱:衛教方案介入對原住民第二型糖尿病患者足部照顧知識、自我效能與行為之成效評估
論文名稱(外文):Evaluation of A Educational Program on Foot-care Knowledge, Self-efficacy and Practice for Aborigine with Type 2 Diabetes in the Mountain Village of Hualien County
指導教授:謝婉華謝婉華引用關係
學位類別:碩士
校院名稱:慈濟大學
系所名稱:原住民健康研究所
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2005
畢業學年度:93
語文別:中文
論文頁數:135
中文關鍵詞:糖尿病衛教原住民自我效能
外文關鍵詞:diabetes educationself-efficacyaborigine
相關次數:
  • 被引用被引用:8
  • 點閱點閱:1026
  • 評分評分:
  • 下載下載:237
  • 收藏至我的研究室書目清單書目收藏:16
國內的糖尿病死亡率逐年升高,自1993年每十萬人中有25.7人,增加為2003年的44.4人;其中,花蓮縣每十萬人口死亡率為74.5人,居全國之冠。糖尿病患者的下肢感染引起的截肢問題是常見併發症。研究顯示若能加強足部照顧技能可以減少下肢感染並有效預防截肢。近來有許多研究顯示自我效能(self-efficacy)可用來預測及解釋糖尿病血糖控制、飲食及運動的結果,但目前台灣在探討衛教方案對增進糖尿病人足部照顧自我效能與行為成效的相關研究較少。因此,本研究為探討「QLAHANG-QAQAY-SU(太魯閣族語:小心你的腳)〜糖尿病足部評估合併足部照顧衛教方案」對原住民第二型糖尿病患者足部照顧知識、自我效能與行為的成效,採非隨機分派兩組控制前後測實驗設計方法,選取花蓮縣山地鄉衛生所內糖尿病共同照護網收案之第二型糖尿病患者為研究對象。共收得實驗個案51名與非實驗個案59名,年齡在35至81歲。實驗個案除依糖尿病共同照護門診程序接受治療外,另接受足部評估,包含糖尿病神經病變症狀、單股尼龍纖維的感覺檢查、音叉的震動感檢查、足背與後脛骨動脈脈搏的觸診及皮膚顏色改變、外觀、趾甲、鞋襪評估及團體衛教方案介入;非實驗組於研究結束後再進行相同之團體衛教。使用結構式問卷「足部照顧知識量表」、「足部照顧行為量表」與「足部照顧自我效能量表」評估兩組個案衛教前與實施四星期課程後之差異。
研究結果:實驗個案在接受足部自我照護衛教方案介入前後之足部自我照護知識4.6/13.4分、自我效能之效能期望52.2/69.7分與結果期望49.8/70.0分、行45.0/68.0分,前後測得分均達統計上顯著差異,且差異量顯著高於對照組(p<0.01)。本結果顯示簡易糖尿病足部評估合併足部照顧衛教方案確實能夠增進糖尿病人足部自我照顧知識、自我效能與行為,並將此可行且實用的衛教課程及內容提供衛生教育人員及單位作為參考。
In Taiwan, the diabetes mortality rate had increased from 25.7/106 in 1993 up to 44.4/106 in 2003, the highest was at Hualien as 74.5/106. Ulceration and amputation on lower extremity limbs are common complications in diabetes. Studies reported to empower patients’ self-skill on foot care will decrease the lower limb amputation rate. Self-efficacy has been shown to be an important predictive variable in initiating and continuing management behaviors such as blood glucose control, appropriate diet and exercise. However, there is rare research on the foot care knowledge, practice and self-efficacy in type 2 diabetes in Taiwan, especially for aborigine. We will evaluate educational program on foot-care knowledge, self-efficacy and practice for Truku aborigine with type 2 diabetes in the mountain Village of Hualien County. The interventation was studied using a nonrandom two-group design including the pre and post testing of fifty-one diabetes for experimental and fifty-nine diabetes for control group. The research subjects were at the ages from 35 to 81 years old. The experimental group will receive a foot care program which includes individual foot care education incorporate monofilament test, tuning fork check, palpate pulses, skin appearance, nail, socks and footwear and structural deformity etc., and group education intervention. The effect of difference on foot-care knowledge, self-efficacy and self-care practice between experimental and control groups was measured after a month intervention. In experimental group, the score of foot-care knowledge (pre/post 4.6/13.4), efficacy expectation (52.2/69.7), outcome expectation (49.8/70.0) and self-care practice (45.0/68.0) were significant increased after one month later of intervention. Furthermore, difference of pre- and post-test in experimental group were significantly higher than control group (p<0.01).
