中文摘要
本研究乃是根據PRECEDE模式進行教育與行為診斷的需求評估研究，運用質化研究發展本土化的問卷，並進而以量化研究瞭解素質因素、促進因素以及增強因素等對自我處理行為的影響情形。本研究之目的為(1)採質化研究訪談方式以深入了解氣喘兒童父母的自我處理行為的實際情形與可能的影響因素。(2)採量化研究調查方式以了解氣喘兒童父母的自我處理行為的情形與素質因素、促進因素及增強因素等的分布情形。(3)探討氣喘兒童父母人口學基本資料對自我處理行為與素質因素、促進因素及增強因素之影響情形。(4)探討氣喘兒童父母素質因素、促進因素及增強因素與自我處理行為之相關情形(5)探討氣喘兒童父母人口學基本資料與素質因素、促進因素及增強因素對自我處理行為之影響情形(6)找出氣喘兒童父母人口學基本資料與素質因素、促進因素及增強因素中對自我處理行為具預測的主要影響因素。
以林口長庚兒童醫院的門診3~14歲氣喘兒童之父母為母群體，首先進行質化研究訪談16位成功控制的氣喘兒童父母。訪談內容分析結果顯示21項行為氣喘兒童父母的自我處理行為，可以分為預防性行為、發作處理行為以及症狀評估行為等三類，經由專家修訂以建立其內容效度，並運用因素分析分為三個類別，解釋變異量達48.2%，可見具有良好建構效度，信度方面，Cronbach's α為 .88。其次在影響因素方面共找出12項因素，根據訪談內容分析，分別編訂問卷，進行量化調查研究，共有133位氣喘兒童父母填寫問卷，結果顯示：
一、氣喘兒童父母自我處理行為達中上程度，平均得分為81.85達77.95%，素質因素方面，氣喘知識略低(63.3%)，氣喘態度、自我效能達七成以上；促進因素方面，環境控制設備平均只有3.4樣，就醫方便性達七成，教育的獲得非常低每人平均只有0.32次；在增強因素方面，家人支持、醫護人員的支持、醫病溝通、評價處理效果以及小孩配合程度都達七成左右。
二、在人口學變項上：父親所感受到的家人支持與醫護支持較母親為高。父母年齡較輕，小孩的配合程度較好。父母社經地位較低者，醫病溝通較滿意。家庭收入較高者，環境控制設備較多。家庭收入較低者，醫病溝通較滿意。中等家庭收入者，其評價處理效果及自我處理行為較好。有照顧經驗者，其氣喘知識較高分、氣喘態度較正向、較有自我效能、就醫較方便、醫護支持較高，自我處理行為較好。診斷年數少於3年者，其環境控制設備較多。除了診斷年數超過8~11年之外。診斷年數較久者，其醫病溝通及評價處理效果較好，診斷年數較少者，小孩配合程度較好。家人吸菸、家族史、居家地點、小孩年齡並未對各因素及自我處理行為有顯著差異。
三、各影響因素與自我處理的相關情形：在素質因素方面，氣喘兒童父母覺得孩子的氣喘越嚴重，越會去評估孩子氣喘的各種症狀。氣喘兒童父母擁有越多的氣喘知識，越會去評估孩子的各種氣喘症狀。氣喘態度越正向的氣喘兒童父母，其自我處理行為也越好，包括預防性行為、發作處理行為與評估症狀行為。自我效能越好的氣喘兒童父母，其自我處理行為也越好，包括預防性行為、發作處理行為與評估症狀行為。在促進因素方面，環境控制設備、就醫方便性與教育的獲得與自我處理行為並無統計上顯著相關。在增強因素方面，家人支持越高的氣喘兒童父母，其自我處理行為越好，包括預防行為、發作處理行為。醫護支持越多的氣喘兒童父母，其自我處理行為越好包括預防性行為及症狀評估行為。醫病溝通情形越好的氣喘兒童父母，其自我處理行為越好包括預防行為、發作處理行為、評估症狀行為。評價處理效果越好的氣喘兒童父母，其自我處理行為越好，包括預防行為、發作處理行為、評估症狀行為。小孩配合程度越好的氣喘兒童父母，其自我處理行為越好，包括預防性行為、發作處理行為、評估症狀行為。
四、總括而言，人口學變項(家庭收入與照顧經驗)與素質因素、促進因素及增強因素對氣喘兒童父母自我處理行為得到48.7%的解釋量，其中預防性行為得到43.2%的解釋量，發作處理行為得到25.0%的解釋量，評估症狀行為得到28.4%的解釋量。
五、經由逐步複迴歸分析，找出具預測力的主要因素，結果顯示氣喘兒童父母自我處理行為的主要預測因素為「評價處理效果」、「自我效能」、「小孩配合程度」與「照顧經驗」，可以解釋50.6%的變異量。氣喘兒童父母預防性行為的主要預測因素為「評價處理效果」、「自我效能」與「小孩配合程度」，可以解釋44.8%的變異量。氣喘兒童父母發作處理行為的主要預測因素為「評價處理效果」，可以解釋26.2%的變異量，氣喘兒童父母評估症狀行為主要的預測因素為「自我效能」、「氣喘知識」、「自覺嚴重程度」與「評價處理效果」，可以解釋31.1%的變異量。
由本研究結果可發現，大部分的父母仍較依賴醫療人員，氣喘兒童父母自我處理行為仍有需要加強之處，尤其是症狀評估行為。為加強其自我處理行為，對於大多數沒有照顧經驗的氣喘兒童父母應計劃完善整體性的教育計劃，以強化各種自我處理的效果，改善小孩的配合，增進自我效能，以及控制各種具有相關的影響因素，以期獲得最大成效。

The Study of Self-Management Behaviors of Parent with Asthma Children and the Influencing Factors
The purpose of this study is a need assessment based on PRECEDE model to diagnose the educational and behavioral factors of parent with asthma child. The first purpose is to explore the self-management behaviors and the educational factors (predisposing, enabling, and reinforcing) from successful management parents with asthma children by qualitative interviewing method. The second purpose is to explore self-management behaviors, predisposing factors, enabling factors, and reinforcing factors by the quantitative survey of 133 outpatient parents with asthma child in Chang-Gung Children's Hospital. The third purpose is to explore the relationship between the demographic data of parents and self-management behaviors, predisposing factors, enabling factors, and reinforcing factors. The forth purpose is to explore the correlation between the predisposing factors, enabling factors, reinforcing factors and self-management behaviors. The fifth purpose is to find the predicable rate of self-management behaviors by the demographic factors and educational factors. The sixth purpose is to find the main predictors of self-management behaviors.
The twenty-one self-management behaviors and twelve educational factors are inducted from the content analysis of 16 successful parents. The construct validity is established by factor analysis of rotation method with Varimax with Kaiser normalization. The extraction sums of squared loading are 48.2%. Three components are extracted from it, named as preventing behaviors, attack managing behaviors and assessing behaviors. The reliability is established by Cronbach's α .88. The questionnaire is developed based on the content analysis. The results of survey 133 parents with asthma children indicate:
