慢性B或C型肝炎病患之疾病相關烙印與自我照顧效能之相關性探討

Chronic Hepatitis-related Stigma and Self-care Efficacy in Patients with Chronic Hepatitis B or C Infection

許馥郁(Fu-Yu Hsu)

指導教授 ： 孫秀卿

國立臺灣大學/醫學院/護理學研究所/碩士(2016年)

https://doi.org/10.6342/NTU201603556

摘要

慢性B及C型肝炎是台灣高盛行率的肝臟疾病，並且是肝硬化、肝癌、肝衰竭的高危險群。雖然近年慢性B及C型肝炎的治療有很大的進步，但是仍有許多病患未接受治療，加上治療效果不易預期，多數病患仍需長期與肝炎病毒共處，因此，病患的自我照顧(self-care)角色日顯重要，其強調以個人為中心，使病患能夠自我掌控疾病，避免疾病進展及維護生活品質，而自我效能(self-efficacy)已被證實是影響自我照顧行為的重要因素。此外，病患除了需要面對疾病帶來身體的改變，還需因應疾病的傳染性和對生命的威脅而造成的烙印(stigma)感受，然而國內尚未有烙印及自我照顧效能的相關研究。因此，本研究探討慢性肝炎病患的烙印與自我照顧效能現況，並探討影響烙印及自我照顧效能的相關因素，研究目的為：(1) 瞭解慢性肝炎病患疾病相關烙印之現況；(2) 瞭解慢性肝炎病患人口學特質及疾病特性、疾病症狀、人格特質與慢性肝炎相關烙印的相關性；(3) 瞭解慢性肝炎病患自我照顧效能之現況；(4) 瞭解慢性肝炎病患人口學特質及疾病特性、疾病症狀、人格特質、慢性肝炎相關烙印與自我照顧效能的相關性，並探討自我照顧效能的顯著相關因素。
本研究為橫斷式相關性研究，採立意取樣及結構性問卷方式於台北某兩家醫學中心肝膽腸胃科門診、雲林某一區域醫院肝膽腸胃科門診、彰化某兩家鄉鎮衛生所及肝病防治基金會104年7月於桃園舉辦的篩檢活動進行收案，收案對象為慢性B或C型肝炎、無肝癌或肝硬化、目前未進行標準抗病毒治療之病患，研究工具包含個人基本屬性問卷、肝臟疾病症狀量表、慢性肝炎病毒感染者烙印量表、台灣版D型人格量表、慢性肝炎自我照顧效能量表進行資料收集。研究資料以描述性統計，包括平均值、標準差、百分比、排序等方式描述各變項的分佈狀況、平均得分；以推論性統計，包括單變數及多元邏輯斯迴歸分析研究變項的相關性，共收案207位，平均年齡為56.4歲。研究結果顯示：(1) 慢性肝炎病患的烙印感受程度偏低，然而在保密病情及負向自我評價面向的烙印程度較高；(2) 慢性肝炎相關烙印與輸血感染、疾病症狀(症狀嚴重度及症狀困擾)、D型人格(負向情緒及社交壓抑)有顯著正相關；(3) 慢性肝炎病患的自我照顧效能普遍良好，然而在日常保健(包括症狀監控、規律運動、良好生活作息及均衡飲食)的面向較差；(4) 自我照顧效能與婚姻、抽菸史有顯著相關，與疾病症狀(症狀嚴重度及症狀困擾)、慢性肝炎相關烙印有顯著負相關；在調整相關因素後，以多元邏輯斯迴歸分析發現婚姻、抽煙史、症狀嚴重度及慢性肝炎相關烙印是自我照顧效能的顯著解釋因素。
藉由研究結果建議如下：(1) 慢性肝炎病患的烙印感受多源於害怕公開病情及負向自我評價，臨床醫護人員在照護慢性肝炎病患時，可給予衛教及心理諮商，提升慢性肝炎病患的正向經驗及建立疾病的正面形象，傾聽並協助改善病患的症狀困擾，並進一步篩檢有D型人格特質的病患，加強其衛教及心理支持，以減少烙印對病患生心理的影響；(2) 慢性肝炎病患普遍缺乏對日常保健的信心，針對日常保健對健康的益處需加強宣導；(3)臨床照護上除了鼓勵病患接受治療以改善疾病症狀，減少病患的烙印感受有助於增加自我照顧效能、促進病患自我照顧能力；(4) 雖然D型人格在本研究中無法顯著解釋自我照顧效能，但有將近30%的慢性肝炎病患擁有此人格特質，並且與烙印、自我照顧效能等心理健康有顯著相關，D型人格已知與健康行為及特定疾病預後有關，在慢性肝炎病患的影響則值得更多研究。研究結果可幫助未來降低慢性肝炎相關烙印、提升病患自我照顧效能的相關臨床照護、護理教育及護理研究。

