西醫門診病患對輔助與替代療法的認知、態度與其行為之研究-以台北市某醫學中心為例

Knowledge, Attitude and Behavior on Complementary and Alternative Medicine (CAM) in Outpatients of Western Medicine in a Medical Center in Northern Taiwan

吳艾倫(Ai-Lun Wu)

指導教授 ： 蘇喜

國立臺灣大學/公共衛生學院/健康政策與管理研究所/碩士(2012年)

https://doi.org/10.6342/NTU.2012.10235

摘要

研究背景與目的：
人口老化與各種慢性疾病的增加，使得當今蔚為主流的西方醫學面臨一大挑
戰，雖然醫療科技持續進步，但主流西方醫學對於某些疾病的治療與處理仍舊面臨了無法突破的瓶頸；此外由於經濟水準的進步、教育的普及以及意識型態的高漲，人們對於健康的態度逐漸由消極治病轉為積極養生防老，單靠主流醫學已逐漸無法滿足民眾對於健康的需求，因而國內民眾使用輔助與替代療法的比率有增加之趨勢。然而在輔助與替代療法逐漸興盛的時代，國內無論是健康照護機構或是民眾，對於輔助與替代療法的認知與理解相較於主流醫學，仍處於較保守且模糊的灰色地帶，過去針對輔助與替代療法的研究多著重於分析患者的使用率、使用型態以及醫護人員的認知及態度，較少有綜合性的探討西醫門診病患使用輔助與替代療法的認知、態度與行為，因此相關的研究實有待進一步的探索與整合。
目的：本研究之目的為：(1)瞭解西醫門診病患對於輔助與替代療法的認知、態度以及其尋求輔助與替代療法時，相關行為的表現(2)瞭解不同人口學特質的西醫門診病患，在輔助與替代療法認知、態度與行為上的差異(3)分析西醫門診病患尋求輔助與替代療法時，其認知、態度與行為之間的關係(4)探討影響西醫門診病患其輔助與替代療法的知識、態度、及行為的重要因素。

研究方法：
本研究為一橫斷性研究，採用自擬結構式自填問卷，探討台灣台北市西醫門診病患對輔助與替代療法的認知、態度以及行為的表現，施測期間為2012年3月至2012年4月，樣本來源為北部某醫學中心，並於西醫門診等候區，以立意取樣（purposive sampling）的方式，隨機挑選候診的成年民眾進行問卷填答。以SPSS18.0統計軟體，利用t-test、卡方檢定、單因子變異數分析、皮爾森相關分析以及逐步複迴歸分析，進行資料分析與驗證研究假說。

研究結果：
本研究共完成350份問卷，其中共有258人在過去一年內曾使用過輔助與替代療法(73.3%)，使用範疇以物質攝入及吸收最多(65.7%)，其中又以使用中藥的人數最多(42.6%)，整體認知得分而言，以位於18-40歲年齡層、高教育程度者(大學含以上)對於輔助與替代療法認知得分較高；居住在台北北區者有較正向的態度；罹患慢性病數為2者，其使用輔助與替代療法的行為表現較無罹患慢性病者積極。迴歸分析結果顯示，居住區為態度構面構面的重要影響因子；年齡、居住區、職業、罹患慢性病數以及認知「超自然調控」構面為行為構面的重要影響因子，且在控制個人特質與輔助與替代療法認知、態度間的交互作用後發現態度構面是影響整體行為構面的重要因子。

結論與建議：
輔助與替代療法之認知與態度成正相關；輔助與替代療法認知與行為表現成正相關；輔助與替代療法態度與行為表現成正相關；輔助與替代療法之認知、態度與行為表現成正相關。態度構面是整體輔助與替代療法行為的關鍵影響因子；輔助與替代療法已在世界各地風行也普遍被民眾使用，因此相關單位應更加重視輔助與替代療法的合宜性及安全性，加強推動整體輔助與替代療法資訊的整合以及相關的臨床實證研究，確保民眾在接觸各類型的輔助與替代療法時，能有更正向的態度以及更合宜的行為表現。

