C型肝炎民眾之相關知識、症狀困擾及因應行為之相關性研究

C型肝炎感染是引起肝細胞癌其中原因之一，世界衛生組織估計全球約有1.8億的人口感染C型肝炎，而在台灣C型肝炎盛行率約2至4%。研究發現感染C型肝炎病患對C型肝炎相關知識不足，容易造成C型肝炎防治的缺口;另外，C型肝炎是一慢性疾病，可能會造成患者身心症狀困擾，患者需要具備相關知識以及瞭解疾病造成之症狀，以達長期的調適與因應。但現今僅有少數針對C型肝炎病患知識、症狀困擾及因應型態的研究。因此，本研究的目的包括：(ㄧ)了解C型肝炎病患其知識程度、症狀困擾及因應行為；(二)確認C型肝炎知識、症狀困擾及因應行為與人口學之相關性與差異；(三)找出C型肝炎相關知識之重要預測因子。本研究以立意取樣調查137位C型肝炎成人病患，以描述性、橫斷式、相關性研究設計，使用結構性問卷收集資料，問卷內容包含人口學、C型肝炎知識量表( Brief Hepatitis C Knowledge Scale)、C型肝炎症狀困擾量表(Symptom profile in HCV infection)及因應行為量表(Jalowiec Coping Scale, JCS)，資料以獨立樣本t檢定、單因子變異數及皮爾森積差相關係數統計分析。研究結果發現(ㄧ)C型肝炎患者其C型肝炎知識程度平均得分13.98/19分，答對率最高前三題分別為，「與C型肝炎者共用牙刷與刮鬍刀是安全的」(96.35%)、「使用新的(沒使用過的)針頭、針筒和用具，能減少C型肝炎的傳染」(95.62%)、「人們可能在不知道已被感染情況下與C型肝炎共存許多年」(93.43%)；而答對率低之排序後三題，依序「現在有C型肝炎疫苗能預防C型肝炎的傳染」(31.39%)、「C型肝炎可能會經由性行為而感染」(52.55%)、「民國79年前接受輸血可能會被傳染C型肝炎」(57.66%)。C型肝炎相關知識程度與分組、年齡、婚姻狀況、教育程度、是否接受過口服抗病毒藥物及干擾素治療者，呈現顯著差異(p<.05)；(二)症狀困擾常見的有身體的疲倦(56.20%)、精神疲倦(55.47%)及睡眠問題(55.47%)；症狀困擾嚴重程度依序為睡眠問題(2.18分)、身體的疲倦(1.88分)、精神疲倦(1.80分)。症狀困擾與分組、年齡、婚姻狀況、教育程度、是否接受過口服抗病毒藥物及干擾素治療者，最常利用就醫習慣及是否接受過靜脈注射經驗呈現顯著差異(p<.05)；(三)因應行為分為整體因應行為使用頻率，平均得分為48.15/125分，最常使用為樂觀因應型態；較少使用為情緒(emotive)因應型態；整體因應行為的幫助性平均得分為(41.53分)，最有幫助因應型態為樂觀因應型態；而最無幫助性的為情緒因應型態。整體因應行為使用頻率與年齡、教育程度、職業、是否接受過口服抗病毒藥物、是否接受過干擾素治療、曾經接受輸血及最常利用就醫習慣呈現顯著差異(p<.05)；整體因應行為幫助性結果顯示整體因應行為幫助性總分在年齡、教育程度、職業、是否接受過口服抗病毒治療、是否接受過干擾素治療及最常利用的就醫習慣呈現顯著差異(p<.05)；(四)C型肝炎相關知識程度與整體因應行為使用頻率呈現正相關(p<.01)、與整體因應行為幫助性呈現正相關(p<.01)；(五) C型肝炎相關知識程度之預測因子結果顯示，整體因應行為幫助性、教育程度高中職以上、已婚，對C型肝炎相關知識達顯著解釋力(p=.002)，可解釋27.2%的總變異量。本研究結果可提供醫療從業人員對C型肝炎患者知識程度、症狀困擾及因應行為認識與了解，其資料能應用於C型肝炎之預防觀念及未來衛生教育內容之設計，並藉由評估患者之身、心症狀及因應行為，以達全方位提升患者完整性照護之目標。

