高血壓病患服藥遵從行為相關因素探討

高血壓是一種複雜性、高發生率及不可逆性的慢性疾病，為2014年臺灣十大死因第八名，其盛行率隨年齡逐年上升。血壓控制不佳易引發高血壓合併症，嚴重者甚至發生死亡。治療高血壓有效方式，就以規律服用高血壓藥物是最佳的控制方法。因此，本研究將探討影響高血壓病人服藥遵從行為的相關因素。研究採橫斷性研究設計，以方便取樣調查南部某醫學中心之高血壓病患作為研究對象。資料收集採問卷調查及病歷查閱方式，問卷內容包含人口學特性、高血壓健康文化認知、中藥健康認知、西藥健康認知、自我健康照護行為及社會支持與服藥遵從行為。本研究資料以SPSS 20.0統計軟體進行資料分析，以平均值、標準差、次數、百分比陳述描述性統計；以獨立樣本t檢定、單因子變異數分析、斯皮爾曼等級相關係、及線性複迴歸進行推論性統計分析。研究共收集121位病患，女生(54.5%)多於男生，平均年齡64.6歲(SD=9.64)，教育程度以高中(28.9%)及小學(24.8%)居多。研究結果發現年齡(F=3.801, p= .012)、就業狀態(F=2.635, p= .038)、自覺健康狀況(F=3.129, p= .028)與服藥遵從行為有顯著差異。西藥用於治療高血壓之好處認知(r= .387，p< .001)、西藥用於治療高血壓之障礙認知(r=.421, p< .001)、一般西藥之障礙認知(r=.337, p< .001)、健康相關的社會支持(r= .231, p= .011)與服藥遵從行為呈現正相關。年齡、就業狀態、自覺健康狀況、西藥用於治療高血壓之好處認知、西藥用於治療高血壓之障礙認知、一般西藥之障礙認知及健康相關的社會支持與服藥遵從行為有顯著相關，其七個預測變項共可解釋「服藥遵從行為」30.1%的變異量，意旨年齡愈低、沒有就業或退休者較就業中病患、健康狀況越差、西藥用於治療高血壓之好處認知越高、服藥副作用愈大，一般西藥之障礙認知越高、健康相關的社會支持越高，服藥遵從性愈低。本研究結果有助於醫療專業人員了解高血壓病患服藥行為遵從行為其影響因素，提供醫療人員對於高血壓患者住院護理活動及衛教之參考與方向。

關鍵字

高血壓；服藥遵從行為

並列摘要

Hypertension is a complicated and irreversible chronic disease with high incidence. Ranked 8th among top 10 causes of death in Taiwan in 2014, its prevalence rises with age on a year-over-year basis. Not well blood pressure control can easily lead to complications of hypertension, which can even result in death in severe cases. As an effective way to treat hypertension, regular intake of hypertension medications is the best control method. Therefore, the present study investigated the factors associated with medication adherence behavior among hypertension patients in Taiwan. This study was a cross-sectional study that surveyed hypertension patients Convenience sampled from a medical center in South Taiwan. Data was collected through questionnaires and medical records. The questionnaire contained demographic characteristics, health and cultural perceptions regarding hypertension, perception of healthcare using traditional Chinese medicine, perception of healthcare using Western medicine, self-care behavior, social support and medication adherence behavior. The data was analyzed using the SPSS 20.0 statistical software and the resultant descriptive statistics summarized mean value, standard deviation, frequency and percentage. Independent samples t-test, one-way ANOVA, Spearman’s rank correlation coefficient and multiple linear regression were conducted for inferential statistical analysis. In the total 121 patients who consented to participate this study, females (54.5%) are slightly more than males, with an average age of 64.6 (SD=9.64), and the majority with the highest education level being either senior high school (28.9%) or elementary school (24.8%). The results reveal significant differences in medication adherence behavior by age (F=3.801, p= .012), employment status (F=2.635, p= .038) and self-perceived health status (F=3.129, p= .028). Perception of the advantage of using Western medicine to treat hypertension (r= .387，p< .001), perception of the disadvantage of using Western medicine to treat hypertension (r=.421, p< .001), perception of the disadvantages of Western medicine in general (r=.337, p< .001) and health-related social support (r= .231, p= .011) have positive correlations with medication adherence behavior. Age, employment status, self-perceived health status, perception of the advantage of using Western medicine to treat hypertension, perception of the disadvantage of using Western medicine to treat hypertension, perception of the disadvantages of Western medicine in general and health-related social support have significant correlations with medication adherence behavior. These seven predicators are able to explain 30.1% of variance in ‘medication adherence behavior’. This means that lower age, the status of unemployment or retirement versus employment, poorer health, better perception of the advantage of using Western medicine, greater medication side-effects, better perception of the disadvantages of Western medicine in general, greater health-related social support, and lower hypertension medication adherence among the participating patients. The results of the study help healthcare professionals understand factors that affect medication adherence behavior among hypertension patients and provide them with some references and directions regarding hospital nursing activities and health education for hypertension patients.