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  • 學位論文

衛教手冊合併電話護理諮詢對住院骨質疏鬆高危險群防治之知識、罹患性認知、行為與骨質密度之改善成效

The Effect of Health Education Programs on Improving Osteoporosis Preventing Knowledge, Perceived susceptibility, Behaviors, and Bone Density Among Inpatient High Risk Group

指導教授 : 陳靜敏

摘要


本研究旨在探討衛教手冊合併電話護理諮詢對住院骨質疏鬆高危險群防治之知識、行為與骨質密度之改善成效。採類實驗性研究設計,以大台北地區教學醫院之住院病患,至少符合一項繼發性骨質疏鬆症之危險因子(指疾病史或藥物史)者,篩選出骨密度T-score小於-1者,採隨機分配方式編為實驗組(n=50)與控制組(n=50),藉由結構式問卷進行骨質疏鬆症防治知識、罹患性認知與預防行為之前測,實驗組給予衛教手冊介入,並於收案後第1、3、6個月,主動給予電話護理諮詢,於六個月後再收集所有研究對象相關變項之改善成效,完成前後測的實驗組與控制組個案分別為34人(68%)及32人(64%)。 本研究對象平均骨密度為-2.57(SD = 1.23),大部分個案之教育程度為國小(包含不識字)佔一半,近六成聽說過骨質疏鬆症,經由醫護人員告知者僅佔兩成,近的一年中僅有17人曾接受過骨密度檢測,僅三成知道自己有骨質疏鬆的現象,卻有近七成沒有人告知有罹患骨質疏鬆症危險性。在危險因子罹患情形方面,61.3%罹患癌症,以服用消炎止痛藥者最多佔57%,平均使用1.05種藥物(SD = 0.22)。平均年齡為62.04歲(SD = 16.03),男性佔57%;有九成多的女性為自然停經,有20%家人有罹患骨質疏鬆症。而目前仍在吸菸者佔17%,有飲酒習慣者佔7%,四成有喝咖啡習慣;近八成無規律攝取鈣質的習慣,有六成多無規律運動行為。 前測結果顯示研究對象對骨質疏鬆症防治之知識平均答對率為67.58%,有六成多的個案表示「同意」未來可能會罹患骨質疏鬆症,預防行為執行平均得分為2.27分,表示個案大多是「偶爾」執行預防骨質疏鬆症之行為,得分最高者為「避免有害行為」(3.63±0.07),平均得分最低的則是「適當運動行為」(1.16 ±1.22分)。 介入六個月後:(一)實驗組之防治骨質疏鬆症知識(t=-7.62, p< .001)、罹患性認知(Z=-4.23, p< .001)、預防行為(t=-3.45, p< .05)有顯著改善成效;(二)後測實驗組之防治骨質疏鬆症知識(t=-6.04, p<.05)、罹患性認知(Z=-5.32, p< .001)、預防行為(t=-2.58, p< .05)進步情形顯著優於控制組,且控制組較實驗組六個月後骨密度有顯著的惡化(t=3.04, p< .001);(三)研究對象對骨質疏鬆症防治之知識、罹患性認知與預防行為間呈現顯著相關;(四)研究對象的組別、飲酒狀況、罹患性認知可預測對骨質疏鬆症防治之知識改善程度;而組別、自覺健康狀況、知識改善程度可預測對骨質疏鬆症防治之罹患性認知改善程度;及知識改善程度可預測對骨質疏鬆症防治之預防行為執行;且發現吸菸狀況可顯著預測骨密度的改善程度。 根據本研究結果得知,以電話護理諮詢合並衛教手冊介入可有效改善研究對象之骨質疏鬆症防治知識、罹患性認知與預防行為,建議可將本研究模式推廣至醫療院所,使得骨質疏鬆症高危險群能夠被早期發現,早期介入及追蹤,進而達到疾病預防的目的。

並列摘要


This study aimed to examine the effect of health education programs (education brochure combined telephone consultation) on improving Osteoporosis preventing knowledge, perceived susceptibility, behaviors, and bone density among inpatient high risk population. The quasi-experimental design was utilized. 100 subjects were recruited from 2 hospitals located in the Taipei metropolitan area. Patients with at least one risk factor of secondary osteoporosis (medical or drug history) and T-score of less than -1would be invited. After the data collection at the baseline, the education brochure would be provided and the telephone consultations were offered at the first, third, and sixth month for the experimental group. The structural questionnaire and bone density screening were used to collect pre- and post- changes between groups. The total of 34 and 32 subjects in experimental and control groups completed the study. The average bone density of the cases were -2.57 (SD = 1.23). Almost 60% of them know about Osteoporosis, but only 20% were informed by the health care workers. In the past year, only 17 subjects had been screened for bone density, nearly 70% cases without the knowledge of being the high risk. In the presence of risk factors, there were 61.3% cases with cancer, 57% cases taking anti-inflammatory pain-relief medications (1.05+0.22 drugs). The average age of the case were 62.04 years (SD = 16.03), men accounted for 57%; 90% women were in natural menopause, 20% of them have family history of Osteoporosis. The smoking prevalence was 17%, and the liquor and coffee drinking prevalence were 7% and 40% respectively. Nearly 80% and 60% of subjects were lack of calcium taking and exercise behaviors. Results of the baseline analyses revealed that subjects had average Osteoporosis preventing knowledge of 67.58%. More than 60% cases "agreed" that they were high risk for Osteoporosis. Most subjects only "occasionally" implementing the prevention behaviors (2.27 ± 0.63), with the highest behaviors as "to avoid harmful behavior" (3.63 ± 0.07), and the lowest in “exercise appropriately” (1.16 ± 1.22). After 6 months, results of the study indicated that education brochure combined with telephone consultations were effective as demonstrated as followed. (1) The knowledge (t =- 7.62, p < .001), perceived susceptibility (Z =- 4.23, p < .001), and preventive behaviors (t =- 3.45, p < .05) all had significantly improved in experimental group. (2) Compared to the control group, subjects in the experimental group had improved more in knowledge (t =- 6.04, p < .05), perceived susceptibility (Z =- 5.32, p < .001), and preventive behaviors (t =- 2.58, p < .05) in the post-tests. Subjects in the control group had significant deterioration of bone density (t = 3.04, p < .001). (3) There were positive correlations among Osteoporosis preventing knowledge, susceptive belief and preventive behaviors. (4) Intervention, drinking habit, perceived susceptibility can predict the improvement of osteoporosis preventing knowledge. Intervention, perceived health status, and improvement in knowledge can predict the changed in perceived susceptibility. Level of improvement in knowledge was the only predictor for susceptibility; smoking behavior was the only predictor for changed in bone density.

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