慢性腎臟病患者健康識能、自我管理與生活品質及疾病控制長期追蹤研究

Health Literacy, Self-Management, Quality of Life, and Disease Control of Patients With Chronic Kidney Disease: A Long-term Follow-up

唐敏華(Min-Hua Tang)

指導教授 ： 丘周萍

義守大學/醫學院/醫務管理學系/碩士(2016年)

摘要

背景：腎臟病屬於慢性病的一種，為避免提早進入透析階段，目前慢性腎臟病患者會接受醫療團隊提供疾病控制、飲食治療及日常保健等相關衛教，但病人是否能確實了解衛教內容及落實自我管理，最後得到良好的控制進而提升生活
品質，這些都是值得去研究探討的。
目的：長期追蹤探討慢性腎臟病患者之健康識能、自我管理與生活品質及相關生理數值控制之現況與其相關性。
方法：本研究採縱貫性研究設計，於南部某醫學中心腎臟科門診進行收案，共收集150位慢性腎臟病患者。以結構性問卷進行資料收集，共進行三次問卷填寫收案。問卷內容包括「慢性腎臟病患者基本資料」、「中文健康識能評估簡式量表」、「慢性腎臟病患自我管理量表」、「SF-36生活品質量表」及「慢性腎臟病患者生理數值登錄表」。收集後資料以SPSS 20.0版套裝軟體進行資料分析。
結果：研究結果顯示，隨著時間的增加，病人的整體生活品質及自我管理皆有顯著改善(p< .001)。是否規律運動，在整體生活品質的得分上有顯著差異
(p< .05)；而症狀干擾與整體生活品質的得分呈顯著負相關(p< .001)。在整體自我管理得分方面，與宗教信仰、教育程度、是否協助讀取醫療訊息及
是否規律運動上達顯著差異 (p< .05)；與健康識能及生活品質達顯著正相關
(p< .05)、於收案後六個月與症狀干擾呈現顯著負相關(p< .001)。eGFR在收案後六個月與第一次收案呈顯著差異(p< .05)。
結論：本研究有助於瞭解慢性腎臟病患者自我管理與生活品質的長期變化，建議醫療團隊可介入多元及適才的照護模式，提升慢性腎臟病患者之整體生活
品質及自我管理，以期延緩病人腎功能的惡化，避免提前進入透析階段。

關鍵字

慢性腎臟病 ； 健康識能 ； 生活品質 ； 自我管理

並列摘要

Background: Chronic kidney disease (CKD) is a kind of long-term disease, in order to prevent from early stage into the dialysis stage, patients will receive advices from the medical team. Such as providing health education on disease control, dieting, maintaining good daily health, and other related topics. However, whether if patients could thoroughly understand the content of health education and implement self-management to enhance their quality of life, is worth the research and investigation.
Purpose: The study explores long-term follow-up CKD patients' health literacy, self-management, quality of life, and the current status of disease control and predicted factor.
Method:This was longitudinal research design , and 150 CKD patients were recruited from medical center hospital in southern Taiwan. This study used structured questionnaires to collect data from them and total three times .The data included a base information sheet, the Symptom distress Scale, Short-form Mandarin Health Literacy Scale, Chronic Kidney Disease Self-Management Scale (CKD-SM) and SF-36 Taiwan Vision . Data were analyzed in SPSS for 20.0 software.
Results:The result of the study shows that as time increases, the CKD patients' quality of life and self-management have improved and significantly correlated (p< .001).Exercise was significantly influenced individual quality of life (p< .05).Symptom distress and quality of life were significantly negatively correlated (p< .05). CKD-SM was significantly influenced individual factors (p< .05) included: religious status, level of education, whether if assisted on reading medical information and exercise. Health literacy and quality of life were significantly correlated (p< .05). However, the score of CKD-SM was significant negative correlated with symptom disease after the sixth months of observation (p< .001). eGFR was different significantly between the initial time and six months (p< .005).
Conclusion: This study assists in understanding long-term changes in CKD patients' self-management and quality of life. It recommends that medical teams can provide diverse and proper care model , enhancing the overall quality of life and self-management of CKD patients, in order to delay the deterioration of their kidney function and avoid the possibility of conducting dialysis.

並列關鍵字

chronic kidney disease ； health literacy ； quality of life ； self-manage

參考文獻

宋藝君、陳淑芬、林秋菊（2008）．慢性病自我管理的概念分析．新臺北護理

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孫嘉慧、林秋菊(2014)‧運用健康知能概念促進慢性腎病患者自我管理‧護

盧瑞芬、曾旭民、蔡益堅(2003)‧國人生活品質評量(I):SF-36台灣版的發

患者憂鬱狀態及健康相關生活品質之研究‧臺灣腎臟護理學會雜誌，11