關鍵字

輔助與替代療法(CAM) ； 知識 ； 態度 ； 行為 ； 問卷調查

並列摘要

Background and objectives：The problems of aging population and the increases risk of chronic diseases become more and more serious,this kind of situation makes today's mainstream western medicine facing a big challenge, Although medical technology has a great progress recently,the mainstream western medicine for the treatment of certain diseases still facing some predicament.Furthermore, due to the level of human economic progress ,the popularization of education and the rising ideology,people changing their attitude toward health,and care more about health promotion, relying solely on mainstream medicine can not meet the health needs for people gradually. Because of this, it's common for people to use complementary and alternative medicine in the world in recent years. Complementary and Alternative Medicine(CAM) is viewed as the added option and has become a trend form of medical care undoubtedly, yet little is known about its use. Therefore, the purposes of this study were (1) To study the outline of knowledge, attitude and behavior on CAM of outpatients who seek the western medicine (2) To study the knowledge, attitude and behavior on CAM among different characteristics of outpatients (3) Analysis the relation among knowledge, attitude and behavior of outpatients who seek the western medicine (4) To examine the impacting factors of using CAM among outpatients who seek the western medicine.

Methods：This cross-sectional study generally and anonymously surveyed 350 outpatients of Western Medicine in a Medical Center in Northern Taiwan from March to April, 2012.The questionnaires about CAM knowledge, attitude and behavior were designed by the author. The author used descriptive analysis, independent-sample T test, one-way ANOVA, Spearman rank correlation, and multiple regression analysis to examine the collected data.

Results：A total of 350 valid questionnaires, and 73.3% of respondents reported ever use of CAM use in the past year. The most popular domain used by these patients were Subatance absorption and intake (65.7%), and the most popular modalities used in this domain by these patients was traditional Chinese medicine (42.6%). 18-40 years of age, high-educated have more CAM knowledge, patients who living in the northern Taipei have more positive CAM attitude, patients who suffering from chronic diseases have more positive behavior than those who do not have chronic diseases. Multiple regression analysis revealed “living area”is important and influential factor of attitude domain. “Age”, “living area”, “occupation” , “the number of chronic diseases”and the knowledge domain“requlation of supernatural power” are the important and influential factors of behavior domain. Controlling the interaction among characteristics, knowledge and attitude, this study found that attitude dimension is an important factor to affect the overall behavior dimensions.

Conclusion and recommendations：There are positive correlations between CAM knowledge and attitude, CAM knowledge and behavior, CAM attitude and behavior. The attitude dimension is an important factor to affect the overall CAM behavior dimensions. It's common for people to use complementary and alternative medicine in the world in recent years, it's suggested tha the responsible health department should pay greater attention on the CAM issue,enhance their own understanding of potential benefits and harms inherent in commonly used CAM, and strengthen the integration of promoting the overall CAM information and the associated clinical and empirical research for sure that people who use this kind of therapies can keep their attitude positive and have more appropriate behavior.

並列關鍵字

Complementary and Alternative Medicine(CAM) ； Knowledge ； Attitude ； Behavior ； Questionnaire

參考文獻

15. 康翠秀、陳介甫、周碧瑟（1998）。台北市北投區居民對中醫醫療的知識、信念與行為意向及其對於醫療利用型態之影響。中華衛誌，17(2)，80-92。

13. 康健壽、陳介甫、周碧瑟（1994）。中醫門診病人對傳統醫學的認知、態度與行為意向的分析研究。中華衛誌，13(5)，432-441。

22. 辜美安（2011）。中老年人使用輔助療法之相關因子。台灣老年醫學暨老年學雜誌，6(1)，29-42。

19. 陳鴻銘（2005）。併用輔助與替代療法之基層醫療病患特質。北市醫學雜誌，2(3)，278-285。

20. 曾月霞、林岱樺、洪昭安（2005）。台中地區社區成人輔助療法使用現況。Chung Shan Med J，16，59-68。