醫病信任、結果預期及自我效能於糖尿病患自我照顧應用

Patient-physician Trust, Outcome Expectations and Self-efficacy in Diabetic Patients' Self-care

李尹暘(Yin-Yang Lee) ； 林麗娟(Ju-Lia L. Lin)

《北市醫學雜誌》 5卷3期 (2008/06) Pp. 304-319

https://doi.org/10.6200/TCMJ.2008.5.3.02

摘要

近年來由於疾病型態改變，慢性病比率增加，病患的醫囑順從與健康行為成為推動公共衛生重要的課題。自我效能理論是一個廣泛被接受的行為科學模式，其理論模式中的自我效能、結果預期等構念，在國內外的許多研究中都證實對慢性病的健康行為有著決定性的影響；同時，近來有關醫病關係的研究也發現醫病信任是另一個重要影響病患醫囑與健康行為的因素。若醫療提供者能同時深入瞭解醫病信任與自我效能理論中各個構念間的關係，並充分應用於衛生計畫的推動與衛教工作的實施上，將可於病患疾病與醫療資源的控制上得到最佳的綜效。本文回顧近年來國內外對於自我效能理論的理論模式與最新發展，並提出醫病信任關係可以是一個重要的影響變數；同時並綜合理論的預測因素與國內外實證結果，以糖尿病為例，提出臨床應用於病患自我照護行為上具體可行的介入方案（表二）；最後，再針對國內外目前研究的現況建議未來可以研究的方向。

關鍵字

自我效能理論 ； 醫病信任 ； 自我效能 ； 結果預期 ； 糖尿病自我照護行為

並列摘要

As disease patterns have shifted towards a high prevalence of chronic diseases in these years, the quality of health is heavily influenced by lifestyle habits and self care management. Patients' inadequate health behaviors and adherence are pervasive and serious problems. It worsens health conditions and raises medical costs. Over past three decades, self efficacy theory has been successively applied in health fields. This theory posits a multifaceted causal structure in which self-efficacy beliefs operate together with outcome expectations and goals in the regulation of human motivation, behavior, and wellbeing. In many existing studies, self-efficacy and outcome expectations are recognized as strongest predictors of health behavior change. Research of interventions incorporating the four specific efficacy-enhancing techniques of facilitating personal mastery, vicarious experiences, identifying distress and providing verbal persuasion have demonstrated lower levels of health care consumption and improved psychosocial adjustment to a new health status. On the other hand, patient-physician trust is also identified to be a strong predictor of patient's adherence and health behaviors. Higher patient trust is found to be associated with better health outcomes in many studies. These concepts provide scientific evidence base for health promotion strategies. In this paper, we contend that patient trust could be a critical variable to make the whole model more practical and effective. We also propose concrete self-managed interventions of diabetes mellitus based on the predictors of social cognitive theory. Finally, future research directions for including the measure of trust and outcome expectations and identifying the practicability of self-managed intervention are suggested.

並列關鍵字

Self efficacy theory ； patient trust ； self-efficacy ； outcome expectations ； diabetic self-care behavior