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  • 學位論文

台灣中風患者之中風教育需求評估及評價計畫

The needs assessment and evaluation program of stroke education for cerebrovascular accident patients in Taiwan

指導教授 : 王理

摘要


主題一:台灣中風患者中風教育之需求評估計畫 研究目的:了解中風患者對於中風相關知識、態度、對社會環境的看法及自我效能,以為在中風患者衛生教育教材內容之參考。 研究背景:中風高居台灣的第二大死因,隨著年齡增加,在台灣中風的死亡率與發生率都有上升趨勢。中風的發生關係到中風知識、生活型態及中風危險因子;對於中風患者要如何避免再次中風及中風後的復健是相當重要,這些都需要有系統的教育教導中風患者。 研究方法:本研究在2007年8月至11月,對於台灣中部某一醫學大學附設醫院及其週邊七個鄉鎮市社區127名中風患者進行中風衛生教育需求評估的調查;以社會認知理論為本研究架構,設計研究問卷,並分析患者特徵與中風相關知識、個人態度、對社會環境的看法及自我效能之間的關係;以頻率及平均數統計中風患者在知識、態度、對社會環境的看法及自我效能的題目狀況。 研究結果:由參與者的特徵與知識、態度、對社會環境的看法及自我效能的做迴歸分析。本研究發現患者的知識缺乏會與年齡增長(P=0.01)相關、有高血壓、糖尿病、高血脂等三種慢性病(P<0.01)及二次以上中風(P<0.05)有關;負向的態度會與中風發作到送醫的時間超過三小時(P=0.01)、低教育程度(P<0.01)相關;對社會環境的負向看法會與男性(P=0.03)、二次以上中風(P<0.05)、沒有高血壓、糖尿病、高血脂等三種慢性病史(P=0.04)相關;負向的自我效能則會與二次以上中風(P<0.01)有關。在知識態度正確回答率的部分,需加強患者的中風徵兆及送醫知識題的「流口水等中風徵兆」及「黃金三小時的急救時間」;危險因子的知識題的「再次中風的機率」、「過度飲酒與中風」、「糖尿病與中風」、「高血脂與中風」及「抽菸與中風」。在態度題需注意「定期復健」、「減少飲酒」、「控制體重」、「外出參與運動」及「願意與人交談」;在對社會與環境的看法題目分數較低為「社會大眾普遍了解中風資訊」、「社會上提供的照護資源」及「在家活動的方便性」;自我效能方面需加強「持續復健」、「壓力調適」及「外出參與活動」。由以上資訊以為將來中風教育內容之參考。 結論:本研究評估台灣中風患者的知識、態度、對社會環境的看法及自我效能。獲得的資料可知中風患者在此方面的需求,可提供作為台灣民眾中風教育的教材內容參考。 主題二;台灣社區輕中度中風患者中風教育計畫 研究目的:本研究探討社區中風衛生教育介入前、後對於輕、中度中風患者的知識、態度與自我效能之影響。 研究背景:腦血管疾病嚴重威脅台灣民眾健康,其症狀比第一次嚴重;因此,對中風患者的中風教育對於再次中風的預防及復健是非常地重要。 研究方法:2007年8月至2007年11月,對於中台灣七個鄉鎮社區的輕、中度中風患者進行招募並實施中風教育介入,內容包括中風講座、中風後復健、心理諮詢及生理功能檢查。參與者需接受教育介入前的前測(T0)、教育介入後一週內的後測(T1)及介入後兩個月的追蹤後測(T2),於三個時間點,參與者皆被施予面對面的問卷訪視。 研究結果:全程參與衛生教育介入的中風患者有45位。經過中風教育介入後,參與者的中風徵兆和就醫知識(T0: 3.09 vs. T2: 3.56, p<0.01)、危險因子知識(T0: 6.33 vs. T1: 7.38, p=0.02; T0: 6.33 vs. T2: 7.60, p<0.01)及飲食知識(T0: 3.58 vs. T2: 3.87, p=0.03)有顯著地增加,患者的社會參與態度(T0: 4.51 vs. T1: 5.11, p<0.03; T0: 4.51 vs. T2: 5.24, p<0.02)及巴氏量表分數(T0: 78.89 vs. T1: 85.91, p<0.01)亦有顯著地提升。 結論:中風在台灣是一個相當重要的公共衛生議題。本研究發現社區中風患者經過中風教育後,在中風相關知識有明顯的進步;患者在社會參與態度及日常生活活動亦有進步。

