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研究生:林美玲
研究生(外文):Lin Mei-Ling
論文名稱:氣喘兒童醫療遵從行為與相關因素之探討
論文名稱(外文):Factors Related to Adherence Behavior in Asthmatic Children
指導教授:葉昭幸葉昭幸引用關係
指導教授(外文):Yeh Chao-Hsing
學位類別:碩士
校院名稱:長庚大學
系所名稱:護理學研究所
學門:醫藥衛生學門
學類:護理學類
論文種類:學術論文
論文出版年:2003
畢業學年度:91
語文別:中文
論文頁數:127
中文關鍵詞:氣喘醫療遵從行為動機認知醫病關係的互動
外文關鍵詞:asthmaadherence behaviormotivationcognitiveclient-professional interaction
相關次數:
  • 被引用被引用:24
  • 點閱點閱:434
  • 評分評分:
  • 下載下載:104
  • 收藏至我的研究室書目清單書目收藏:3
本研究的主要目的乃是探討氣喘病童醫療遵從行為與相關因素,其研究變項包括:人口學變項、認知、內在動機、醫病互動關係和醫療遵從行為。研究方法為橫斷性量性研究,以結構性問卷為測量工具。研究對象的選取方式採立意取樣,共收集88位氣喘兒童及其父母親。資料以描述性統計、T檢定,變異數分析、皮爾森積差相關、複迴歸分析、收方操作特徵曲線等統計方式進行分析,研究結果顯示如下:。
一. 氣喘兒童之醫療遵從行為:出現在用藥遵從行為之整體平均上,兒童佔4.28父母親佔4.64,父母親協同報告的遵從程度高於兒童自我報告;而平均回診率77%(SD=23.08),其規則回診的病患佔一半以上;以PEF來說,大部分的值多落在60-80%的範圍佔62%,治療結果的呈現大多控制在中度之疾病嚴重度。
二. 氣喘兒童自我報告及其父母親協同報告之醫療遵從行為的一致性:以Pair-t test來說,用藥遵從量表於兒童自我報告及父母親協同報告上,並未達統計上的顯著差異(t=-1.68; p>0.05);而以Pearson‘s Correlation來說,「用藥遵從行為-兒童自我報告版」與「用藥遵從行為-父母協同報告版」間呈現有意義之正相關(r=0.28; p <0.05)。故氣喘兒童自我報告及其父母親協同報告在用藥遵從行為上具一致性。
三. 各自變項與遵從行為之關係:人口學變項中,氣喘兒童的年齡與「用藥遵從行為-兒童自我報告版」(t=-2.6, p <0.05)達統計上顯著意義,此結果表示兒童的年齡愈大,其在用藥行為方面的遵從程度愈高。而在認知方面,「兒童認知」與「用藥遵從行為-兒童自我報告版」,其呈現有意義之正相關(r=0.23; p <0.05),表示兒童的認知程度愈高,其在用藥行為方面的遵從程度愈高。在醫病互動方面,「父母親醫病互動」與「用藥遵從行為-兒童自我報告版」(r=0.38; p <0.01)、「用藥遵從行為-父母協同報告版」(r=0.32; p <0.05)皆呈現有意義之正相關,亦即父母親與醫護人員的互動愈好,其在用藥的遵從行為上也愈好。
四. 遵從行為相關因素間的相對重要性:「用藥遵從行為-兒童自我報告版」與選入的自變項「父母醫病互動」達有意義之正相關(r=0.38; p<0.01),且選入的變項能預測「用藥遵從行為-兒童自我報告版」13%的變異量;其次是「用藥遵從行為-父母協同報告版」,達9%的解釋變異量;而回診率及PEF預測值之測量與各自變項並未達有意義之相關。由此可知「父母醫病互動」為醫療遵從行為之最佳預測變項。
五. 醫療遵從行為的界定:氣喘兒童用藥遵從行為之自我報告的AUC值為0.49,父母協同報告之AUC值為0.47,規定門診回診率之AUC值為0.51。氣喘兒童用藥遵從行為之自我報告、父母協同報告及規定門診回診率之AUC值均未到達0.7以上,顯示這些評估工具並不能有效測量出氣喘兒童之醫療遵從行為,在推論上需較保守。
  本研究對氣喘病童醫療遵從行為及相關影響因素之探討,能提供護理人員了解氣喘病童不遵從醫療的原因,以期望對未來的氣喘衛教及照顧上有更佳的醫療品質。
The purpose of this study was to explore the medical adherence behavior and associated factors of asthmatic children. A cross-section quantitative design with structured questionnaires was employed. In total, 88 subjects were the II-III stage asthmatic children and their parents. The data were analyzed by descriptive statistics, t-test, one -way ANOVA. Pearsone’s productment correlation, stepwise multiple regression and receiver operating characteristic curve. The main findings of this study were as follows:
1.The level of medical adherence behavior of asthmatic children’s parents report(4.64) was higher than that of asthmatic children report(4.28). The average of OPD follow up rate was 77% . PEF measurement of 62% showed health outcome to compliance that kept by moderate persistent asthma level of severity.
2.Asthmatic children self report and asthmatic children’s parents report showed significant positive relationships.