These results indicate that foot-care educational program was effective in promoting the knowledge, self-efficacy and behaviors of self-care for aborigine with diabetes. We will provide the results of this study to professional health-providers for policy making and modifying clinical education of type 2 diabetes in tribes of Hualien County.
中文摘要 1
ABSTRACT 4
第一章 緒論 9
第一節 研究背景及動機 9
第二節 研究目的與假設 13
第三節 名詞界定 14
第四節 研究意義 15
第二章 文獻探討 16
第一節 糖尿病足部病變的病理生理學 16
第二節 足部問題的篩檢 22
第三節 足部照護衛教介入 26
第四節 自我效能相關的探討及運用 29
第三章 研究方法 39
第一節 研究概念架構 39
第二節 研究設計 40
第三節 研究對象 40
第四節 研究工具 41
第五節 研究工具效度與信度之檢定 46
第六節 研究流程及步驟 47
第七節 資料分析 49
第四章 研究結果與綜合結論 50
第一節 實驗個案的基本資料 50
第二節衛教方案介入前糖尿病患者足部自我照護知識、自我效能與行為的狀況 58
第三節 方案介入前糖尿病患者足部自我照護知識、自我效能與行為的影響因素 64
第四節 衛教方案介入對糖尿病患者足部自我照護知識的成效 73
第五節衛教方案介入對足部照護自我效能的成效 77
第六節 衛教方案介入對足部自我照護行為的成效 86
第七節 衛教方案介入的反應分析 91
第五章 討論 92
第一節 探討研究對象基本資料 92
第二節 探討衛教方案介入前,糖尿病患者足部自我照護知識、自我效能與行為的情況 94
第三節 衛教方案介入對糖尿病患者足部自我照顧知識的成效 96
第四節 探討衛教方案介入對糖尿病患者足部照護自我效能的成效 98
第五節 探討衛教方案介入對糖尿病患者足部自我照護行為的成效 100
第六章 結論與建議 102
第一節 結論 102
第二節 應用與建議 103
第三節 研究限制與展望 104

圖表目次
圖 1糖尿病足部潰瘍及截肢發生的原因與過程 22
圖 2、糖尿病足部照護風險評估之模式 23
圖 3、效能預期與結果預期之區別 31
圖 4、研究架構 39
圖 5 教學架構 44
圖 6、研究流程 47
表 1、糖尿病足部照護實證研究之文獻彙整表 28
表 2、提高與降低自我效能之來源與對策 32
表 3、糖尿病自我效能實證研究之文獻彙整表 35
表 4糖尿病足部評估合併足部照顧衛教方案活動一覽表 45
表4- 1 對照組無法參加衛教課程的原因 50
表4-1. 1 實驗組與對照組個案人口學資料 51
表4-1. 2 實驗組與對照組個案生活習慣資料 52
表4-1. 3 實驗組與對照組個案相關衛教資料 53
表4-1. 4 實驗組與對照組個案疾病史資料 54
表4-1. 5 實驗組與對照組個案體位評估資料 55
表4-1. 6 實驗組與對照組個案生化檢測資料 55
表4-1. 7 實驗組與對照組個案足部評估資料 56
表4-1. 8糖尿病患者足部自我照護知識、自我效能與行為前測得分檢定 57
表4- 2 糖尿病人的足部自我照護知識得分 58
表4-2. 1 糖尿病人足部自我照護知識得分情形 59
表4-2. 2 糖尿病人的足部自我照護結果期望、效能期望與行為得分 60
表4-2. 3糖尿病人足部自我照護的效能期望、結果期望與行為得分情形 62
表4-2. 4 糖尿病人足部自我照護知識、結果效能、自我效能與行為的相關情況 63
表4- 3 糖尿病患者之人口學變項對足部自我照護知識、結果期望、效能期望與行為前測的相關情況 64
表4-3. 1糖尿病患者之生活習慣變項對足部自我照護知識、自我效能與行為前測的相關情況 65
表4-3. 2 糖尿病患者之相關衛教變項對足部自我照護知識、自我效能與行為前測的相關情況 65
