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研究生: 彭莉琴
Li-Chin Peng
論文名稱: 某醫學中心中風高血壓病人遵醫囑服藥行為階段及相關因素之探討
An Exploration of the Stage of Drug Compliant Behaviors and Related Factors of Stroke and Hypertensive Patients at a Medical Center
指導教授: 鄭惠美
學位類別: 碩士
Master
系所名稱: 健康促進與衛生教育學系
Department of Health Promotion and Health Education
論文出版年: 2001
畢業學年度: 89
語文別: 中文
論文頁數: 173
中文關鍵詞: 中風高血壓遵醫囑服藥行為健康信念社會支持改變階段模式
論文種類: 學術論文
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  • 腦中風高居我國十大死因第三位,根據臨床經驗發現腦中風病人復發而再度入院的原因多為不遵醫囑服藥,因而,本研究依據PRECEDE模式為理論架構,以瞭解中風高血壓病人遵醫囑服藥行為階段的情形,並探討素質、使能、輔強等三類因素與遵醫囑服藥行為階段的關係。
    本研究以某醫學中心神經及腦血管障礙門診,診斷為腦中風與高血壓者為研究對象,抽取301人進行問卷調查,所得資料以描述性統計、卡方檢定等統計方法進行分析,重要結果如下:
    一、研究對象的服藥行為遵從程度偏高。遵醫囑服藥行為階段的情形,處於「沈思前期」佔2.7﹪,「沉思期」佔1.7﹪,「準備期」佔15.9﹪,「行動期」佔5.3﹪,其中中風治療期間為6個月及以下者佔93.8﹪,「維持期」佔74.4﹪。
    二、不遵醫囑服藥的原因:(1)隨心情、身體狀況調整服藥;(2)忘記服藥;(3)自行更改服藥方式後,無不適;(4)藥物太複雜;(5)害怕與其他藥相互作用;(6)不知藥已更改;(7)擔心副作用或有副作用;(8)試看看不吃藥會如何。
    三、在素質因素中,中風治療期間為1年及以下處於「行動期」者明顯多於治療1.1年及以上者。
    四、在使能因素中,無疲倦的副作用者,其遵醫囑服藥行為階段較多處於「維持期」。
    五、在輔強因素中,社會支持高者遵醫囑服藥行為較社會支持低者好,多處於「行動期」、「維持期」。
    依據研究結果提出對未來研究、臨床醫療照護及行政上的建議,作為日後研究、醫療服務人員、行政措施之參考。

    ABSTRACT
    Stroke is the third leading cause of death in our country . According to the clinical experience , we found most stroke patients hospitalized again because of drug noncompliance . Therefore , this study was based on PRECEDE model as the theoretical structure in order to comprehend the stage of drug compliant behaviors of stroke and hypertensive patients and explored the relationship between the factors in predisposing , enabling , and reinforcing and the stage of drug compliant behaviors .
    We enrolled three hundred and one patients diagnosed as stroke and hypertension in the outpatient department at a medical center to embark on questionnaires . The acquired data was analyzed by descriptive statistics and Chi-square test .
    The main results of this study were as follows:
    1.Subjects had a high score on drug compliant behaviors scale . The percentages of each stage for drug compliant behaviors were as follows:precontemplation 2.7 , contemplation 1.7 , preparation 15.9 , action 5.3 , and maintenance 74.4 .
    2.The reasons for drug noncompliance included:(1)adjusted to take the medicine according to mood and health status ,(2)forgot to take the medicine ,(3)felt fine after changing the way of taking medicine by themselves ,(4)complicated medication ,(5)feared for the interaction with the other medicine ,(6)didn’t know the medicine had been changed ,(7)worried about side effects or having side effects ,(8)tried to find what would happen without taking any medicine .
    3.In predisposing factors , the drug compliant behaviors in action stage , subjects who had accepted stroke treatment for one year(and less)were more than for 1.1 years(and above).
    4.In enabling factors , for most subjects who had no fatigue caused by drugs , the stage of drug compliant behaviors mainly lay in maintenance .
    5.In reinforcing factors , about the drug compliant behaviors , the numbers of those who had higher degree of social support were more than those who had lower degree of social support . They mainly lay in the stages of action and maintenance .
    Based on the results of this study , I provide some suggestions for the future research , clinical medical care and administration as the reference to future research , medical attendants and administration .