3.Independent variables and adherence behavior: there were significant positive relationships between “Age of children” and “Adherence scale of children” (t=-2.6, p <0.05), “Cognitive of children” and “Adherence scale of children”(r=0.23; p <0.05), “Client-professional interaction of parents” and “Adherence scale of children”(r=0.38; p <0.01), “Client-professional interaction of parents” and “Adherence scale of parents” (r=0.32; p <0.05).
4.Associated factor “Client-professional interaction of parents” was the best predictor of adherence behavior.
5.The identification of adherence behavior of assessment methods did not show the statistically significant level.
Based on this study, we suggest that, in order to improve quality of care, nurses need to understand the related factors of adherence behavior and further provide health education for asthma.
目錄
指導教授推薦書…………………………………………………………
口試委員會審定書………………………………………………………
授權書…………………………………………………………………..iii
誌謝……………………………………………………………………..iv
目錄……………………………………………………………………...vi
中文摘要…………………………………………………………………x
英文摘要………………………………………………………………..xii
第一章    緒論……………………………………………………1
第一節 研究動機及重要性……………………………………1
第二節 研究的目的……………………………………………4
第三節 研究問題………………………………………………5
第四節 名詞界定……………………………………………...6
第二章 文獻探討……………………………………………...9
第一節 氣喘概觀……………………………………………..9
第二節 遵從行為的定義……………………………………15
第三節 遵從行為的測量……………………………………18
第四節 影響遵從行為的相關因素…………………………26
第三章 研究方法………………………………….…………30
第一節 研究架構……….……………………………………31
第二節 研究設計…………………………………….………32
第三節 研究對象及場所…………………………………….33
第四節 倫理考量…………………………………………….34
第五節 研究工具…………………………………….………35
第六節 研究過程…………………………………….………46
第七節 資料處理及統計分析……………………….………49
第四章 研究結果與資料分析……………………………….51
第一節 研究對象之基本資料……………………………….52
第二節 疾病嚴重度及病歷資料調查之描述……………….55
第三節 氣喘兒童醫療遵從行為之描述…………………….59
第四節 氣喘兒童自我報告及其父母親協同報告之醫療遵從行為的一致性………………………………………..63
第五節 各自變項與遵從行為之關係………………………..64
第六節 遵從行為與相關因素間的相對重要性……………..70
第七節 醫療遵從行為測量工具之截切點結果分析………..72
第五章 討論…………………………………………………..74
第一節 氣喘兒童之醫療遵從行為…….…………………….75
第二節 氣喘兒童自我報告及其父母親協同報告之醫療遵從行為的一致性………………………………………..77
第三節 各自變項與遵從行為之關係………………………..78
第四節 遵從行為與相關因素間的相對重要性……………..81
第五節 醫療遵從行為測量工具之界定……………………..82
第六章 結論…………………………………………………..83
第一節 總結…………………………………………………..83
第二節 研究限制及建議……………………………………..86
第三節 護理上的應用………………………………………..88
參考文獻………………………………………………………………..89
附錄
附錄一. 台灣地區主要死亡原因(民國90年)………………………98
附錄二. 主要死亡原因標準化死亡率之國際比較…………………99
附錄三. 兒童參與研究同意書……………………………………..100
附錄四. 家長參與研究同意書……………………………………..101
附錄五. 正式問卷-兒童版…………………………………………102
附錄六. 正式問卷-父母版…………………………………………109
附錄七. 正式問卷-訪視者版………………………………………112
附錄八. 二因素社經地位指標……………………………………..115
附錄九. 問卷內容效度專家名單 ………………………………117
圖表目錄
圖 3-1 氣喘兒童醫療遵從為之概念架構…………………………...31
表 2-1 氣喘之嚴重度分級…………………………………………...12
表 2-2 氣喘急性發作之居家治療……………………………………13
表 2-3 氣喘遵從行為相關研究之測量方式………………………...24
表 3-1 研究工具之填答對象、測量層面、題數、得分範圍及信度……………………………………………………………..44
表 3-2 醫病互動關係量表之專家內容效度平均得分……………..45
表 4-1 氣喘兒童之基本資料………………………………………...53
表 4-2 氣喘兒童父母親之基本資料………………………………...54
表 4-3 氣喘嚴重度白天及晚間症狀之分布情形…………………...57
表 4-4 處方藥物之使用情形………………………………………...58
表 4-5 尖峰吐氣流量院內測量之預測值百分比分布……………..59
表 4-6 規定之門診回診率分布……………………………………..60
表 4-7 兒童自我報告版/父母親協同報告版用要遵從行為亮表之整
    體得分情形…………………………………………………..62
表 4-8 氣喘兒童自我報告及父母協同報告於用藥遵從行為之一致性分析……….………………………………………………..63
表 4-9 不同人口學變項在用藥遵從行為上的統計分析…………...65
表 4-10 醫療遵從行為測量工具之相關性………………………….59
表 4-11 各自變項和醫療遵從行為之相關性……………………….67
表 4-12 各自變項之間的相關性…………………………………….69
表 4-13 各自變項預測遵從行為之逐步多元迴歸分析…………….71
表 4-14 ROC Curve之檢定方式分析……………………………….73
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