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研究生:潘嬿竹
研究生(外文):PAN, YEN-CHU
論文名稱:社會心理因素對第二型糖尿病照護結果之影響
論文名稱(外文):Influence of Social Psychological Factors on Care Outcomes of Patients with Type 2 Diabetes
指導教授:蔡秀鸞蔡秀鸞引用關係
指導教授(外文):Tsay,Shiow-Luan
口試委員:許貞媛顏聖烈
口試委員(外文):Hsu,Chen-YuanYan,Sheng-Lei
口試日期:2017-07-27
學位類別:碩士
校院名稱:大葉大學
系所名稱:健康產業管理碩士在職學位學程
學門:商業及管理學門
學類:醫管學類
論文種類:學術論文
論文出版年:2017
畢業學年度:105
語文別:中文
論文頁數:96
中文關鍵詞:社會心理因素第二型糖尿病照護結果
外文關鍵詞:Type 2 diabetessocio-psychological factorcare outcome
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糖尿病為全球性疾病,被許多國家視為重要的慢性病之健康議題。台灣糖尿病盛行率極高,毅然威脅國民健康。然而第二型糖尿病病人在生理、心理與社會因素,影響治療結果深遠,研究卻少見完整探討,因此本研究目的旨在探討社會心理因素對第二型糖尿病照護結果之影響。研究方法:採描述性、相關性設計,以方便取樣,於南部某區域教學醫院收案,運用結構式問卷進行資料收集。研究工具:基本資料問卷、社會支持量表、自覺糖尿病自我管理量表中文版、病人健康憂鬱問卷中文版、壓力感受量表、健康生活品質調查問卷。
以SPSS 22 for Windows統計軟體進行資料建檔和分析;研究統計方法:描述性統計、獨立樣本t檢定、單因子變異數、皮爾森相關係數、多元線性迴歸、二元邏輯式迴歸等分析。共收案133人,女性居多,普遍已婚,年齡分佈集中於60-69歲,教育程度以國小為主,主要經濟來源為個人,罹病年齡以5-10年最多,且未出現糖尿病相關併發症,血糖值與糖化血色素皆普遍分佈在異常值。
結果顯示,糖尿病人之憂鬱與社會支持(r=-0.27, p=<.05)、心理痛苦與社會支持(r=-0.21, p=<.05)呈顯著負相關、心理痛苦與憂鬱(r=0.85, p=<.01)呈顯著正相關、生活品質與憂鬱(r=-0.64, p=<.01)、生活品質與心理痛苦(r=-0.59, p =<.01)呈顯著負相關。
連續性變項以回歸分析,結果顯示,憂鬱和經濟自給共解釋32.1%生活品質生理構面之變異量,其中憂鬱解釋27.9%,而經濟自給可解釋4.2%。憂鬱和心理痛苦共解釋61.3%生活品質心理構面之變異量,其中憂鬱解釋59%,而心理痛苦可解釋2.3%。經濟依賴他人解釋3.1%之住院次數的變異量。憂鬱解釋3.7%急診次數的變異量。教育程度解釋4.3%併發症數的變異量。
類別變項以二元邏輯斯迴歸分析,結果顯示,教育程度對年平均血糖值有顯著的影響(p=>.03)。憂鬱對最後一次糖化血色素值(p=<.05)及年平均糖化血色素值(p=>.03)有顯著影響。藉由本研究結果,以提供護理人員臨床照護參考,照護糖尿病病人時,應考量社會心理因素對照護結果的影響,適時介入憂鬱情緒的輔導與治療,以提升照護結果之成效。
Diabetes is a global, chronic disease that has been recognized as an important health issue in many countries. The prevalence rate of diabetes is very high in Taiwan that poses a serious threat to the health of people. Patients’ physical and psychosocial factors all have an impact on the treatment result. However, this issue has not been extensively discussed in previous research. The purpose of this study was to investigate the effects of socio-psychological factors on the care outcomes of Type 2 diabetes.
The study is a descriptive and correlation design; used structured questionnaires collected data from a large regional teaching hospital located in southern Taiwan. Instruments included a basic information form, Social Support Scale, Chinese version of Perceived Diabetes Self-Management Scale, Chinese version of Patient Health and Depression Questionnaire, Perceived Stress Scale, and Health-related Quality of Life Scale.
Data were coded and analyzed using SPSS 22.0 software for Windows. The analysis methods included descriptive statistics, independent-sample t-test, one-way ANOVA, Pearson product-moment correlation, multiple linear regression, and binary logistic regression. The sample consisted of 133 patients. In this sample, women constituted the majority; most patients are married, aged between 60~69, having elementary education as highest level of education, and economically independent. Majority patients were diagnosed of the disease over the last 5~10 years.
Results showed that among the diabetes patients, depression was significantly negatively related to social support (r=-0.27, p=<.05), psychological distress was significantly negatively related to social support (r=-0.21, p=<.05), psychological distress was significantly positively related to depression (r=0.85, p=<.01), quality of life was significantly negatively related to depression (r=-0.64, p=<.01) and psychological distress (r=-0.59, p= <.01).
Continuous outcome variables were analyzed using regression analysis. Results indicated that depression and economic independence jointly explained 32.1% of variance in the physical aspect of quality of life (27.9% by depression and 4.2% by economic independence). Depression and psychological distress jointly explained 61.3% of variance in the psychological aspect of quality of life (59% by depression and 2.3% by psychological distress). Economic dependence on others explained 3.1% of variance in the number of hospital stays. Depression explained 3.7% of variance in the number of emergency department visits. Education level explained 4.3% of variance in the number of complications.
Categorical outcome variables were analyzed using binary logistic regression. Results showed that education had a significant effect on average glucose level over the last year (p=>.03). Depression had a significant effect on both the last HbA1c level (p=<.05) and average glucose level over the last year (p=>.03). Results of this study suggest that when providing clinical care to diabetes, nurses should also consider the effects of socio-psychological factors on the care outcomes and provide necessary counseling and treatment of depression to enhance the effectiveness of care.
封面內頁
簽名頁
中文摘要 iii
Abstract iv
誌謝 vi
目錄 vii
圖目錄 ix
表目錄 x

