The Study of Medication Adherence in Outpatients with Hypertension in a Medical Center -- The Influence of Self-efficacy and Cues to action

本研究目的主要是以Becker（1974）的健康信念模式及Bandura（1977）的自我效能理論去探討門診高血壓病人其服藥遵守行為及影響服藥遵守行為的重要相關變項。研究對象為臺北市某醫學中心門診其服用降血壓藥物三個月以上之高血壓病人。採結構式問卷為研究工具，內容包括：高血壓病人之基本資料、服藥遵守行為量表、健康信念量表、行動線索量表及自我效能量表。採一對一訪談方式，共收集112份有效問卷，研究結果如下：、本研究以收縮壓大於140mmHg或舒張壓大於90mmHg，且服藥遵守量表平均得分小於4.557分作為不遵守服藥之定義，研究對象中遵守服藥且血壓控制良好者佔了65.2％，不遵守服藥且血壓控制不理想者佔了7.1％。、研究對象中最常發生未規則或中斷服藥的原因為：忘記了；經常出現的不遵守行為包括：減少服藥次數、減少服藥種類、減少服藥顆數。、研究對象之自我效能與高血壓服藥行為有顯著的正相關，可解釋服藥遵守行為的總變異量為7.6％，自覺罹患性、自覺嚴重性、自覺行動利益、自覺行動障礙及行動線索則不具有顯著的預測力。、年齡在自覺嚴重性、自覺行動障礙與正向行動線索的得分上達統計顯著性差異，年齡小於65歲之研究對象其自覺嚴重性與自覺行動障礙的信念較高、得到正向行動線索的頻率較多。教育程度不同會影響病人的自覺嚴重性及自覺行動利益，教育程度高中及其以上者其自覺嚴重性及自覺行動利益高於教育程度高中以下者。論：自我效能能預測高血壓病人服藥遵守行為，且能增加健康信念的解釋力。護理建議：（1）加強高血壓病人忘記服藥之護理措施及衛教；（2）強化個案對服藥自我照顧的自信心及能力（3）善用年齡及教育程度的評估去做合適的高血壓病人服藥衛教。The purposes of this study are to apply Becker’s health belief model（1974）and Bandura’s self-efficacy theory(1977) to exploring the medication adherence behaviors and relevant factors in out-patients with hypertension. The research subjects, who had received anti-hypertension treatment over 3 month, from cardiac clinics of a medical center in Taipei. The formal structured questionnaire was composed of patient’s basic informations, “Adherence behaviors scale”, “Health belief scale”, “Cues to action scale” and “Self-efficacy scale”. A total of 112 subjects were interviewed face-to-face. The results shown were as follows:.An objective definition of poor adherence to prescription was the score of “Adherence behavior scale” less than 4.557, and systolic blood pressure more than 140 mmHg or diastolic blood pressure more than 90 mmHg. According to this definition, the poor adherence rate was 7.1%, and adherence rate was 65.2%..The main reason for subjects not taking their medications was forgetfulness. Their poor adherence behaviors included omissions of medication schedule, omissions of medication type and dose..The self-efficacy had a significant correlation with medication adherence behaviors and also explained the 7.6% of total variation in subjects’ medication adherence behaviors..The subjects’ age affected perceived severity、 perceived barriers of action and positive cues to action. The subjects’ education level affected perceived severity and perceived benefits of action. onclusions: Bandura’s self-efficacy theory can be used to predic drug adherence behaviors of hypertension patients.ecommendations: (1) Nurses should emphasize the management of medication for forgetfulness；(2) Nurses can strengthen patient’s ability and confidence for medication adherence；(3) Nurses have to design the education plan of according to education level and age of hypertensive patients for medication education.誌謝 .................................................I要 ................................................IIbstract ...............................................III錄 .................................................V目錄 ...............................................VII目錄 ................................................IX一章 序論 ........................................1一節 研究動機與重要性 ...............................1二章 文獻查證 ........................................4一節 健康信念模式 ...............................4二節 自我效能 ........................................7三節 高血壓之現況及管理建議 ......................8四節 高血壓病人服藥遵守行為及其評量方式 ............11五節 影響高血壓病人服藥遵守行為之重要因素 ............15六節 影響健康信念模式之社會人口學因素 ............23三章 研究設計 .......................................26一節 研究架構 .......................................26二節 名詞界定 .......................................27三節 研究假設 .......................................28四章 研究方法 .......................................29一節 研究對象 .......................................30二節 研究工具 .......................................31三節 研究步驟 .......................................35四節 研究工具信度與效度檢定 .....................35五節 資料處理與分析 ..............................38五章 研究結果 .......................................39一節 社會人口學分析 ..............................39二節 服藥行為與相關因素之描述性分析 ............46三節 差異性分析 ..............................56四節 服藥行為與健康信念、行動線索、自我效能之關係 ...68五節 服藥遵守行為與相關因素之解釋力分析 ............73六節 其他研究發現 ..............................74六章 討論 .......................................78一節 高血壓病人服藥遵守行為 .....................78二節 健康信念對服藥遵守行為之影響 ............80三節 行動線索對服藥遵守行為的影響 ............82四節 自我效能對服藥遵守行為的影響 ............84五節 社會人口學與健康信念之關係 .....................84七章 結論與建議 ..............................87一節 結論 .......................................87二節 護理上的應用 ..............................88三節 研究限制及建議 ..............................89考資料 ................................................92件一 開放式訪談的結果 .............................100件二 結構式問卷內容 .............................10