以健康信念模式探討影響腎移植病患執行正確服藥及感染預防行為之相關因素

A Study of the Factors Related to Medication Adherence and Infection Prevention Behaviors among Renal Transplant Recipients Based on the Health Belief Model

龔本珍(Pen-Chen Kung)

指導教授 ： 張媚

國立臺灣大學/醫學院/護理學研究所/碩士(2011年)

https://doi.org/10.6342/NTU.2011.01563

摘要

本研究以健康信念模式中的四個基本概念來分析影響腎移植後病患執行正確服藥以及感染預防行為的影響因素，屬橫斷性研究，以立意取樣，選取台北某醫學中心接受腎臟移植滿六個月，定期於腎移植門診追蹤之腎移植病患為對象，共收案122份有效問卷。以自擬結構式問卷收集資料，包括：「基本資料」、「排斥與感染之健康信念問卷」、「腎移植病友正確服藥及感染預防之行為問卷」三部分。所得資料將以描述性統計、獨立樣本t 檢定、單因子變異數分析、皮爾森相關、複回歸分析等統計方法進行分析。研究結果如下：
一、 研究對象正確服藥行為及排斥相關健康信念
研究對象自行報告的正確服藥行為平均得分4.52；其中以「我能服用正確劑量的抗排斥藥」得分最高，平均值4.91，而以「我曾忘記服用抗排斥藥」為執行較差的項目。研究對象之正確服藥行為與移植時間呈現統計顯著負向相關性。排斥相關健康信念影響因素方面：曾接受透析治療者及曾發生排斥經驗者於自覺排斥罹患性的信念較強；移植地點在台灣、藥物引起之症狀困擾數目越多、過去曾發生嚴重感染或非常嚴重感染的個案其正確服藥障礙性信念較大。預測因子方面，移植時間較長、藥物引起之症狀困擾數目較多、排斥罹患性信念較低、正確服藥利益性信念較低者，正確服藥行為較差。
二、 研究對象感染預防行為及感染相關健康信念
研究對象自行報告整體感染預防行為平均得分4.23；以「我會注意口腔保健及衛生」得分最高，而「出入公共場所時，我會記得戴口罩」為執行較差的項目；而「忘記」是多數個案感到不易執行感染預防行為的主要原因。女性於感染預防行為執行上顯著優於男性。個案過去透析時限水遵從度越高者其感染預防行為遵從度也越好。感染相關健康信念影響因素方面：當自覺感染預防障礙性信念越強則感染預防行為越差；年齡越高以及過去透析治療為期較短的個案其自覺感染罹患性信念較低；年齡越高者其自覺感染嚴重性信念較低；無工作者其自覺感染嚴重性大於兼職者又大於退休者，而全職工作者其自覺感染嚴重性大於退休者；在台灣接受移植者自覺感染預防行動障礙信念較強。預測因子方面，自覺感染預防障礙性越高、透析時限水遵從度越差者感染預防行為較差。
結論：腎移植個案的服藥行為及預防感染行為受到其健康信念等因素的影響。移植時間較久、藥物引起之症狀困擾數目較多、排斥罹患性信念較低、正確服藥利益性信念較低的腎移植個案，正確服藥行為相對較差。自覺感染預防障礙性較高、過去透析時限水遵從度較低的腎移植個案，感染預防行為相對較不積極。

關鍵字

腎臟移植 ； 正確服藥行為 ； 感染預防行為 ； 健康信念

並列摘要

This study employs the four basic concepts of the Health Belief Model to investigate the factors influencing the medication adherence and infection prevention behaviors of kidney transplant recipients. Using purposive sampling, this cross-sectional study distributed questionnaires at a medical center in Taipei to patients that had received kidney transplants more than six months previously. A total of 122 valid questionnaires were retrieved. A structural questionnaire was drawn up and employed to collect data in three areas: personal information, health beliefs regarding transplant rejection and infection, and medication adherence and infection prevention actions. The obtained data was analyzed using descriptive statistics, an independent t-test, one-way ANOVA, Pearson’s correlation, and multiple regression. The results of the study are as follows:
1. Health beliefs involving medication adherence and transplant rejection
The average score of the responses from study subjects on correct medication adherence was 4.52. Among the items in this construct, taking the correct dosage of immunosuppressive drugs, scored the highest with an average of 4.91; taking medicine on time, however, was an item implemented less well. The relationship between medication adherence of the study subjects and time elapsed since transplant showed a negative correlation. In regards to factors influencing health beliefs in transplant rejection, patients that had received dialysis treatment or had encountered rejection perceived susceptibility to rejection more strongly. Transplant recipients who had undergone transplants in Taiwan, had suffered more drug-induced symptoms, or had contracted severe to extremely severe infections in the past encountered more barriers in observance of medication adherence. The number of instances of time elapsed since transplant, drug-induced symptoms, perceived susceptibility to rejection, and perceived benefits of medication adherence were the major factors influencing medication adherence.
2. Health beliefs and prevention behavior involving infection
The average score of the overall responses from the study subjects on infection prevention actions was 4.23. Subjects paid the most attention to oral care and hygiene; remembering to wear surgical masks in public was a measure implemented less well. “Forgetting” was the primary reason that prevented transplant recipients from effective implementation of infection prevention measures. Female patients were better at infection prevention than male patients. Transplant recipients showing a higher degree of compliance with water restrictions during dialysis in the past also exhibited better compliance with infection prevention. In regards to factors influencing health beliefs in infection, subjects that perceived more barriers to infection prevention found it more difficult to implement; older subjects and subjects with a shorter dialysis treatment history perceived less susceptibility to infection, and older patients also possessed weaker perceptions of the severity of infection. Unemployed subjects perceived the severity of infection more strongly than those that worked part-time, who further perceived the severity of infection more strongly than retired subjects. Subjects that had a full-time job also perceived the severity of infection more strongly than retired subjects. Subjects that had received their transplants in Taiwan encountered more barriers to infection prevention. Perceived barriers of infection prevention and water restrictions in dialysis treatments in the past were the primary factors influencing actions to prevent infection.
Conclusion: The medication adherence and infection prevention of renal transplant recipients were influenced by their health beliefs. Transplant recipients who received their transplants for a longer period of time, had more drug-induced symptoms, perceived less susceptibility to rejection, or perceived less benefits of medication adherence exhibited relatively poor medication adherence. Transplant recipients who perceived more barriers to infection prevention or exhibited a lower degree of compliance with water restrictions in dialysis treatments in the past were less active in preventing infection.

並列關鍵字

kidney transplant ； medication adherence ； infection prevention ； health beliefs

參考文獻

汪素敏、顧乃平、林幸台、魏崢（1998）．心臟移植術後病人症狀困擾、社會支持與自我照顧行為相關之探討．護理研究，6（1），4-17。

林文綾、顧乃平、徐國雄、李文宗（2002）．腎臟移植後病患生活品質及其相關因素．榮總護理，19（3），326-336。

林春香、劉雪娥、廖張京隸（1993）．腎臓移植病患生活品質及其相關因素之探討．護理研究，1（4），369-380。

胡文郁、曾春典、戴玉慈、余玉眉．（1996）．高血壓患者服藥遵從行為及其相關因素之探討．中華公共衛生雜誌．15（4），319-332。

翁麗雀、戴玉慈（2005）．腎臟移植手術後病患的生理、心理、社會與靈性議題．護理雜誌，52（4），65-70。