繼發性骨質疏鬆防治衛教手冊內容需求探討：以住院高危險個案觀點為例

The Need for Developing Health Education Pamphlet for Secondary Osteoporosis: The Perspectives of High-Risk Hospitalized Secondary Osteoporosis Patients

蔡沁筠(Chin-Yun Tsai)

指導教授 ： 陳靜敏

臺北醫學大學/護理學院/護理學研究所/碩士(2009年)

https://doi.org/10.6831/TMU.2009.00063

摘要

因老化以及婦女更年期所引起之原發性骨質疏鬆症，近年來在衛生署的大力宣導下，已受到民眾的重視，但由藥物或其他疾病所造成的繼發性骨質疏鬆，則往往讓醫療專業人員及病人所疏略，也疏於對此高危險族群提供適當的衛教及相關防治策略。在審視現今骨質疏鬆相關的衛教單張與手冊皆多侷限於原發性骨質疏鬆患者或者是針對更年期婦女與老年人之族群，鮮少有針對繼發性骨質疏鬆高危險群病患的衛教需求發展衛教單張與手冊。因此，本研究目的在於透過焦點團體會談法：（1）瞭解繼發性骨質疏鬆高危險群之衛教需求；（2）認知現有骨質疏鬆高危險群之防治策略；（3）經由焦點團體討論，了解繼發性骨質疏鬆高危險群衛教內容之合適性。研究以立意取樣臺北縣某地區型教學醫院之兩個院區內外科病房住院病人中至少符合一項繼發性骨質疏鬆之危險因子，且經骨質密度測試儀檢驗出骨質密度T score<-1者做為研究對象。另設計一份開放式結構型訪談大綱，作為焦點團體的訪談指引，以探詢繼發性骨質疏鬆高危險群個案對誘發繼發性骨質疏鬆認知、態度等相關議題。共進行二場的焦點團體訪談法。資料內容在受訪者同意下進行筆稿、錄音與錄影，並在訪談後將焦點團體訪談之錄音以逐字稿方式轉錄成文書訪談紀錄。研究者反覆細讀所有的訪談內容，採內容分析方式，歸納統整出所有資料中之細類目、從屬概念與主概念，藉以整理出受訪者之意見及其論述。根基於兩場繼發性骨質疏鬆共19位病患之焦點團體訪談紀錄，共歸納統整出「體察疾病之相關認知」、「體認防治骨質疏鬆策略」與「體察疾病之態度反應」三個主要概念。體察疾病之認知方面，大部分受訪者對於繼發性之骨質疏鬆症表示全然不了解亦分類不完全。受訪者雖能闡述對骨質疏鬆的一般性認識，但對於疾病確切或更深入的認知就顯得格外的不足。體認防治骨質疏鬆策略方面，受訪者大約都知道骨質疏鬆應補充鈣質等食物來源，但對於確切符合骨質疏鬆的飲食種類與應補充之鈣質含量就顯得不清楚。且受訪者雖能提及運動對於骨質疏鬆的整體好處所在，但疾病適合的運動種類及頻率就顯得較不熟悉。而在面臨原有疾病與對疾病影響治療的兩難中，皆認為本身疾病的治癒才是最重要的。最後在體察疾病之態度反應中發現，當受訪者一般知道自己有骨質疏鬆症時就會積極的去正視與處理此一問題，而當中藉由臨床醫護人員去提供相關的資訊與提及正確的衛教亦是必要的。故針對焦點團體訪談後所得結果，研擬針對住院期間繼發性骨質疏鬆高危險群個案衛教手冊內容包括以下七點：（一）、繼發性骨質疏鬆的定義、分類與危險因子，（二）、繼發性骨質疏鬆造成的嚴重影響，（三）、骨質疏鬆自我風險評估，（四）、骨質疏鬆的診斷與臨床徵候，（五）、骨質疏鬆就醫須知，（六）、繼發性骨質疏鬆的預防與保養，包含1.飲食、2.運動、3.生活作息、4.定期檢查的重要性、5.居家注意事項、及（七）、常見迷思。藉由本研究結果，設計完整的衛教手冊做為介入工具，期望能喚起繼發性骨質疏鬆症高危險群及醫療提供者的重視，並提供未來相關研究及介入性衛教措施的參考。

關鍵字

繼發性骨質疏鬆症 ； 衛教手冊 ； 焦點團體訪談法

並列摘要

The primary osteoporosis caused by aging and menopause have been publicized by the Health Department of Taiwan and have drawn the public’s attention. However, secondary osteoporosis caused by medicine and other diseases is usually ignored by the health professionals and patients. The provision of health education and prevention strategies to high risk population of secondary osteoporosis is lacking. Current osteoporosis health education pamphlets and brochures are found limited within the realm of menopausal women and the elderly. This study employs focus group interview to (1) acquire the health education need of high risk hospitalized secondary osteoporosis patients, (2) acknowledge current prevention strategies for this population, and (3) comprehend proper health education for them.Purposive sampling technique is utilized to recruit patients from two campuses of a teaching hospital in Taipei county who has bone density T score <-1checked by osteometer and meets any risk criteria of secondary osteoporosis. An semi-structure interview guide is developed. Two texted, audio & video-taped focus group interviews are hold with study participants’ agreement to collect information and transcribed into interview record later on. After repeatedly reviewing record with content analysis technique, categories, domains, and themes are deduced along with participants’ statements . From two focus group interviews with 19 participants, 3 major categories : (1) relevant cognition of understanding the disease, (2) acknowledgement of osteoporosis prevention strategies, and (3) attitudinal responses of understanding disease are revealed.
In the aspect of “relevant cognition of understanding the disease”, most participants either have not heard about or do not understand the classification of secondary osteoporosis. In “acknowledgement of osteoporosis prevention strategies” , most participants know the source of calcium supplement, but they are not clear about the details that precisely meet the need for preventing or treating osteoporosis. Participants have insight about the advantage of exercise, but they are not familiar with the appropriate type and the frequency. When participants facing the dilemma of their original diseases and the influence of thems on the treatment of osteoporosis, they all agree as curing their original diseases is the priority. In “attitudinal responses of understanding disease” , participants will face up to osteoporosis and handle this disease with positive attitude. The necessity of providing proper health education for participants by the health professional is highlighted as well.
A patient education brochure for hospitalized high risk population of secondary osteoporosis is developed. It contains 7 parts: (1) the secondary osteoporosis (definition, classification, and risk factors), (2) health impact, (3) risk self-assessment, (4) diagnoses and clinical symptoms, (5) doctor visit necessity, (6) prevention and care (diet, exercise, life style, regular check, and guidelines for home care), and (7) misunderstanding . It is expected that the study results can be used to develop a health education brochure as an intervention tool that can arouse the attention of this high risk group and health care provider as well as providing evidence for intervention and future research.

並列關鍵字

Secondary osteoporosis ； Health education brochure ； Focus group interview

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