中風病患照顧者健康識能與出院準備度之相關性探討

研究背景與目的：中風存活者在生、心理層面程度不等的失能，會影響其獨立性，因而照顧者的角色十分重要。過去研究顯示，照顧者健康識能不足會影響病患的恢復狀況與生活品質。進行中風病患出院規劃時，照顧者的健康識能是否與其出院準備度有關，目前尚未有相關之研究。因此，本研究探討中風病患照顧者之健康識能與出院準備度之相關性，以提出改善出院規劃之建議。研究方法：本研究為一橫斷性研究，以臺灣北部某醫學中心神經內外科病房與復健病房即將出院之中風病患照顧者為對象，採立意取樣，使用自擬之結構式問卷調查，研究工具包括腦中風相關健康識能評估量表與中風病患照顧者出院準備度量表，所蒐集之量性資料以SPSS mac 25.0版統計軟體進行分析。研究結果：自民國107年5月至9月期間共收集100位個案的資料進行統計分析，研究結果顯示：(1)腦中風病患照顧者之健康識能總分平均為9.73分。照顧者健康識能得分因照顧者之教育程度（大學及以上組高於國中及以下組）、職業（醫療相關人員高於非醫療相關人員）及感受出院規劃足夠程度（8-10分組高於小於等於7分組）不同而有統計上的顯著差異；另中風病患之查爾森共病指數1分組其照顧者健康識能得分顯著高於查爾森共病指數大於1分組。(2)中風病患照顧者之出院準備度單題平均得分為2.58分，介於有些準備到相當有準備之間。照顧者出院準備度得分因中風病患之查爾森共病指數（1分組得分高於大於1分組）、照顧者感受出院規劃足夠程度（8-10分組得分高於小於等於7分組）與經濟狀況（無困難者得分高於有困難者）不同而有統計上的顯著差異。 (3)中風病患照顧者健康識能與出院準備度達顯著正相關。(4)迴歸分析顯示，中風病患照顧者之健康識能與感受出院規劃足夠程度為出院準備度之顯著預測因子，可解釋其總變異量為37.2%。結論與建議：本研究顯示中風病患照顧者之健康識能與出院準備度呈顯著正相關，建議未來出院規劃可將照顧者健康識能與出院準備度納入評估，並針對健康識能低下與出院準備度不足的照顧者提供適當識讀性的衛教資料以提升對訊息的理解度。此外可針對查爾森共病指數大於1之中風病患照顧者進行深入探討，了解其所面臨的困境予以適當與具體的引導，提供復健與長期照護諮詢專線與資源，以減少出院準備困難情況，協助病患與家屬順利離開急性醫療機構。

關鍵字

中風；腦血管意外；照顧者；健康識能；出院準備度

並列摘要

Background and Purpose: The independence of a stroke survivor is strongly affected by his/her physical and mental disability. As a result, the role of caregiver is significant in terms of assisting post-stroke recovery. Caregivers with low health literacy will have an impact on patients’ recovery and quality of life. There is no existing research regarding the relationship between health literacy and discharge readiness among caregivers of stroke patients. Therefore, the purpose of this study is to explore the correlation of health literacy and readiness for hospital discharge among caregivers of stroke patients. Methods: This is a cross-sectional study. The participants were caregivers of stroke patients in neurosurgery, neurology and rehabilitation ward in a medical center in Taipei. Participants were asked to fill out two structural questionnaires which included Stroke-Related Health Literacy Scale and Readiness of Hospital Discharge Scale for Caregivers of Stroke Patients. The collected data were analyzed by SPSS mac version 25.0. Results: From May 2018 to September 2018, one hundred caregivers of stroke patients were included in this study. It was found that: (1) The mean score of caregivers’ health literacy was 9.73. There were significant differences between different caregivers’ educational level (the group of university and above is higher than the group of junior high school and below), different job occupation (the group of medical related is higher than the group of non-medical related), and perceived different satisfaction of discharge planning (the group of scored 8-10 is higher than the group of scored ≤7). Higher mean score of caregivers’ health literacy were also observed in stroke patients with lower Charlson comorbidity index (the group of CCI=1is higher than the group of CCI ≥1). (2) The mean score of readiness for hospital discharge is 2.58. There were significant differences between different caregivers’ financial status (the group of without financial difficulties is higher than the group of financial difficulties) and different satisfaction of discharge planning (the group of scored 8-10 is higher than the group of scored ≤7). Higher mean scores of caregivers’ readiness for hospital discharge were also observed in stroke patients with lower Charlson comorbidity index (the group of CCI=1 is higher than the group of CCI ≥1). (3) There was a significant positive correlation between caregiver’s health literacy and their readiness for hospital discharge. (4) Regression analysis showed that caregivers’ health literacy and perceived satisfaction of hospital discharge planning affected their readiness for hospital discharge. The total variance was explained 37.2%. Conclusions and Suggestions: The study identified that caregiver’s health literacy and their readiness for hospital discharge were significantly positively correlated. It is suggested to assess caregivers’ health literacy and readiness for hospitaldischarge in the future discharge planning. Furthermore, providing health education materials with proper readability for caregivers with low health literacy will improve their understandings to medical related information. Future discharge planning could focus on stroke patients with Charlson comorbidity index ≥1, to explore their problems, and provide suitable resources and supports in order to help them transfer smoothly from hospital to home.