    目錄 第一章 緒論 第一節 研究動機…………………………………………………1 第二節 研究的重要性……………………………………………3 第三節 研究目的…………………………………………………5 第四節 待答問題…………………………………………………5 第五節 研究假設…………………………………………………6 第六節 名詞界定…………………………………………………7 第二章 文獻探討 第一節 遵醫囑服藥行為的測量方法………………………….10 第二節 遵醫囑服藥行為的歸類及遵醫囑程度……………….14 第三節 影響遵醫囑服藥行為的相關因素……………….……20 第四節 理論架構……………………………………………….38 第五節 改變階段模式…………………………………….……44 第三章 研究方法 第一節 研究架構……………………………………………….52 第二節 研究對象……………………………………………….52 第三節 研究預期關係………………………………………….55 第四節 研究工具……………………………………………….58 第五節 主要變項的定義與測量……………………………….67 第六節 研究步驟……………………………………………….74 第七節 資料處理與分析……………………………………….75 第四章 研究結果與討論 第一節 研究對象之描述……………………………………….76 第二節 遵醫囑服藥行為階段的相關因素…………………..116 第五章 重要發現、結論、限制與建議 第一節 重要發現………………………………………………137 第二節 結論……………………………………………………141 第三節 研究限制………………………………………………141 第四節 建議……………………………………………………143 參考文獻……………………………………………………………147 附錄 附錄一 預試問卷………………………………………………157 附錄二 內容效度專家名單……………………………………164 附錄三 正式問卷……………………………………..………165 表 目 錄 表2-1 各種測量遵醫囑行為之方法的比較…………………………10 表3-1 自變項與依變項間之預期關係………………………………55 表3-2 腦中風、高血壓疾病及治療相關知識的問卷難度與鑑別度67 表3-3 研究變項及操作型定義………………………………………68 表3-4 本研究統計方法摘要表………………………………………75 表4-1 研究對象之社會人口學………………………………………78 表4-2 遵醫囑服藥行為總分分佈情形………………………………80 表4-3 遵醫囑服藥行為………………………………………………82 表4-4 遵醫囑服藥行為階段…………………………………………82 表4-5 過年前與過年期間研究對象的遵醫囑服藥行為比較………85 表4-6 素質因素的分佈情形…………………………………………91 表4-7 研究對象之腦中風、高血壓疾病及治療相關知識…………96 表4-8 研究對象之健康信念(罹患性、利益性、障礙性)………97 表4-9 研究對象之健康信念(嚴重性)……………………………98 表4-10 使能因素的分佈情形……………………………………….103 表4-11 輔強因素的分佈情形………………………………….……108 表4-12 研究對象之社會支持………………………………….……109 表4-13 社會支持回答「不會」者的自覺需要性…………….……110 表4-14 素質因素與遵醫囑服藥行為階段的關係………………….118 表4-15 中風後現有症狀與遵醫囑服藥行為階段的關係………….122 表4-16 合併的內科疾病與遵醫囑服藥行為階段的關係………….124 表4-17 使能因素與遵醫囑服藥行為階段的關係………………….126 表4-18 藥物副作用與遵醫囑服藥行為階段的關係……………….129 表4-19 醫療保險與遵醫囑服藥行為階段的關係………………….132 表4-20 輔強因素與遵醫囑服藥行為階段的關係………………….133 圖 目 錄 圖2-1 健康信念模式架構圖…………………………………………40 圖2-2 PRECEDE衛生教育診斷模式架構圖…………….……………43 圖3-1 本研究之研究架構……………………………………………53

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