1. The self-management behavior of parents is middle level; most parents are depending on hospital and doctors more than by themselves. Asthma knowledge, attitude, and self-efficacy are middle level. The number of facilities of environmental control is little. The feasibility of transportation is around 70%. The opportunity of education is poor. The results of family's support, health caregiver's support, doctor-patient communication, perceived self-management efficacy and cooperation of child are around 70%.
2. Demographic data: Father perceived more family support and health caregiver's support than mother. The younger the parents, the more cooperative of children. The lower socioeconomic status of parent, the better doctor-patient communication they perceived. The more family income of parent, the more facilities of environment control they have. The lower family income of parent, the better doctor-patient communication they perceived. The parent with middle family income has better perceived self-management efficacy and self-management behaviors. The experienced parent has higher asthma knowledge, more positive asthma attitude, and higher self-efficacy, better feasibility of transportation, higher health caregiver's support, and better self-management behaviors. The parents their child has been diagnose asthma less than 3 years have more facilities of environmental control. Besides the parents whose child have been diagnose asthma more than 8~11 years, the more the years they diagnose, the better the doctor-patient communication and the better the child's cooperation. Family's smoking, family history, family location and children's age are not the significant factors in this study.
3. The correlation between educational factors and self-management: In predisposing factors, the more severity the parents perceived and the more asthma knowledge they have the more assessing behaviors they have. The more positive asthma attitude of parents, the better self-management behaviors they have. In enabling factors, the facilities of environmental control, the feasibility of transportation, and the opportunity of education are not significantly correlated with self-management behaviors. In reinforcing factors, the more family support, the better health caregiver's support, the better doctor-patient communication, the better perceived self-management efficacy and the more child's cooperation, the better the self-management behaviors the parents have.
4. Totally, the demographic factors (family income and care experience) and educational factors can explain 48.7% self-management behaviors, 43.2% preventing behaviors, 25.0% attack managing behaviors, and 28.4% assessing behaviors.
5. The results of Stepwise Multiple Regression indicate the main predictors of self-management behaviors are perceived self-management efficacy, self-efficacy, child's cooperation, and care experience (R2 = .506). The main predictors of preventing behaviors are perceived self-management efficacy, self-efficacy, and children's cooperation (R2 = .448). The main predictors of attack managing behaviors are perceived self-management efficacy (R2 = .262). The main predictors of assessing behaviors are self-efficacy, asthma knowledge, subjective severity and perceived self-management efficacy (R2 =. 313).
From the results of this study, The self-management behaviors are not very well performed by parent, especially in assessing behaviors. Most parents still depending on health care professionals. Besides, perceived self-management efficacy, children's cooperation, and self-efficacy are the important factors to predicate self-management behaviors. In order to increase the independent self-management behaviors, we must reinforcing the efficacy of self-management, improving the cooperation of child, and promoting the self-efficacy by a comprehensive asthma education.

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