社區膝痛中高齡者尋求醫療照護之健康信念及其相關因素研究-以退化性膝關節炎為例

Health Belief and Its Related Factors in Health-Seeking Behavior of Middle-Aged to Elderly People with Knee Pain in Community -With Knee Osteoarthritis as an Example

黃慧雅(Hui-Ya Huang)

指導教授 ： 陳毓璟

國立中正大學/教育學院/成人及繼續教育系高齡者教育研究所/碩士(2015年)

摘要

研究目的：退化性膝關節炎是導致中高齡者失能與影響其生活品質相當重要的慢性病，多數患者常有延遲就醫或就醫比例偏低的情形。本研究旨在探討社區膝痛中高齡者，對於退化性膝關節炎尋求醫療照護之健康信念與相關因素，以提出未來衛生教育之對策。
研究方法：本研究為橫斷面研究，以健康信念模式為理論基礎，採用問卷調查法，以自行發展之結構式問卷為研究工具，研究對象為50歲以上且過去1年內曾膝痛之雲嘉地區慈濟環保站志工，以SPSS 21.0統計軟體進行資料處理與分析。
研究結果：共收錄181位受試者，平均年齡69.0歲，女性佔85.6%。過去1年內膝痛曾尋求醫療照護之比例為42.5%。本研究之健康信念量表，信效度良好，總解釋變異量為70.8%，各構念之Cronbach’s α介於.870至.938。整體受試者之健康信念，以自我效能最高，自覺行動障礙最低。不同性別、年齡、教育程度、居住狀況、職業、退化性膝關節炎病史、膝痛發病時間、膝痛頻率、日常活動影響、膝痛分數之社區膝痛中高齡者，其健康信念有顯著差異。階層式邏輯斯迴歸分析顯示，社區膝痛中高齡者尋求醫療照護之預測因子，包括女性、膝關節受傷史、膝痛發病時間5年以上至10年以內、膝痛影響蹲下站起或上下樓梯、膝痛影響走路、行動線索及自覺罹患性。
結論與建議：就醫者對於膝痛尋求醫療照護的自覺行動利益並沒有比無就醫者高，而自覺行動障礙也沒有比無就醫者低，此表示病患認為就醫並無法對其疾病有太大的助益，也間接指出現有的退化性膝關節炎之醫療照護需有所改善。膝痛者決定就醫的重要因素，來自日常活動受到影響，這顯示出膝痛者經常會有延遲就醫直到症狀加劇的問題。未來在退化性膝關節炎的實務方面，相關醫療人員應接受完整的退化性膝關節炎之教育訓練，並提供疾病管理模式；醫療人員應以選擇、最適化與補償模式為基礎，根據病患之健康信念，教育病患有適當的因應行為；社區教育單位應結合鄰近醫療資源，宣導退化性膝關節炎之知識與就醫，並提供病患行為改變之學習資源。

關鍵字

尋求醫療照護 ； 退化性膝關節炎 ； 中高齡者 ； 健康信念模式

並列摘要

Purpose: Knee osteoarthritis (OA) is one of the more important chronic diseases that cause disability and quality of life impairment in middle-aged to elderly people. It is quite common for these patients to either delay or forgo seeking medical care. This study aims at exploring their health belief and related factors in health-seeking behavior in order to propose a better health education strategy.
Method: This research is a cross-sectional study based on the health belief model using a self-developed structured questionnaire. The participants consisted of volunteers recruited from Tzu Chi recycling stations in Yunlin and Chiayi areas. They were over 50 years old with a history of knee pain in recent one year. Statistical analysis was performed using SPSS 21.0.
Results: There were 181 participants with a mean age of 69.0 years and 85.6% were female. The percentage of participants seeking medical care in recent one year was 42.5%. The validity of the health belief scale was quite good which explains 70.8% of the total variance. The Cronbach’s α of each construct was between .870 to .938. Among the participants, the highest factor of health belief was self-efficacy and the lowest one was perceived barriers to taking action. Factors with significant difference of health belief were sex, age, educational level, living arrangement, occupation, history of knee OA, time of onset of knee pain, frequency of knee pain, impact on daily activity and knee pain score. Hierarchical logistic regression analysis showed that the predicting factors for the participants in seeking medical care were female, history of knee joint injury, knee pain of over 5 years but less than 10 years, knee pain influencing squatting or climbing stairs, knee pain influencing walking, cues to action and perceived susceptibility.
Conclusion and suggestion: Comparing participants with and without health-seeking behavior, the perceived benefits of taking action were not higher while the perceived barriers to taking action were not lower. This suggests that the participants may not expect the medical treatment to be effective, indicating that further improvement is required in knee OA medical care. The most important factor influencing the participants in seeking medical care was the impact of daily activities. This means that the participants often delay their health-seeking behavior until when the symptoms become severe. To improve the care of knee OA patients, medical professionals should receive comprehensive medical education and provide disease management program. Based on the model of selective optimization with compensation, medical professionals should provide a suitable health behavior education program according to the health belief of the patients. Community educational organizations should work with health care professionals, to advocate on spreading knowledge and health-seeking information of knee OA while offering learning resources to help patients in behavior changes.

並列關鍵字

health-seeking behavior ； knee osteoarthritis ； middle-aged to elderly people ； health belief model

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