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研究生:廖文貴
研究生(外文):Liao, Wen-Kuei
論文名稱:健康生活管理方案對社區思覺失調症病人健康生活行為與健康功能之成效探討
論文名稱(外文):Effects of Healthy Living Program on Healthy Living Behavior and Health Functions of Community-Dwelling Schizophrenia Patients
指導教授:戎瑾如戎瑾如引用關係
指導教授(外文):Rong, Jiin-Ru
口試委員:林寬佳郭千哲魏秀靜賴倩瑜
口試委員(外文):Lin, Kuan-ChiaKuo, Chian-JueWei, Shiow-JingLai, Chien-Yu
口試日期:2020-06-16
學位類別:博士
校院名稱:國立臺北護理健康大學
系所名稱:護理研究所
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:2020
畢業學年度:108
語文別:中文
論文頁數:173
中文關鍵詞:健康生活自我管理方案健康生活行為健康功能思覺失調症
外文關鍵詞:Healthy living and self-management programhealth living behaviorshealth functionsschizophrenia
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摘  要
目的:慢性精神病人處於疾病慢性化,在長期服藥及不健康的生活型態影響下,增加精神病人罹患慢性疾病發生率與死亡率,思覺失調症病人可由精神科醫院取得抗精神疾病藥物與復健治療資源,病人其他慢性疾病亦可獲得醫療與控制,也延長了病人的年齡與壽命,因此,社區思覺失調症病人不僅有疾病慢性化及高齡化之趨向,也會面臨健康問題與社區生活功能的挑戰。本研究目的旨在建構健康生活自我管理方案,促進社區思覺失調症病人健康生活行為及健康功能。
方法:本研究分兩階段進行,第一階段為發展與建立健康生活自我管理方案;第二階段為實驗性研究,旨在執行並評價社區思覺失調症病人健康生活自我管理方案處置之成效。本研究共有107位社區思覺失調症病人參與(實驗組 52位及對照組55位)。實驗組接受健康生活自我管理方案,同時進行日常生活常規活動,對照組僅進行日常生活常規活動。分別在健康生活自我管理方案處置實施前(Time 1,T1)、十六週處置結束後(Time 2,T2)與處置結束後第四週(Time 3,T3)等3個時間點,以結構式問卷收集二組病人資料。測量問卷有自我控制行為量表(SCS)、健康生活自我管理態度量表(HSM)、健康行為自我效能量表(SES)、活性與負性症狀量表(PANSS)、五項認知能力評量表、生活品質量表(WHOQOL-BREF台灣簡明版)及量測體適能等資料。運用SPSS 20.0版套專軟體進行統計分析,包括描述性、推論性統計分析與概式估計方程式(Generalized Estimating Equation; GEE) 分析以確認方案介入的成效。
結果:第一階段共評讀13篇實證文獻並建構完成本研究健康生活自我管理之處置方案,共計16週、每週一次每次90分鐘之小團體活動,依此方案進行實驗介入處置。第二階段研究為實驗性研究,二組病人實際進行三次測量後,結果發現,二組病人在T1並無顯著差異,實驗組在接受介入處置方案後,在健康自我管理行為、健康生活自我管理態度、健康生活管理自我效能、認知功能及生活品質,均較對照組病人有顯著改善,且隨著時間序列與介入處置有交互作用,顯示病人在停止方案介入處置後4週,仍有持續改善的趨勢;在精神病症狀部分,亦呈現下降的趨勢,但在體適能部分,二組病人均未有顯著改善。
結論:健康生活自我管理方案能顯著提升社區病人之自我管理態度與技能,且此效果能維持到處置方案結束後四週。建議未來對於社區慢性思覺失調症病人可提供健康生活自我管理方案訓練,協助個案提升自我管理技能與健康功能。
ABSTRACT
Objectives: Schizophrenia is a serious mental illness. The development of chronic diseases in patients with schizophrenia may be attributed to long-term use of their medications, disease-related health problems, and unhealthy lifestyle behaviors. The population of older adults with schizophrenia who are seeking antipsychotic treatment on a regular basis has increased. As patients become older, however, they are weakened by increasingly complex health problems. The aim of this study was to evaluate the effects of a healthy living program on the healthy living behaviors and health functions of community-dwelling patients with schizophrenia.
Methods: The study comprised two phases. In phase 1, the aim was to systematically review the literature on healthy living and self-management program and their efficacy in the care of patients with schizophrenia. Phase 2 aimed to construct, implement, and evaluate a healthy living and self-management program. This experimental study was conducted with 107 middle-aged and older adult community-dwelling outpatients with schizophrenia (mean age= 55.5 ± 5.8 years). The control group (n = 55) performed routine daily activities alone, while the experimental group (n = 52) received the healthy living and self-management program training. The data were collected at three time points : baseline, week 16, and week 20 (4 weeks after training ended). This study measured several outcome variables, including health self-management behaviors (using the self-control schedule [SCS]) and health self-management schedule [HSM]), self-efficacy in health behavior (using the self-efficacy scale [SES]), psychiatric syndromes (using the positive and negative syndrome scale [PANSS]), cognitive function (using the cognitive function scale), quality of life (using the WHOQOL-BREF scale), and fitness measurements.
Results: Thirteen papers met the criteria for inclusion in the systematic review. A healthy living and self-management program was developed and provided once a week for a total of 16 weeks, with sessions lasting 90 minutes per group. Our generalized estimating equation (GEE) model showed the program significantly improved the scores of SCS, HSM , SES, PANSS, cognitive function, and quality of life for the experimental group at week 16 and 20, compared with the control group. However, there was no significant improvement in physical fitness for patients in either group.
Conclusion: Significant and positive outcomes were achieved by the experimental group in terms of healthy living behaviors and health functions. Mental health care professionals should understand the abilities and behaviors of healthy living, as well as self-management programs of patients, and help patients to continue to live in their communities. In addition, patients should be encouraged to maintain healthy behaviors, which will enhance functioning and quality of life.
目  次
中文摘要 i
英文摘要 iii
目  次 v
表  次 vii
圖  次 ix
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究問題之重要性 6
第三節 研究目的 8
第二章 文獻查證 9
第一節 慢性思覺失調症病人之健康功能 9
第二節 影響慢性思覺失調症病人健康功能之因素 12
第三節 健康生活與自我管理之理論 14
第四節 精神病人健康生活自我管理方案之實證相關文獻 17
第五節 健康生活自我管理態度、行為及自我效能 21
第三章 研究方法 24
第一節 第一階段發展與建立健康生活自我管理方案 24
第二節 第二階段執行及評價健康生活自我管理方案處置成效 26
第三節 研究對象權益與維護 38
第四章 研究結果 39
第一節 健康生活自我管理方案系統性文獻回顧 39
第二節 思覺失調症病人實驗組與對照組介入方案 57
第三節 研究對象人口學基本資料描述 61
第四節 健康生活自我管理態度量表因素分析結果 63
第五節 處置前研究變項描述及同質性檢測 67
第六節 比較實驗組與對照組於三時間點成效之組內差異分析 72
第七節 比較實驗組與對照組在處置、時間序列及交互作用之概式估計方程式(GEE)結果分析 81
第五章 討論 101
第一節 健康生活自我管理方案的建構與執行 101
第二節 健康生活自我管理態度量表測量工具 103
第三節 健康生活自我管理方案之成效 104
第六章 結論、建議與限制 112
第一節 主要研究成果 112
第二節 建議 116
第三節 研究限制 118
參考文獻 119
中文部分 119
英文部分 123
附錄 141
附錄一 IRB證明 141
附錄二 問卷 142
附錄三 研究工具使用同意書 157