第一章 緒論 1
第一節 研究動機及重要性 1
第二節 研究目的 3
第三節 研究問題 4
第四節 名詞操作型定義 4
第二章 文獻查證 9
第一節 糖尿病相關介紹 9
第二節 糖尿病之社會心理相關因素 11
第三節 影響糖尿病照護結果之預測 20
第四節 糖尿病與生活品質 22
第三章 研究方法 24
第一節 研究概念架構 24
第二節 研究對象及場所 25
第三節 研究工具 26
第四節 研究步驟與資料收集過程 30
第五節 資料處理及統計分析 31
第四章 研究結果 33
第一節 基本資料和疾病資料描述 33
第二節 研究變項描述 36
第三節 研究變項之相關性 37
第四節 研究變項和基本資料與疾病資料之相關性 38
第五節 社會心理因素與治療結果之相關性 50
第五章 討論 57
第一節 第二型糖尿病人的人口學資料與變項 57
第二節 第二型糖尿病人的社會心理因素之變項 57
第三節 第二型糖尿病人的社會心理因素與照護結果 59
第四節 憂鬱對第二型糖尿病人的影響程度 61
第六章 研究結論 63
第一節 結論 63
第二節 建議 63
第三節 限制 65
第七章 參考文獻 66
附件一、社會支持量表 85
附件二、自覺糖尿病自我管理量表中文版 86
附件三、病人健康憂鬱問卷中文版測量 87
附件四、壓力感受 88
附件五、簡式健康量表 89
附件六、生活品質以健康生活質素調查問卷 90
附件七、人體實驗委員會(Institute Review Board, IRB)審核通過證書 91
附件八、研究問卷 92

一、中文部份

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13. 盧佳怡、張美智、林光洋(2010).以糖化血色素診斷糖尿病.北市醫學雜誌,7(2),109-118. doi: 10.6200/tcmj.2010.7.2.01。[Lu, C. Y., Chang, M. C., Lin, K. Y.(2010). Application of Glycosylated Hemoglobin in the Diagnosis of Diabetes Mellitus. Taipei City Medical Journal, 7(2), 109-118.doi:10.62
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