探討慢性精神疾病患者戒菸方案之成效：以跨理論模式為基礎

The effects of smoking cessation program in chronic psychiatric patients:Based on the transtheoretical model

黃秋敏(Chiu-Min Huang)

指導教授 ： 謝佳容

臺北醫學大學/護理學院/護理學研究所/碩士(2011年)

https://doi.org/10.6831/TMU.2011.00151

摘要

研究背景：「菸」是影響慢性精神疾病患者最大的成癮物質，卻又難以戒斷，過去對於慢性精神疾病患者戒菸的實證研究不多，且鮮有不同治療模式的吸菸行為比較。
研究目的：瞭解不同治療模式的慢性精神疾病患者的吸菸行為差異及戒菸意圖，並進而探討戒菸團體介入後對慢性精神疾病患者在戒菸意圖、吸菸行為及生活品質的影響成效。
研究方法：採調查法與類實驗研究設計，第一部分使用問卷調查法，以南部某精神科專科醫院精神病患為母群體，針對三種模式（精神養護中心、精神護理之家和社區復健中心）進行資料收集，共獲得有效樣本為160人。第二部份介入方案，執行對象為68人，採立意取樣，實驗組進行跨理論模式設計的戒菸團體方案；對照組則依病房常規執行。研究工具使用尼古丁依賴程度量表、臨床整體評估表、SF-36生活品質量表、吐氣一氧化碳檢測。資料分析使用無母數統計，並進行相關的研究假設驗證。
結果：慢性精神疾病患者在三個不同治療模式的吸菸率具有顯著差異；精神養護中心和精神護理之家的吸菸者大多屬輕度尼古丁依賴，但社區復健中心的吸菸者大多屬重度尼古丁依賴。研究對象中吸菸者表示有意願購買劣質菸的比率高達八成，其戒菸行為階段以無意圖期佔最多（82.00%）。經過8 週的戒菸方案介入後，實驗組研究對象每日吸菸支數、吐氣一氧化碳濃度、尼古丁依賴分數降低（Z=-4.08、-3.21、-2.45, P=.00、.00、.01; 依序之），且戒菸行為改變的階段顯示動機增加（Z=-4.17， P=.00），但生活品質得分未達統計顯著差異。
結論：依據本研究結果，證實跨理論模式應用於慢性精神疾病患者是可行且有效的，且對於不同戒菸階段之慢性精神疾病患者應提供適用於該階段之介入措施，藉以強化個案的戒菸動機，增強其戒菸信心，以維持其戒菸行為。

關鍵字：慢性精神疾病患者、戒菸團體、跨理論模式

關鍵字

慢性精神疾病患者,戒菸團體,跨理論模式

並列摘要

Backgrounds: Cigarettes are the most prominent addictive substances influencing patients with chronic psychiatric patients, and it is difficult to for the patients to abstain from smoking. Empirical studies of the smoking cessation behavior of patients with chronic psychiatric patients are rare, and few have compared the smoking behavior in various treatment environments.
Purpose: The purpose of this study is to understand the differences in the smoking behaviors and the intentions for quitting smoking of chronic psychiatric patients treated via different models. This study then further investigates the effects of the intervention of smoking cessation groups on the intention to quit smoking, smoking behavior, and quality of life.
Methodology: This study used the questionnaire investigation method and a quasi-experimental design. The first part of the study used questionnaire surveys as the basis of the intervention program, and the subjects were chronic psychiatric patients of a psychiatric hospital in Southern Taiwan. Data were collected from three sources (psychiatric residential-care center, the psychiatric nursing home, and the community rehabilitation centers), and 160 effective samples were obtained. The second part of the study was a group intervention program, and the subjects for this part of the study were 68 patients who were assigned judgment sampling to the experimental or control groups. The smoking cessation group programs of the transtheoretical model were conducted on the experimental group, and routine processes were implemented in the control group. The tools used were the Fagerstrom test for nicotine dependence, the Clinical Global Impression, 36-item Short-Form Health Survey, and an expired carbon monoxide detector. The data was analyzed using nonparametric statistics; hypothesis validation was also performed for the related studies.
Results: The smoking rates of chronic psychiatric patients were significantly different in three various treatment environments: smokers in the psychiatric residential-care center and the psychiatric nursing home mostly had mild nicotine dependence, but most of the smokers in the community rehabilitation centers had heavy nicotine dependence. The proportion of subjects who were willing to purchase poor quality cigarettes was as high as 80 %, and most of them (82 %) had no intention to abstain from smoking. After the intervention of the smoking cessation program, the number of cigarettes smoked each day, the concentration of expired carbon monoxide, and the nicotine dependence scores dropped in the subjects of the experimental group (Z=-4.08、-3.21、-2.45, P = 0.00, 0.00, and 0.01; respectively); there were also significant increases in the level of motivation to quit smoking (Z=-4.17, P = 0.00); however, the score for quality of life did not change significantly.
Conclusion: The results of this study verify that the transtheoretical model is feasible and effective on patients with chronic psychiatric patients, and that patients at different stages of quitting smoking are to be provided with intervention measures appropriate to their particular stage. Prolonging the intervention procedure, encouraging and fortifying the motivations of patients to quit smoking, and increasing their confidence to quit smoking are recommended for future studies to promote smoking cessation.

Keywords: chronic psychiatric patients, smoking cessation groups, transtheoretical model

並列關鍵字

chronic psychiatric patients, smoking cessation groups, transtheoretical model

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