表次
表3-1「健康生活自我管理方案」實驗研究設計 29
表3-2 實驗設計與資料收集時間 31
表4-1 實證文獻分析-實驗性文章 48
表4-2 實證文獻分析-系統性文獻回顧文章 55
表4-3 健康生活自我管理方案大綱 60
表4-4 研究對象人口學基本資料描述 62
表4-5「健康生活自我管理態度量表」項目分析 64
表4-6「健康生活自我管理態度量表」因素分析矩陣 66
表4-7 主要研究變項前測(Time 1)之統計值描述 69
表4-8 實驗組與對照組處置前(Time 1)主要研究變項之同質性檢定 71
表4-9 自變項與依變項之間的相互關係 72
表4-10 實驗組「健康生活自我管理團體」3次時間點資料之比較 76
表4-11 對照組「日常生活常規活動」3次時間點資料之比較 81
表4-12 兩組病人以GEE分析健康自我管理行為在組別與時間的差異 82
表4-13 兩組病人以GEE分析健康生活自我管理態度在組別與時間的差異 84
表4-14 兩組病人以GEE分析健康生活管理自我效能在組別與時間的差異 85
表4-15 兩組病人以GEE分析精神病症狀在組別與時間的差異 87
表4-16 兩組病人以GEE分析認知功能在組別與時間的差異 88
表4-17 兩組病人以GEE分析生活品質在組別與時間的差異 89
表4-18 兩組病人以GEE分析體重在組別與時間的差異 91
表4-19 兩組病人以GEE分析體脂肪在組別與時間的差異 92
表4-20 兩組病人以GEE分析身體質量指數(BMI)在組別與時間的差異 93
表4-21 兩組病人以GEE分析腰圍在組別與時間的差異 95
表4-22 兩組病人以GEE分析臀圍在組別與時間的差異 96
表4-23 兩組病人以GEE分析坐姿體前彎在組別與時間的差異 97
表4-24 兩組病人以GEE分析一分鐘仰臥起坐在組別與時間的差異 99
表4-25 實驗組與對照組各主要變項於處置前後與時間交互作用之分析 100
表4-26 實驗組與對照組體重、體脂肪、BMI、腰圍變項於處置前後與時間交互作用之分析 100
表4-27 實驗組與對照組臀圍、坐姿體前彎、一分鐘仰臥起坐變項於處置前後與時間交互作用之分析 100

圖次
圖3-1 研究架構圖 26
圖3-2 研究資料收集流程 32
圖4-1 文獻篩選流程圖 41
圖4-2 健康生活自我管理態度量表因素分析陡坡圖 66
圖4-3 兩組病人之健康自我管理行為於三個時間點之比較 83
圖4-4 兩組病人之健康生活自我管理態度於三個時間點之比較 84
圖4-5 兩組病人之健康生活管理自我效能於三個時間點之比較 86
圖4-6 兩組病人之精神病症狀於三個時間點之比較 87
圖4-7 兩組病人之認知功能於三個時間點之比較 88
圖4-8 兩組病人之生活品質於三個時間點之比較 90
圖4-9 兩組病人之體重於三個時間點之比較 91
圖4-10 兩組病人之體脂肪於三個時間點之比較 92
圖4-11 兩組病人之身體質量指數(BMI)於三個時間點之比較 94
圖4-12 兩組病人之腰圍於三個時間點之比較 95
圖4-13 兩組病人之臀圍於三個時間點之比較 96
圖4-14 兩組病人之坐姿體前彎於三個時間點之比較 98
圖4-15 兩組病人之一分鐘仰臥起坐於三個時間點之比較 99

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