表4-3. 3 糖尿病患者之相關疾病變項對足部自我照護知識、自我效能與行為前測的相關情況 66
表4-3. 4糖尿病患者之體位變項對足部自我照護知識、自我效能與行為前測的相關情況 66
表4-3. 5糖尿病患者之足部狀態變項對足部自我照護知識、自我效能與行為前測的相關情況 67
表4-3. 6與糖尿病足部自我照護知識有關的各自變項間共線性診斷 67
表4-3. 7與糖尿病足部自我照護效能期望有關的各自變項間共線性診斷 68
表4-3. 8 與糖尿病足部自我照護結果期望有關的各自變項間共線性診斷 68
表4-3. 9 與糖尿病足部自我照護行為有關的各自變項間共線性診斷 68
表4-3. 10糖尿病患者足部自我照護知識前測得分之迴歸摘要 69
表4-3. 11 糖尿病患者足部自我照護效能期望前測得分之迴歸摘要 70
表4-3. 12 糖尿病患者足部自我照護結果期望前測得分之迴歸摘要 71
表4-3. 13糖尿病患者足部自我照護行為前測得分之迴歸摘要 72
表4- 4 足部衛教方案介入前後糖尿病患者足部自我照顧知識得分之比較 73
表4-4. 1糖尿病患者足部自我照護知識前後測答對改變量比較 75
表4- 5足部衛教方案介入前後糖尿病患者足部自我照顧結果期望與效能期望得分之比較 77
表4-5. 1糖尿病患者足部自我照護結果期望前後測答對改變量比較 79
表4-5. 2糖尿病患者足部自我照護效能期望前後測答對改變量比較 83
表4- 6 足部衛教方案介入前後糖尿病患者足部自我照顧行為得分之比較 86
表4-6. 1糖尿病患者足部自我照護行為前後測答對改變量比較 88

附錄 118
【附錄一】問卷內容效度之專家名單 118
【附錄二】問卷內容 119
【附錄三】糖尿病人衛教課程內容 128
【附錄四】QLAHANG-QAQAY-SU〜居家糖尿病人足部自我照顧 133
【附錄五】糖尿病人衛教上課情況 134
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1. 王秀紅:自我照顧的概念及其在國內護理研究應用之評析。護理雜誌2000;47(2):64-70。
2. 王璟璇、王瑞霞、林秋菊:自我照顧行為、自我效能和社會支持對非胰島素依賴型糖尿病患者血糖控制的影響。高雄醫誌1998;14(12):807-15。
3. 呂榮國:糖尿病神經病變。當代醫學2002;29(10):819-24。
4. 周碧瑟、董道興、李佳琳、莊紹源、林敬恆、楊南屏:台灣地區糖尿病流行病學。台灣衛誌2002;21(2): 83-96。
5. 林淑君、戴玉慈:護理介入方案對糖尿病患者足部自我照顧之成效。台灣醫學2001;5(1):19-28。
6. 柯舜娟、孫麗娟、劉波兒、王潤清、袁光霞:糖尿病患足部照護知識、態度、行為及其影響因素之探討。弘光學報1999;34:193-221。
7. 張峰紫、林秋菊:以自我效力評估胰島素依賴型糖尿病患者之自我照顧情形。高雄醫誌1997;13(6): 351-9。
8. 張峰義:糖尿病患常見之感染及其治療原則。感染控制雜誌2001;11(4)。摘自台灣醫院感染管制學會網站http://www.nics.org.tw/magazine/11/11-4-3.htm 2004
9. 張國欽、杜明勳:糖尿病病足病變之預防與處置。台灣醫界1996;39(9):35-8。
10. 莊嬌榮、鄭綺、林佳靜、林宏達:第二型糖尿病患者血糖控制自我管理模式之探討。新台北護理期刊1999;1(1):11-9。
11. 郭清輝:糖尿病慢性併發症。臨床醫學 1998;41(5)=245:336-348。
12. 陳滋茨、張媚、林豔君:自我效能、社會支持與糖尿病人居家自我照顧行為相關之探討。護理研究1998;6(1):31-43。
13. 章淑娟、傅振宗:花蓮縣糖尿病照護品質病患成果評估及其預測因子。慈濟護理雜誌 2004;3(4):38-48。
14. 傅振宗,戴東原:糖尿病的三段五級預防。摘自金山社區醫學遠距教學計畫網站 http://med.mc.ntu.edu.tw/~fm/community/course/fu_chen_chung.htm 2003。
15. 葛應欽、劉碧華、謝淑芬:台灣地區原住民的健康問題。高雄醫誌1994;10:337-51。