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系統識別號 U0026-2808202007591400
論文名稱(中文) 思覺失調症病患疾病觀感對其遵囑服藥及精神症狀之影響
論文名稱(英文) The Effects of Illness Perceptions on Their Medication Adherence and Psychiatric Symptoms among Patients with Schizophrenia.
校院名稱 成功大學
系所名稱(中) 護理學系
系所名稱(英) Department of Nursing
學年度 108
學期 2
出版年 109
研究生(中文) 許佳茵
研究生(英文) Jia-Yin Hsu
學號 T26064045
學位類別 碩士
語文別 中文
論文頁數 92頁
口試委員 指導教授-林靜蘭
口試委員-藍祚鴻
口試委員-李佳桂
中文關鍵字 思覺失調症  疾病觀感  遵囑服藥  精神症狀  中介效果 
英文關鍵字 schizophrenia  illness perceptions  medication adherence  psychiatric symptoms  mediation effect 
學科別分類
中文摘要 背景:藥物治療為思覺失調症病患主要治療方式,但病患不遵囑服藥比例卻相當高,進而造成反覆發作、自殺、醫療資源浪費及生活品質降低等問題,目前少有研究探討思覺失調症病患疾病觀感之相關影響。本研究旨在探討思覺失調症病患疾病觀感對遵囑服藥及精神症狀之影響,並檢視其遵囑服藥對疾病觀感與精神症狀間的中介效果。
方法:採橫斷面調查性研究,以方便取樣方式於南部某區域教學醫院收案,選取思覺失調症病患200位,研究工具包括基本屬性、修改版疾病觀感問卷、服藥處方認知量表、簡版藥物態度量表、遵囑服藥行為評估表及簡明精神病量表。除了服藥處方認知量表、遵囑服藥行為評估表及簡明精神病量表等為研究人員評估,其餘為自填量表。
結果:病患之疾病觀感較負向,疾病認知較差、認為疾病較慢性及週期循環性、會造成負向後果、疾病自控能力偏低、但認為治療對疾病控制及治療效果為中度幫助、有較負向的情緒表徵,歸咎罹病原因為壓力或煩惱、心態問題,而非因食物或飲食習慣、環境污染及免疫力。複迴歸分析顯示:個人對疾病的可控制性愈佳、治療對疾病的可控制性愈佳及情緒表徵愈負向等,能顯著預測較佳的遵囑服藥態度;疾病認知能正向預測較佳的遵囑服藥行為;疾病認知及治療對疾病的可控制性能負向預測精神症狀。拔靴分析顯示,遵囑服藥態度對於疾病認知、疾病時間週期循環性、個人對疾病的可控制性、治療對疾病的可控制性、疾病的一致性認識及情緒表徵等構面的疾病觀感及精神症狀具有中介效果;遵囑服藥行為對於曾經驗過的症狀、疾病認知、個人對疾病的可控制性及治療對疾病的可控制性等構面的疾病觀感及精神症狀具有中介效果。
結論:本研究發現思覺失調症病患具有較為負向之疾病觀感。正向的疾病觀感可預測正向遵囑服藥態度、較佳的遵囑服藥行為及較低之精神症狀。並且遵囑服藥態度及遵囑服藥行為對疾病觀感與精神症狀具有中介效果。建議精神衛生專業人員可關切思覺失調症病患之疾病觀感,增進其正向疾病觀感,以促進遵囑服藥態度及遵囑服藥行為,進而改善其精神症狀。
英文摘要 Medication is the primary treatment for patients with schizophrenia. However, the proportion of schizophrenia patients who are not adherence is relatively high. Few studies explored the related effects of illness perceptions on schizophrenia patients. This study investigates the effects of illness perceptions on medication adherence and psychiatric symptoms among patients with schizophrenia. This study is a cross-sectional study. It uses a convenience sampling method in a regional teaching hospital in southern Taiwan. Research tools including essential attributes, Illness Perception Questionnaire-Revised (IPQ-R), Regimen Knowledge Scale (RKS), Drug Attitude Index-10 (DAI-10), Clinician Rating Scale (CRS), and Brief Psychiatric Rating Scale (BPRS). Two hundred patients with schizophrenia were recruited. The patient’s illness perceptions are relatively negative. Moreover, the patient’s illness identity is low. Patients believe that disease is more chronic and cyclical, causing negative consequences, and low self-control ability. However, they think treatment is moderately helpful for disease control, and the treatment effect is moderate and had a negative emotional expression. Multiple regression analysis shows that positive illness perceptions can predict positive medication adherence attitudes, positive medication adherence behavior, and lower psychiatric symptoms. Bootstrapping analysis shows the mediating impact of medication adherence attitude, medication adherence behavior on illness perceptions, and psychiatric symptoms. Future research suggests that mental health professionals should be concerned about the illness perceptions of patients with schizophrenia. Moreover, we should improve their positive illness perceptions.
論文目次 摘要 I
Abstract III
致謝 VI
第壹章 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
第貳章 文獻查證 5
第一節 思覺失調症 5
第二節 思覺失調症病患之遵囑服藥問題 8
第三節 思覺失調症病患疾病觀感及相關研究現況 12
第參章 研究方法 19
第一節 研究設計與架構 19
第二節 研究對象與場所 20
第三節 研究變項之操作性定義 21
第四節 研究工具 22
第五節 資料蒐集過程 28
第六節 統計分析 29
第七節 研究倫理考量 31
第肆章 研究結果 32
第一節 思覺失調症病患基本人口學變項資料:描述性統計 32
第二節 思覺失調症病患疾病屬性變項資料:描述性統計 35
第三節 思覺失調症病患疾病觀感之表現情形:描述性統計 38
第四節 思覺失調症病患遵囑服藥之表現情形:描述性統計 42
第五節 思覺失調症病患精神症狀之表現情形:描述性統計 44
第六節 思覺失調症病患疾病觀感各構面之相關性:相關性分析 45
第七節 思覺失調症病患疾病觀感與遵囑服藥、精神症狀之相關性:相關性分析 47
第八節 思覺失調症病患疾病觀感對其遵囑服藥及精神症狀之影響:簡單迴歸分析 49
第九節 思覺失調症病患疾病觀感對其遵囑服藥及精神症狀之影響:複迴歸分析 52
第十節 思覺失調症病患之遵囑服藥對疾病觀感與精神症狀間的中介效果:拔靴法 55
第伍章 討論 58
第一節 思覺失調症病患基本屬性之比較與分析 59
第二節 思覺失調症疾病觀感、遵囑服藥及精神症狀之比較 60
第三節 思覺失調症病患疾病觀感對其遵囑服藥及精神症狀之影響 62
第四節 思覺失調症病患之遵囑服藥對疾病觀感與精神症狀間的中介效果 63
第陸章 結論與限制 64
第一節 結論 64
第二節 限制 65
第三節 建議 66
參考資料 68
附錄一、人體研究/試驗計畫許可書 81
附錄二、研究問卷 83
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