氣喘青少年自我管理意向之預測因子

Predictors for self-management intention of adolescents with asthma

談靜慧(Ching-Huei Tan)

指導教授 ： 洪志秀

高雄醫學大學/護理學院/護理學系研究所/碩士(2004年)

摘要

本研究目的在探討氣喘青少年的自我管理意向現況，以及其重要預測因子，以Ajzen和Fishbein的理性行動理論（Theory of Reasoned Action）與Bandura自我效能理論所形成的ASE模式（attitude, social influences & self-efficacy model）為研究架構。採用橫斷式研究設計，以高雄市市立34所專設國民中學之氣喘學生為抽樣母群體，採隨機集束抽樣 (cluster sampling) 選取七所國中為研究樣本，完成有效問卷204份。研究工具為結構式問卷，包括（1）自我管理意向量表、（2）氣喘態度量表、（3）社會影響量表、（4）自我效能量表、以及（5）個案基本資料表。所得研究資料以SPSS 10.0統計套裝軟體進行t檢定、變異數分析、皮爾森積差相關及階層複迴歸分析。主要的研究結果發現：
一、研究對象中大多數（75%）的氣喘青少年具有正向的自我管理意向，標準化得分為77.7。其中又以「氣喘發作時會主動的處理」得分最高，而以「會主動地避開過敏的東西」得分最低。
二、氣喘態度標準化得分為77.7，以「預防氣喘發作」態度較佳，而「氣喘用藥」態度最差；社會影響的標準化得分為73.7，氣喘青少年仍感受到重要他人的影響程度以醫師最高，而班上的同學影響程度最小；自我效能的標準化得分為55.2，以「預防氣喘發作」的自我效能較佳，「氣喘發作處理」的自我效能較差。
三、氣喘態度、社會影響、自我效能與自我管理意向皆呈現正相關，疾病特性方面以患病年數、過去一年的發病次數及有無住院與自我管理意向具有顯著差異。
四、氣喘疾病的自我管理意向的重要預測因子為氣喘態度、社會影響、自我效能、過去一年的發作次數達七次以上以及有住院者，可解釋之總變異量為43.9%。其中氣喘態度、社會影響和自我效能為正向的影響，而過去一年的發作次數達七次以上和有住院者為負向的影響。
本研究結果可以提供臨床醫護人員與校護在促進氣喘青少年對於疾病自我管理的參考，依研究結果建議應加強與澄清氣喘青少年對於藥物治療與其副作用的瞭解，並針對過敏原的預防給予個別性的指導，進而培養疾病控制的責任感與自信心。同時，此份研究成果可以作為未來進一步介入性措施研究的基礎及方向。

關鍵字

自我效能 ； 氣喘 ； 青少年 ； 自我管理意向 ； 氣喘態度 ； 社會影響

並列摘要

The purpose of this study was to investigate current self-management intention, and related predictive factors in adolescents with asthma. The conceptual framework of the study, the ASE (Attitude, Social influences & Self-efficacy) model, was derived from Ajzen and Fishbein’s theory of Reasoned Action and Bandura’s theory of Self-Efficacy. This study was a survey design and the subjects were selected using cluster sampling. Students with asthma were invited from 7 out of 34 primary high schools in Kaohsiung city. There were 204 questionnaires eventually completed and response rate was 57.5%. Data were collected with five structured questionnaires, including: 1) Self-Management Intention Scale; 2) Asthma Attitude Scale; 3) Social Influences Scale; 4) Self-Efficacy Scale; and 5) Demographic data sheet. Data analysis was used SPSS/10.0 Windows software statistical package. The main study findings are as follows:
1. Majority (75%) of the adolescents with asthma showed positive self-management intention with standard score of 77.7 (%). The highest score was the item of “well- management the situation when the asthmatic attack occurs”, while the item of the “well-avoidance the stuff which makes one allergic” was graded as lowest.
2. The standard score on the Asthma Attitude Scale was 77.7 %. Within the scale, students demonstrated good attitude in “prevention of asthmatic attack” and poor attitude in “administration the asthmatic medications”. The standard scored on the Social Influences Scale was 73.7 %. For these adolescents with asthma, they perceived the most important person in their life was the physician, and their classmate was the least influence. The standard score for the Self-Efficacy Scale was 55.2 % . The score “to prevent asthmatic attack” was high in Self-Efficacy; and “to manage an asthmatic attack” was low in self-efficacy.
3. A positive relationship exists between asthma attitude, social influences, self-efficacy and self-management intention. In addition, according to disease characteristics, significant differences are found when contrasting self-management intention with disease history by years, frequency of asthmatic attack within the pervious year, and whether or not hospitalization.
4. With multiple regression analysis, asthma attitude, social influences, self-efficacy, frequency (greater than 7) of asthmatic attacks within the past year, and hospitalization were significant in explaining 43.9% of the variance in self-management intention for asthma. Within this model, asthma attitude, social influences and self-efficacy were positive predictors of the outcome measure; whereas negative predictors were frequency of asthmatic attacks within the past year and hospitalization with the self-management intention.
The results of this study have implications regarding adolescents’ knowledge of about medication therapy and side effects for drugs. This information should be clarified and emphasized in the education for adolescents with asthma. Moreover, to prevent allergic risk, more appropriate education and attention are needed to increase adolescents’ responsibility and confidence for self-management of their disease. In addition, we hope that the study findings will help clinical healthcare providers and school nurses in fostering more effective self-management of this disease in adolescents and provide a fundamental base for further interventional research.

並列關鍵字

self-efficacy. ； social influences ； asthma- attitude ； self-management intention ； adolescent ； asthma

參考文獻

蔣立琦、黃璟隆、呂昌明（1999）．學齡氣喘兒童氣喘素質因素與自我處理行為之調查及夏令營對其之影響．護理研究，7（4），307-319。

陳滋茨、張媚、林豔君（1998）．自我效能、社會支持與糖尿病病人居家自我照顧行為相關之探討．護理研究，6（1），31-43。

陳黛娜、李從業（1997）．台北市國小氣喘學童的疾病知識與適應行為之探討．護理研究，5（2），160-169。

中文部分：

王碧華（1997）．門診躁鬱病患健康控制信念對鋰鹽態度與鋰鹽遵從相關性探討．護理研究，5（6），499-510。