關鍵字

C型肝炎；知識；症狀困擾；因應行為

並列摘要

Hepatitis C virus infection is one of the causes to induce hepatic cellular carcinoma. World Health Organization estimated that 180 million population of the world were infected by hepatitis C virus. The prevalence of hepatitis C infection was 2 to 4 percentage in Taiwan. Several studies demonstrated that the patients with hepatitis C infection had insufficient knowledge of the disease which might develop the gap for preventing hepatitis C virus infection. Since hepatitis C virus infection is regarded as a chronic disease, patients may experience disease-related physical and mental symptom distresses, and they need to learn the ways to cope with the disease as well. Only few studies investigated the knowledge, disease-related symptoms and coping styles for patients with hepatitis C infection. The purposes of this study were 1) to understand the knowledge, symptom distress and coping behaviors of within hepatitis C patients; 2) to determine the relationships and difference among knowledge of hepatitis C, symptom distress, coping behavior and demographic /medical data; 3) to predict the factors that may influence the patient’s knowledge of hepatitis C. 137 adult Taiwanese participants with hepatitis C infection were purposively recruited into this study. A descriptive and cross-sectional study design was used to explore the knowledge, disease-related symptoms and coping styles of participants. Four questionnaires included demographic data, brief hepatitis C knowledge scale, symptom profile in HCV infection, and Jalowiec Coping Scale (JCS) were used to measure the variables. Data were analyzed by descriptive statistics, t-test, one-way ANOVA, Pearson’s correlation coefficient, and multiple regression. Results indicated that: 1)the mean score of hepatitis C knowledge was 13.98/19 score and the top three high scores of knowledge were: people with hepatitis C cannot safely share their toothbrushes and razors with other people (96.35%), using ‘new’ (i.e. never used before) needles, syringes, and equipment reduces the risk of being infected with hepatitis C (95.62%), people can live with hepatitis C for many years without knowing that they have been infected with the virus (93.43%). The three lowest scores of knowledge were: there is no a hepatitis C vaccine to prevent Hepatitis C virus (31.39%), hepatitis C can be given to someone during sexual intercourse (52.55%), received a blood transfusion in Taiwan before 1990 may have been infected with hepatitis C (57.66%). The statistically significant difference on knowledge level of hepatitis C were between/within different setting, age, marriage status, education level, with/without treatment of oral anti-virus medication and interferon therapy (p<.05). 2) The top three common symptoms are physical tiredness (56.20%), mental tiredness (55.47%), and sleep problem (55.47%). The top three severe symptoms were sleep problem (2.18 score), physical tiredness (1.88 score) and mental tiredness (1.80 score). The statistically significant difference on symptom distress were between/within the different setting, age, marriage status, educational level, with/without treatment of oral anti-virus medication and interferon therapy, place to seek medical advice and with/without any experience on intravenous injection (p<.05). 3) Optimistic coping style was the most frequently used by patients. On the contrary, the least used coping style was emotive coping style. The top helpful coping style was optimistic coping style, but the least helpful one was emotive coping style. The statistically significant difference on overall score of frequently used coping style were between/within the different age, educational level, occupation, with/without treatment of oral anti-virus medication and interferon therapy, with/without transfusion, and place to seek medical advice (p<.05). The statistically significant difference on overall score of helpful coping style were between/ within the educational level, occupation, with/without treatment of oral anti-virus medication and interferon therapy, and place to seek medical advice (p<.05). 4) Knowledge of hepatitis C were significantly positive correlated with overall score of frequent used coping style and overall score of helpful coping style (p<.01) . 5) The education level, marriage status and overall coping scale of help may be the predictors of the knowledge of hepatitis C that 27.2% of variance can be explained (p=.002). The findings from this study may contribute significantly for directing the educational programs of primary and secondary prevention of hepatitis C and detecting the disease-related symptoms.