以關係連結觀點探討衛教人員溝通行為對第二型糖尿病患自我管理行為之影響

A Relationship Bonds Perspective: The influence of the health education staff Communication Behavior and Self-mangement Behavior of Type II Diabetes patient.

蔡季芸(Chi-Yun Tsai)

指導教授 ： 楊文惠

中國醫藥大學/管理學院/醫務管理學系碩士班/碩士(2014年)

摘要

糖尿病是一種常見且複雜的慢性疾病，控制不佳時會產生多種嚴重併發症，且其患病的人數、醫療花費皆持續攀升，但透過衛教可增進病患自我管理行為，使病患可穩定控制其糖尿病。因此本研究希望藉由關係連結的觀點來探討衛教人員溝通行為對第二型糖尿病患自我管理行為的影響。本研究為橫斷面問卷調查研究，以便利取樣選取中部地區具糖尿病衛教門診之糖尿病健康促進機構數家，並以所有至樣本機構衛教門診接受衛教之第二型糖尿病患為研究對象，以自行設計之結構式問卷為研究工具，經信效度處理並通過研究倫理委員會審查後，由經訓練後的訪員進行一對一的問卷訪問，本研究共回收270份問卷，回收率為98.2％，回收之問卷資料以結構方程模式進行本研究之分析。
研究結果顯示衛教人員之溝通行為對衛教人員與病患間社會性與結構性連結具有顯著影響，且衛教人員與病患間結構性連結對病患之自我管理行為具有顯著影響，但溝通連結對自我管理行為無顯著影響，且衛教人員與病患間結構性連結在影響路徑中不具有中介效果。本研究結論為良好的溝通行為，僅能使衛教人員與病患間一般社交互動的社會性連結有所提升，且溝通行為對於病患之自我管理行為並沒有直接影響；再者，若衛教過程雙方溝通良好，會使衛教人員減少對該病患之後續追蹤；而病患藉由衛教人員進行疾病追蹤，或是讓該病患加入糖尿病相關照護計畫所產生之結構性連結，會使病患的自我管理行為提升。本研究建議衛教人員應鼓勵病患加入糖尿病相關照護計畫，並且定期追蹤病患及病控制情形，藉此增進病患對於自身疾病之自我管理行為。

關鍵字

第二型糖尿病 ； 溝通行為 ； 關係連結 ； 自我管理行為

並列摘要

Diabetes is a common and complicated chronic disease. When inappropriately controlled, it will generate multiple and serious complications. The number of patients as well as costs for medical treatment continue to rise. However, patients are able to enhance their self-management behavior and stabilize control diabetes through sanitary education. Accordingly, this research hopes to discuss, through the perspective of relationship bonds, health education personnel communication behavior’s influence on type II diabetes patient’s self-management behavior.
This research is a cross-sectional questionnaire survey which is convenient for the selection of several diabetes health promotion institutions that come with diabetes clinics in the central Taiwan area. This research also utilizes type II diabetes patients accepting health education in sample health institutions as objects for research. Self-designed structural questionnaire is used as a research tool which has been gone through credibility process and passed research committee’s ethics review. Trained interviewers conducted one-on-one questionnaire interview for this research which has collected a total of 270 questionnaires with the retrieving rate of 98.2％. Questionnaires retrieved are then analyzed by this research in structured program mode.
Research result indicates that health education personnel’s communication behavior poses significant influence over social bond and structure bond between them and diabetes patients. Meanwhile, structure bond between health education personnel and diabetes patients also poses significant influence over patient’s self-management behavior. However, communication bond does not have significant influence over self-management behavior and structural bond between health education personnel and patients does not have media effect on the influence path.
Conclusion from this research considers that good communication behavior only serves to enhance social bond of average social interaction between health education personnel and patients. Communication behavior does not have direct influence over patient’s self-management behavior. Furthermore, health education personnel’s follow-up on patients will be reduced if there is good communication between both parties in the health education process. Through health education personnel’s disease follow-up as well as structural bond from patients’ participation into diabetes related nursing programs, patient’s self-management behavior will therefore be enhanced. This research suggests that health education personnel should encourage patients to participate in diabetes related nursing programs, and should regularly follow up on patients as well as their disease control condition for the purpose of enhancing patient’s self-management behavior over their diseases.

並列關鍵字

Type II diabetes ； Communication behavior ； Relationship bonds ； Self-management behavior

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