並列摘要


Subject I: The needs assessment program of the secondary stroke prevention education for stroke patients in Taiwan Research Objective: This study attempted to understand the knowledge, attitude, brief of social environment and self efficacy of stroke patients for development of the stroke education material for patients. Background: Stroke or Cerebrovascular accident (CVA) has been the second cause of death in Taiwan. As the age increases, both the mortality rate and incidence rate of cerebrovascular accidents in Taiwan increases. The occurrence of cerebrovascular accidents related to knowledge about stroke, lifestyle and risk factors of stroke. It is very important for stroke patient to know how to avoid secondary stroke and rehabilitation after strokes, which requires systematic education in order to make them available to stroke patients. Research Methods: The study was conducted from August to November 2007. It performed a needs assessment of stroke education for 127 stroke patients in a college medical center and its surrounding 7 municipal communities in Central Taiwan. The study was structured based on social cognitive theories, with which the questionnaires were designed, and the relationships between characteristics of patients and their stroke related knowledge, personal attitude, brief of social environment and self-efficacy were analyzed. The study also statistically analyzed conditions of stroke patients on items regarding to knowledge, attitude, brief of social environment and self-efficacy by measures of calculating frequency and means. Results: We did a regression analysis according to the participants’ characteristics, knowledge, attitude, brief of social environment and self-efficacy. This research found that lack of knowledge in the patients was related to aging (P=0.01), diagnosis with three types of chronic diseases (including hypertension, diabetes mellitus, and hyperlipidemia) (P<0.01) and occurrence of cerebrovascular accident at least twice and above (P=0.01). Negative attitude was related to low education level and delay of stroke attack treatment for more than three hours (P<0.01). Besides, a negative perspective towards social environment was related to male (P=0.03), patients who were not diagnosed with three types of chronic diseases (including hypertension, diabetes mellitus and hyperlipidemia) (P=0.04) and occurrence of stroke at least twice and above (P<0.05). However, negative self-efficacy was related to stroke of twice and above (P<0.01). For the knowledge related to the stroke warning signs and hospital admission, the stroke patients had a lower correct response rate for some of the items such as “Difficulty to swallow and drooling are the warning signs for stroke” and “The golden three hours to receive medical treatment is within the first three hours after the onset of stroke”. The answers with a lower correct response rate in the section related to risk factors knowledge include “Stroke patients have a higher chance of secondary stroke than the regular person”, “Alcohol drinking is bad for health”, “The high blood glucose in diabetes patients is related to stroke”, “Stroke patients should have adequate exercise”, “Patients with hyperlipidemia have a higher chance of stroke”, and “Smoking is related to the onset of stroke”. In the part of attitude items, the personal attitude score was low in "Regular visit to the medical institutions if rehabilitation is needed",“Drink alcohol moderately”, “Weight controlling”, “Participation in the social activities” and “Actively engaging in a conversation with the others”. The three items with lower scores in the section on brief of the social environment included the improvement of living environment was helpful with ambulation, social care resources were beneficial for stroke patients and the public had understanding towards stroke information. For the section on self-efficacy of the stroke patients, there were three items with lower score included stress adjustment, physical activities and continuous rehabilitation. Conclusion: This study evaluated the knowledge, attitude, brief of social environment and self-efficacy of the stroke patients in Taiwan. The information gathered by this study will provide an understanding of the needs for stroke patients in several aspects. In addition, it can be used as a reference for the public teaching materials of the stroke education. Subject II:The stroke education program on community based for mild and moderate stroke patients Research Objective: This study explores the impact of intervention of stroke education on knowledge, attitude, brief of social environment and self-efficacy of mild and moderate stroke patients before and after intervention in a community. Background: Cerebrovascular disease is a persistent threat to the health of the general public in Taiwan. Symptoms of stroke were more severe than the first stroke. Hence, it is important that the stroke patient is essential for stroke education. Method: From August to November 2007, mild and moderate stroke patients resident in 7 communities of Central Taiwan were recruited and intervention of stroke education was implemented. The content of the intervention combines stroke prevention education sessions, rehabilitation after stroke, psychological consultation and physiological function examination. Pretest (T0) was measured before the health education intervention while the posttest (T1) was immediately measured after the eight weeks intervention. Two months after the education intervention, telephone interview was used to measure the follow-up test (T2). The assessment was focused on the stroke prevention knowledge, attitude, brief of social environment, self-efficacy, and impact on activities of daily living. Besides, the effect of health education for stroke was examined. Results: There 45 stroke patients who participated in the intervention of stroke education for the whole course. After education intervention, warning signs and attitude in hospital admission knowledge (T0: 3.09 vs. T2: 3.56, p<0.01), risk factors knowledge (T0: 6.33 vs. T1: 7.38, p=0.02; T0: 6.33 vs. T2: 7.60, p<0.01) and dietary knowledge (T0: 3.58 vs. T2: 3.87, p<0.03) of the stroke patients had improved significant. The patients’ social participation attitude (T0: 4.51 vs. T1: 5.11; T0: 4.51 vs. T2: 5.24, p<0.02) and their ADL scores (T0: 78.89 vs. T1: 85.91, p<0.001) had been significantly elevated. Conclusion: It was found that intervention of stroke education has a significantly positive effect on stroke related knowledge of the stroke patients in the community. It also enabled the patients to hold a positive social participation, and improved patient’s activities of daily living (ADL).

參考文獻


陳慧玲與賴明美。中風。基層醫學 2003;18:292-302。
鄭建興與葉炳強。腦血管疾病的危險因子。當代醫學 2001;28:13-19。
葉炳強等。急性中風的緊急處理。當代醫學 2006;55:469-473。
台大醫院腦中風中心。全方位照護腦中風。健康世界 2005;230: 20-45。
陳人豪與嚴崇仁。老年人之生理變化與檢驗數據判讀。台灣醫學 2003;7:352-362。

被引用紀錄


廖唯安(2015)。台灣腦中風患者居住地都市化程度與住院復健次數之相關性探討〔碩士論文,長榮大學〕。華藝線上圖書館。https://doi.org/10.6833%2fCJCU.2015.00158
林佳淑(2011)。轉銜期照護模式對腦中風病患及照顧者之成效〔碩士論文,長榮大學〕。華藝線上圖書館。https://doi.org/10.6833%2fCJCU.2011.00018

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