臺灣博碩士論文加值系統

世界衛生組織(World Health Organization, WHO)指出約十分之一的40歲以上成人罹患慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD，以下簡稱COPD)，而全球性疾病負擔(global burden of disease)報告中指出2016年全球有2.51億例患者罹患COPD；2015年全球死於COPD之人數，約有320萬人，為全球死亡第四大死因，佔全球總死亡人口數5 %，世界衛生組織預測到2030年COPD將成為全球第三大死亡原因。COPD病人須長期與疾病共存，故疾病的自我管理扮演重要的角色，自我管理可以減少惡化及住院的頻率，維持生活品質，健康識能為影響自我管理因素之一，並與病人對自我管理的遵從性相關，健康識能不足會影響病人學習自我照顧與自主管理的障礙，健康識能被認為是疾病自我管理的決定因素。目前國內鮮少研究針對COPD病人之健康識能作探討，故此研究結果可作為未來發展相關介入措施及相關政策之參考。
研究目的:瞭解慢性阻塞性肺疾病病人之健康識能與自我管理二者間相關性及其影響因素。
研究方法：此研究採用橫斷面研究法及描述相關性研究之設計，於北部某區域教學醫學胸腔科門診進行收案。以結構式問卷收集資料，包括人口學變項、疾病特性、中文版成人功能性健康識能量問卷(Test of Functional Health Literacy in Adults；TOFHLA），以及慢性疾病自我管理量問卷(PIH Scale)，以SPSS 22進行描述性統計、推論性統計及多元線性迴歸進行資料分析，P< 0.05為達統計顯著意義。
結果：研究結果顯示男性居多 (占82.1%)，年齡集中在40-91歲，已婚占82.1%，結果發現人口學變項之婚姻狀況(F=7.104，P<0.01)及年齡(t=2.567，P<0.05)的不同而有顯著差異，已婚者、年齡較大者之疾病管理得分較好。研究對象之健康識能平均值為78分，大多研究對象為足夠健康適能，可閱讀與解析大部分健康相關訊息。研究對象之疾病自我管理平均值為73.82，大部分研究對象自我管理程度為好。成人功能性健康識能評估量表整體量表得分與疾病自我管理量表呈現正相關。年齡與健康識能在本研究中為COPD病人疾病自我管理之重要預測因子。
結論:由此研究結果顯示年齡及提升病人之健康識能與病人的疾病自我管理有顯著相關，未來可依照年齡及健康識能對病人提供個別性措施，設計其能理解的自我管理衛教單張及方式，以助獲得健康訊息的知識及理解力，進而對疾病有所改善，也可作為未來研究方向之參考。

World Health Organization (WHO) has indicated about 10% of global population over 40 years old diagnosed with chronic obstructive pulmonary disease (COPD). Global Burden of Disease (GBD) has also reported there were 251 million people diagnosed with COPD in 2016; In addition, the number of mortality due to COPD on 2015 was 3.2 million globally which is the fourth leading cause of death in the world, about 5% of global death toll (WHO, 2016). WHO predicted COPD will become the third leading cause of death in the world in 2030. Self-management plays an important role which decreases the frequency of exacerbation and hospital admission, maintaining the quality of life regarding living with COPD in long term.Health literacy is a social factor which is related to compliance of self-management. Health literacy is considered as the determinant of disease self-management, in contrast, lack of health literacy is regarded as a barrier of learning self-care and self-management to patients. There have been less researches of the health literacy of COPD patients in our country, the results of this research may be the reference of relative interventions and policies in the future.
Purpose:
This study focused on the relationships between health literacy and self-management of patients with COPD.
Methods:
This study used cross-sectional study design.The structural questionnaires includingbasic demographics , disease severity, Test of Functional Health Literacy in Adult (TOFHLA) scale and the Partner in Health (PIH) scale were used to collect data. The data were analyzed by descriptive, inferential and logistic regression statistics with SPSS 22. The statistical significance is defined as P< 0.05.
Results: Male patients were the majority (82.1%)，age among 40 to 91 year-old and 82.1% were married in this research. The result indicated significant difference regarding marriage status(F=7.104，P<0.01) and age (t=2.567，P<0.05) of demographic variable. Generally, married and aged patients had better scoring of disease self-management.The patient’s average score of heath literacy was 78 indicating most of them had adequate health literacy and were capable to read most of heath care related information.The patient’s average score of disease self-management was 73.82 indicating most of them had good levels of self-management.The scoring of Test of Functional Health Literacy in Adults(TOFHLA) and PIH scale were positive correlated.Age and health literacy were important predictive factors of disease self-management among COPD patients in this research.
Concluson:Customized interventions based on the associated factors found in this research may significantly enhance heath literacy to COPD patients and improve their disease self-management. The results of this research may provide helpful information to health caregivers and further researches.

正文目錄..............................................I-IV
「表」目錄...............................................V
「圖」目錄...............................................VI
「附錄」目錄........................................... VII
中文摘要...............................................VIII
英文摘要..................................................X
第一章 緒論...............................................1
第一節 研究動機與重性......................................1
第二節 研究目的...........................................3
第二章 文獻查證...........................................4
第一節 疾病自我管理之相關概念...............................4
壹、疾病自我管理定義.......................................4
貳、疾病自我管理之影響因素及其造成之影響.....................5
參、疾病自我管理評量工具...................................11
第二節 慢性阻塞性肺疾病之相關概念 ..........................13
壹、慢性阻塞性肺疾病之定義..................................13
貳、慢性阻塞性肺疾病之病生理變化............................14
參、慢性阻塞性肺疾病診斷及分類..............................15
肆、慢性阻塞性肺疾病造成之影響..............................18
第三節 慢性阻塞性肺疾病與疾病自我管理之關係及其相關研究…......18
第四節 慢性阻塞性肺疾病病人疾病自我管理之影響因素及其相關研
究 .........................................21
第三章 概念架構...........................................26
第一節 研究架構...........................................26
第二節 名詞定義...........................................27
壹、慢性阻塞性肺部疾病.....................................26
貳、健康識能..............................................27
參、疾病自我管理..........................................28
第三節 研究問題...........................................29
第四章 研究方法...........................................30
第一節 研究設計...........................................30
第二節 研究場所與對象......................................30
第三節 研究工具...........................................31
壹、基本資料..............................................31
貳、健康識能評估量表.......................................35
參、慢性疾病自我管理量表...................................36
第五節 研究步驟...........................................37
第六節 資料處理與統計分析..................................38
第七節 研究倫理考量.......................................39
第五章 研究結果...........................................40
第一節 COPD病人人口學變項分佈..............................40
第二節 COPD病人疾病特性、健康識能、疾病自我管理之分布……......42
第三節COPD病人人口學變項與疾病自我管理之關係………………..........44
第四節 COPD病人疾病特性、健康識能與疾病自我管理之關係…......…46
第五節 影響COPD病人疾病自我管理之預測因子...................48
第六章 討論 .........................................51
第一節 COPD病人人口學變項、疾病特性、健康識能與疾病自我管
理之情形………………………………………………………......................51
第二節、COPD病人人口學變項與疾病自我管理之關係……………..........53
第三節、COPD病人疾病特性、健康識能與疾病自我管理之關係........53
第四節 COPD病人疾病自我管理之預測因子………………….............……54
第七章 結論與建議.........................................56
第一節 結論...............................................56
第二節 研究限制...........................................57
第三節 建議...............................................57
壹、護理實務面............................................57
貳、護理教育面............................................57
參 、護理研究面...........................................58
參考文獻.................................................59
英文文獻.................................................59
中文文獻.................................................68

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