| 摘要: | 背景與目的 依據行政院衛生署公告之國人十大死因，顯示影響台灣民眾健康的主要疾病型態，已由過去的急性傳染病轉變為以慢性疾病為主。對於罹患慢性病之治療計畫中，病人的居家自我健康管理亦是重要環節之一，許多醫療機構運用各式的衛教來提升病人的自我照護能力，然而這些教材並未全然發揮到預期的效果，在美國醫學研究機構(Institute of Medicine, IOM) 的報導中提出，約90萬成年人對書面資料的定位與整合有困難，也提出低健康素養者在疾病管理知識和健康促進的行為較不足；其中這些健康資訊造成病人資訊超載感受與認知風險之顧慮及其認知自我效能，可能是影響其疾病自我管理行為的重要原因之一。因此，本研究欲探討影響罹患慢性病者採用健康衛教資訊於疾病自我管理行為意向之因素。自變數包含判斷性資訊超載、情緒性資訊超載、評價性資訊超載、認知風險及認知自我效能，依變數為行為意向，病人健康素養程度可能間接影響或干擾各自變數與行為意向的結果，因此將病人健康素養納入作為干擾變數。期望從實證結果，提出具體建議供醫療照護體系參考，進而有效針對病人需求給予最關鍵適切的健康資訊或衛教文件，以提高病人遵循醫療指引的執行及達成疾病自我管理之目標。方法 本研究採用問卷調查法進行研究，對象為南部某醫學中心初次診斷為冠心症的病人，健康資訊為個案醫院之冠心症自我照護衛教文件。研究分析軟體為SPSS 與SmartPLS 2.0®。資料分析以描述性統計陳述填答者基本資料分布，並採用結構方程模式之偏最小平方法（Partial least squares, PLS）進行信度、建構效度及研究模式之評估與假說檢定。結果 本研究共募集110位病人同意並完成問卷填答，排除4份不完整問卷，其有效問卷為106份，有效回收率為96.36 % 。在PLS結構模式中其路徑分析結果顯示，整體變數對行為意向的解釋力為0.483；判斷性資訊超載對行為意向有顯著負向影響(β = -0.325, t- value = 2.209, P < 0.05)，情緒性資訊超載對行為意向的影響並不顯著(β = 0.080, t- value = 0.574, P > 0.05)，評價性資訊超載對行為意向的影響並不顯著(β = 0.094, t- value = 0.806, P > 0.05)，認知風險對行為意向有顯著負向影響(β = -0.153, t- value = 2.112, P < 0.05)，認知自我效能對行為意向有顯著正向影響(β = 0.487, t- value = 4.093, P < 0.001)，病人健康素養在各變數與行為意向間的干擾效果未達顯著水準。結論 本研究結果發現判斷性資訊超載、認知風險及認知自我效能對於病人採用衛教資訊作為疾病自我管理的行為意向有顯著影響效果，且認知自我效能為最關鍵性之影響因子，在判斷性資訊超載與認知風險則以負向的影響呈現。因此，本研究建議在提供病人衛教資訊作為疾病自我管理的行為意向上，可先不需考慮病人健康素養的問題，以及可不用擔心病人會有情緒性或評價性資訊超載的反映；另，建議醫療機構在製作給病人的衛教資訊中應減少專業術語，提供衛教資訊給病人的同時，醫療人員應有好的溝通和說明讓病人更了解內容，並適時引導及鼓勵病人獲取健康資訊，增加自我照護知識、技能及其自信心，增進病人對衛教資訊的使用意願，並使健康教育活動達到其成效，進而提升醫療品質及減少醫療成本浪費之目標。
Background and PurposeSelf-management of chronic disease at home is mandatory as part of treatment. However, there is lack of effectiveness in lots of institutions to offer all kinds of education materials which these information overload, perceived risks, and perceived self-efficacy may be the causes of poor self-management for the patients. The purpose of this study aims to integrate above information to explore the behavioral intention of patients with chronic disease how to use the health information for self-management. Since the dependent variables contain judgment information overload, emotional information overload, evaluative information overload, perceived risk and perceived self-efficacy, while independent variable includes the behavioral intention of patients to use information. The health literacy level is considered to be a confounder and therefore it should be adjusted to avoid interfere the outcome. We wish to provide our data to help patients with chronic disease to effectively use medical information (e.g., health education information or documents) in our healthcare system in order to improve the compliance and adherence for patients with self-management in chronic disease.MethodsThe cross-sectional study used a structured questionnaire for data collection, focusing on the patients with coronary artery disease (CAD) in a medical center in southern Taiwan. Analyses were performed using the SPSS and SmartPLS 2.0®. Data were analyzed using descriptive statistics of the basic information distribution of the questionnaire respondents, and Partial Least Squares (PLS) structural equation model to study the reliability and construct validity to verify our hypotheses.ResultsTotally 110 patients were enrolled in this study, and 106 completed whole questionnaires, with effective rate was 96.36%. In the structural model of PLS the overall variables on behavioral intention had power effect of 0.483. The behavioral intention have a negative impact on judgment information overload (β = -0.325, t- value= 2.209, P < 0.05), impact on emotional Information overload was not significant (β = 0.080, t-value = 0.574, P> 0.05), impact on evaluative information overload was not significant (β = 0.094, t-value = 0.806 , P> 0.05), negative impact on perceived risk (β = -0.153, t- value= 2.112, P < 0.05), and positive influence on Perceived self-efficacy (β = 0.487, t- value= 4.093, P < 0.001) with statistically significant, while the level of health literacy had no statistically significant of causal-related effect.ConclusionsThis preliminary study demonstrated that judgment information overload, perceived risk, and Perceived self-efficacy were statistically significant with behavioral intention to patients using the educational information, and Perceived self-efficacy was the crucial factor. Our study suggested that health literacy is a confounding factor and should be adjusted before statistics, neither did the emotional and evaluative information overload. We suggested that the health information to educate patients should reduce the medical jargon to reach the understanding and decision-making by the patients. In addition, medical staffs should explain the information programs to patients in order to have better understanding of the contents and encourage patients to obtain useful self-care knowledge and skill to increase their confidences. In promoting the intention to use medical information thereby enabled patients to participate in education programs can lead to the effectiveness to raise the quality of medical care and therefore reduce the health costs in the long run. |
