臺灣老人對退化性膝關節炎知識與因應：量表發展與信效度初探

Older Adult’s Knowledge and Coping Behaviors of Knee Osteoarthritis in Taiwan：Scale Development and Preliminary Evidence of Reliability and Validity

羅文忏(Wen-Qian Luo)

指導教授 ： 陳毓璟 ； 蘇雅蕙

國立中正大學/社會科學院/心理學系/碩士(2013年)

摘要

隨著台灣老年人口的上升，退化性膝關節炎為老人常見的慢性疾病，此疾病造成老年人身體上的疼痛與行動不便，嚴重導致老人日常生活的不便，因此教導老人與疾病共存的正確知識為衛教人員重要的課題。而本研究以常識模式為背景理論，並參考國內外對此疾病實徵研究，以發展一份「台灣老人的退化性膝關節炎知識與因應量表」，以瞭解台灣老人對退化性膝關節炎知識程度與因應行為。為顧及台灣老人的識字程度較低，建立口語版(閩南語)施測流程，方便老人瞭解題目內容及作答。本研究以台灣嘉義地區的老人進行問卷資料收集，樣本總計為281人，以項目分析檢驗題目優劣、驗證性因素分析檢驗量表信、效度，最後以結構方程模式檢驗疾病知識與因應間關係。
驗證性因素分析支持知識四因素及因應二因素之模式結構，而知識量表中「疾病症狀」以及因應量表中「問題中心」與「情緒中心」分量表皆有良好信度，其餘知識量表中「疾病時間」、「疾病導因」及「疾病控制與治癒」三個概念，因為部分不良試題導致分量表信、效度表現不佳。疾病知識正確性顯示，大部分老人對退化性膝關節炎的疾病症狀與罹病原因有80%以上的正確率，而疾病的時間與控制治療方法只有55%的正確率。因應行為中傾向休息、避免可能造成疼痛的行為，其次為就醫與用藥等醫療方法。疾病知識對因應行為的影響結果顯示有二，一、當老人對疾病症狀的知識越高時，會引發老人對疾病的情緒，進而表現出較多因應行為；二、當老人對疾病控制與治癒的知識越高時，會直接影響老人表現出較多的因應行為。
本研究發展之台灣老人的退化性膝關節炎知識與因應量表，有助於瞭解退化性關節炎老人知識程度與老人對疾病因應行為之外並釐清疾病知識間關係，有助於未來醫護人員利用此研究結果設計衛生教育課程，加強老人自行照顧的能力。

關鍵字

退化性膝關節炎 ； 常識模式 ； 疾病知識 ； 疾病因應

並列摘要

Since Taiwan turned into an aging society; Knee Osteoarthritis becomes one of the most common chronic diseases in elder generations. Nowadays, OA is the major cause of pain and disability to aged people; It not only influences them physically and psychologically, but also makes great impact to their social health. Accordingly, to enhance illness management, health care interventions should concentrate on the spread of knee Osteoarthritis illness knowledge. This study uses the common sense model for developing knowledge and coping questionnaire of the knee osteoarthritis issue in Taiwan. Consideration of the low level of literacy of the elder, the measurement procedure was established in spoken version (Minnan). Furthermore, it was special designed for senior people, so they can easily understand questions and write down the answer as well. A total of 281 participants were collected from Chiayi, Taiwan. The collection data were analyzed by item analysis, confirmatory factor analysis (CFA), and Structural Equation Modeling (SEM).
The results support the four factors of knowledge and two factors of coping. There are three subscales with good reliability and validity, which are about “symptoms” in knowledge scale, “problem-focused coping” and “emotion-focused coping” in coping scale. However, there are some bad items effects the reliability and validity to the following three subscales in the knowledge scale: “timeline’, “cause” and “control and cure”. The majority of the patients have a high awareness about symptoms and cause. Their average accuracy rate were over 80%. Nevertheless, the confused timeline, control and cure average accuracy rate were only 55%. Their coping behavior preferences were rest and avoiding any behavior that may causes pain; Secondary medical treatment or taking medicine. There are two results about coping behaviors were affected by illness knowledge. First of all, the effects of illness symptoms knowledge and coping are mediated by emotion. Secondly, the more they know about disease control and cure of knee OA knowledge, the more they show the coping behavior.
This questionnaire will be used to clarify the degree of knee osteoarthritis knowledge in older adult’s. In the future, health care workers could use this questionnaire to understand the patients’ knowledge of knee OA and design health education programs, thus enhancing the self-care ability of patients.

並列關鍵字

Knee Osteoarthritis ； Common Sense Model ； Knowledge of Illness ； Coping with Illness

參考文獻

行政院衛生署國民健康局（2010）。全民健康保險醫療統計年報。台北市：行政院衛生署。

何郁宣、洪麗珍、郭憲文﹙2008﹚。退化性關節炎病患憂鬱程度與自我照顧能力之相關性研究。長期照護雜誌，12﹙2﹚，179-190。

吳岱穎、陳建志、楊榮森、林光洋、郭冠良、黃惠娟、廖振焜﹙2005﹚。退化性關節炎的另類治療。北市醫學雜誌，2﹙3﹚，240-247。

吳岱穎、楊榮森、廖振焜、郭冠良、林光洋﹙2009﹚。美國骨科醫學會(AAOS)膝部退化性關節炎的治療指引。臺灣醫學，13﹙2﹚，181-190。

李麗珊、陳富鈞、王美華（2007）。退化性膝關節炎之中醫治療。北市醫學雜誌，4（8），730-736。