關鍵字：慢性肝炎、烙印、自我照顧、自我效能、人格特質、症狀

關鍵字

慢性肝炎 ； 烙印 ； 自我照顧 ； 自我效能 ； 人格特質 ； 症狀

並列摘要

Chronic hepatitis B and C are common in Taiwan and also the leading cause of liver cirrhosis, hepatocellular carcinoma and liver failure. Although effective therapies have recently emerged for the disease, not all patients receive treatment and the outcome is not always successful. As the majority of patients have to live with a long-term condition, the role of self-care which focuses on indivisual-centered is increasingly critical for them to manage disease, prevent disease progression and have better quality of life. Self-efficacy is believed to have a great impact on self-care behavior. In addition to manage physical change of chronic illness, patients living with hepatitis also cope with perception of stigma due to infectious and fatal of the disease. However, no study regarding hepatitis-related stigma or self-care efficacy has been carried out in Taiwan. The current study attempted to explore the current status of hepatitis-related stigma and self-care efficacy and their association factors in a group of chronic hepatitis B or C. The purposes of this study were to: (1)explore the status of hepatitis-related stigma among chronic hepatitis patients; (2) explore the relationships among demographic and disease-related, liver disease symptoms, personality factors and hepatitis-related stigma; (3) explore the status of self-care efficacy among chronic hepatitis patients; and(4) understand the demographic and disease-related, liver disease symptoms, personality and hepatitis-related stigma factors associated with self-care efficacy and explore significant explanatory factors.
We conducted a cross-sectional, structured questionnaire survey with purposive sampling to recruit eligible participants from outpatient settings in six sites, including three gastroenterology departments of two medical centers and a free hepatitis screening activity held in July 2015 in northern Taiwan, one metropolitan hospital and two public health centers in southern Taiwan. The inclusion criteria were chronic hepatitis B or C patients and who still receiving standard antiviral therapy or suffering from liver cirrhosis or liver cancer were excluded. Research materials included demographic and disease-related information, liver disease symptoms and distress assessed with the Liver Disease Symptom Index 2.0, personality assessed by the Type D scale-14 Taiwanese version-revised, hepatitis-related stigma assessed with the Stigma Scale of Chronic Hepatitis Patients, self-care efficacy measured with the Self-care Efficacy Scale of chronic hepatitis patients. Data were analyzed by descriptive statistics and logistic regression methods. A total of 207 patients in this study and average age was 56.4. The results indicated that: (1) The overall mean scores of hepatitis-related stigma favored a lower perception, however, the degree of nondisclosure and negative self-estimation were relative high; (2) The factors of transfusion etiology, liver disease symptoms (include symptom severity and symptom distress) and type D personality (include negative affection and social inhibition) were associated with stigma degree; (3) The overall mean score of self-care efficacy was around the high-level, but the degree of health-care efficacy (include exercise, diet, regular lifestyle and self-monitor symptoms) was relative low; (4) The factors of marital status, smoking history,liver disease symptoms (include symptom severity and symptom distress), type D personality (include negative affection and social inhibition) and hepatitis-related stigma were associated with self-care efficacy degree. After adjusted association factors with multiple logistic regression, marital status, smoking history, symptom severity and hepatitis-related stigma were significant determinants of self-care efficacy.
In conclusion and suggestion: (1) the perception of hepatitis-related stigma centralize on the level of nondisclosure and negative self-estimation. The care for chronic hepatitis could focus on promotion of positive experience and image of disease, listening and assist patients to cope with symptom distresses with education and psychological consultation. And screening of type D personality among patients to reinforce education and give mental support for them could help to reduce negative impact of physical and mental health by stigma; (2) The level of confidence with health-care needs to be enhanced by reinforcing its benefits; (3) In addition to improve disease symptoms by encouraging patients to accept treatment, help patients to reduce perception of hepatitis-related stigma are beneficial to enhance self-care efficacy and self-care ability. (4) Although type D personality not significantly explained the study outcome variables after adjusting other factors, nearly 30 percent of patients had this personality and associated with psychological variables such as stigma and self-care efficacy in the current study. As type D personality is suggested to impair health behavior and health outcomes with specific disease, more studies need to be carried out in this particular group. This study provides valuable information about hepatitis-related stigma and self-care efficacy and it is helpful in clinical care, education and future research in nursing.

Key words：Chronic hepatitis, Stigma, Self-care, Self-efficacy, Personality, Symptom.

並列關鍵字

Chronic hepatitis, Stigma ； Self-care ； Self-efficacy ； Personality ； Symptom

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