[[alternative]]Relationships among of disease knowledge, self-efficacy and quality of life in patients with hypertension nephropathy

[[abstract]]背景：高血壓與腎臟病是一種複雜性、高盛行率及不可逆性的慢性疾病，且隨年齡逐年上升，且已威脅到全球人們的健康，同時也是全球所關心的健康議題之一。兩者有著密不可分的關係，高血壓會影響腎臟功能，而腎功能惡化亦會影響血壓，血壓若控制不當會進展成高血壓腎病變，而病人的疾病知識與自我效能對於疾病控制是很重要的議題，其後果將會影響病人的生活品質。目的：本研究旨在探討高血壓腎病變患者疾病知識、自我效能與生活品質之相關性。方法：採橫斷式研究設計，以方便取樣於臺灣北部某區域教學醫院腎臟內科門診收案，共收得213位由醫師確定診斷高血壓腎病變患者，未進行腎臟替代療法。研究工具包含高血壓腎病變疾病知識量表、慢性腎臟病之自我效能量表(The chronic kidney disease self-efficacy instrument, CKD-SE)及MOS SF-12生活品質量表(Medical Outcome Study Short Form-12, MOS SF-12)。以SPSS 20.0統計軟體進行描述性統計、獨立樣本 t檢定(Independent sample t test)、單因子變異數分析(One-way ANOVA)與皮爾森相關係數(Pearson's correlation analysis)及逐步迴歸法(Stepwise regression)之統計分析。結果：(1)高血壓腎病變疾病知識屬中上程度(77.75%)，自我效能屬中上程度(71.94%)，整體生活品質呈現中上程度(73.49%)，高血壓腎病變患者心理構面的生活品質(MCS)優於生理構面的生活品質(PCS)；(2)教育程度、有無飲酒習慣、慢性腎臟病分期及有無接受過衛生教育者與疾病知識呈統計學上顯著差異；教育程度、有無就業、居住狀況、有無飲酒習慣及自備血壓機且有每日監測血壓者與自我效能達統計學上顯著差異；教育程度、有無就業及自備血壓機且有自我監測血壓者與生活品質達統計學上顯著差異；(3)疾病知識(r = .297, p < .01)、自我效能(r = .496, p < .01)與生活品質有顯著正相關，表示高血壓腎病變患者疾病知識程度越好、自我效能程度越高，其整體生活品質越好；年齡(r = - .154, p < .05)及收縮壓(r = - .188, p < .01)與生理構面的生活品質有顯著負相關，表示研究對象年齡越老、收縮壓數值越高，其生理構面的生活品質越差；(4)將生活品質設為依變項，將具有顯著差異或相關性之人口學資料與疾病特徵、疾病知識與自我效能設為自變項，進行逐步迴歸分析。研究結果顯示年齡、教育程度、就業情形、收縮壓、有自我監測血壓者、高血壓腎病變疾病知識及自我效能等七個變項對整體生活品質之總解釋變異量為32.8% (R2 = .328 p < .001)。其中自我效能為最重要之解釋因子，可單獨解釋變異量為12.8%( R2 change = .128, p < .001)。。結論：本研究證實年齡越老，高血壓腎病變患者疾病知識程度越低，疾病的自信心越差，生活品質越差，高血壓腎病變患者疾病知識程度越好，自我效能呈程度越好其整體生活品質越高。瞭解患者對於疾病知識程度，適時介入提升自我效能之相關性措施，進而提升生活品質。臨床實務運用：本研究結果可提供此未來想進行高血壓腎病變患者相關研究之文獻佐證，以及提供相關行政機構或醫療人員發展提升疾病知識及自我效能之介入方案，進而增進患者生活品質。[[abstract]]Background: As complex, irreversible chronic diseases with high prevalence in aging populations, hypertension and kidney disease threaten people's health and are health issues of global concern. Hypertension affects renal function, and the deterioration of renal function further affects the control of blood pressure, making the two inextricably related with each other. If hypertension is not properly controlled, it progresses to hypertensive nephropathy; therefore, it needs to be further explored whether patients’ knowledge and self-efficacy of the disease will affect their quality of life.Purpose: To investigate the relationship among disease knowledge, self-efficacy and quality of life in patients with hypertensive nephropathy.Method: A cross-sectional related research design was used to collect a total of 213 patients using convenience sampling in the outpatient department of nephrology of a teaching hospital in the north Taiwan. The research tools included the Scale for Knowledge of Hypertensive Nephropathy and the Chronic Kidney Disease Self-Efficacy Instrument (CKD-SE) and the Medical Outcome Study Short Form-12 (MOS SF-12). SPSS 20.0 statistical software was adopted for the descriptive statistics analysis, independent sample t test, one-way ANOVA, Pearson’s correlation analysis, stepwise regression analysis, and other statistical analyses.Results: This study made a number of findings. First, the disease knowledge of patients with hypertensive nephropathy was above average (77.75%), their self-efficacy was above average (71.94%), their overall quality of life was above average (73.49%), and the mental component summary (MCS) of life quality of patients with hypertensive nephropathy was better than the physical component summary (PCS) of life quality. Second, there was a statistically significant difference among education level, drinking habits, stages of chronic kidney disease, and the presence or absence of health education with disease knowledge. Education level, whether the patients were employed, living status, drinking habits, and owning a sphygmomanometer for the self-monitoring of blood pressure showed statistically significant differences regarding self-efficacy. There were also statistically significant differences between education level, whether the patients were employed, and whether they had their own sphygmomanometers for the self-monitoring of blood pressure with overall quality of life Third, age (r = - .154, p < .05) and systolic blood pressure (r = - .188, p < .01) were significantly negatively correlated with the physical component summary of life quality. In addition, disease knowledge (r = .297, p < .01) and self-efficacy (r = .495, p < .01) both had a significant positive correlation with overall life quality. And fourth, age, education level, whether the patients were employed, systolic blood pressure, owning a sphygmomanometer for the self-monitoring of blood pressure, knowledge of hypertension nephropathy, and self-efficacy were all important factors that could predict overall quality of life, with a total variance explained of 32.8% (p < .001), , where self-efficacy was the greatest predictor, which alone can explain the variation of 13% (R2 change = .130, p < .001).Conclusion: The results of this study showed that older patients with hypertensive nephropathy have a lower degree of disease knowledge, worse self-confidence regarding disease self-efficacy, and worse overall quality of life. Nursing staff should focus on assessing disease knowledge in elderly patients and intervene with relevant measures to promote self-efficacy in a timely manner to improve the patients’ overall quality of life. Clinical application: The results of this study could provide literature on future studies of patients with hypertensive nephropathy and facilitate medical personnel to develop intervention programs for the promotion of disease knowledge and self-efficacy, thereby improving the life quality of patients