慢性B或C型肝炎病患之疾病相關烙印與自我照顧效能之相關性探討

許馥郁

doi:10.6342/NTU201603556

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慢性B或C型肝炎病患之疾病相关烙印与自我照顾效能之相关性探讨

Chronic Hepatitis-related Stigma and Self-care Efficacy in Patients with Chronic Hepatitis B or C Infection

许馥郁 , 硕士　　导师：孙秀卿　　

繁体中文 DOI： 10.6342/NTU201603556

慢性肝炎；烙印；自我照顾；自我效能；人格特质；症状； Chronic hepatitis, Stigma ； Self-care ； Self-efficacy ； Personality ； Symptom

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摘要 │ 参考文献 (197) │ 国际计量

摘要〈TOP〉

慢性B及C型肝炎是台湾高盛行率的肝脏疾病，并且是肝硬化、肝癌、肝衰竭的高危险群。虽然近年慢性B及C型肝炎的治疗有很大的进步，但是仍有许多病患未接受治疗，加上治疗效果不易预期，多数病患仍需长期与肝炎病毒共处，因此，病患的自我照顾(self-care)角色日显重要，其强调以个人为中心，使病患能够自我掌控疾病，避免疾病进展及维护生活品质，而自我效能(self-efficacy)已被证实是影响自我照顾行为的重要因素。此外，病患除了需要面对疾病带来身体的改变，还需因应疾病的传染性和对生命的威胁而造成的烙印(stigma)感受，然而国内尚未有烙印及自我照顾效能的相关研究。因此，本研究探讨慢性肝炎病患的烙印与自我照顾效能现况，并探讨影响烙印及自我照顾效能的相关因素，研究目的为：(1) 了解慢性肝炎病患疾病相关烙印之现况；(2) 了解慢性肝炎病患人口学特质及疾病特性、疾病症状、人格特质与慢性肝炎相关烙印的相关性；(3) 了解慢性肝炎病患自我照顾效能之现况；(4) 了解慢性肝炎病患人口学特质及疾病特性、疾病症状、人格特质、慢性肝炎相关烙印与自我照顾效能的相关性，并探讨自我照顾效能的显着相关因素。
本研究为横断式相关性研究，采立意取样及结构性问卷方式於台北某两家医学中心肝胆肠胃科门诊、云林某一区域医院肝胆肠胃科门诊、彰化某两家乡镇卫生所及肝病防治基金会104年7月於桃园举办的筛检活动进行收案，收案对象为慢性B或C型肝炎、无肝癌或肝硬化、目前未进行标准抗病毒治疗之病患，研究工具包含个人基本属性问卷、肝脏疾病症状量表、慢性肝炎病毒感染者烙印量表、台湾版D型人格量表、慢性肝炎自我照顾效能量表进行资料收集。研究资料以描述性统计，包括平均值、标准差、百分比、排序等方式描述各变项的分布状况、平均得分；以推论性统计，包括单变数及多元逻辑斯回归分析研究变项的相关性，共收案207位，平均年龄为56.4岁。研究结果显示：(1) 慢性肝炎病患的烙印感受程度偏低，然而在保密病情及负向自我评价面向的烙印程度较高；(2) 慢性肝炎相关烙印与输血感染、疾病症状(症状严重度及症状困扰)、D型人格(负向情绪及社交压抑)有显着正相关；(3) 慢性肝炎病患的自我照顾效能普遍良好，然而在日常保健(包括症状监控、规律运动、良好生活作息及均衡饮食)的面向较差；(4) 自我照顾效能与婚姻、抽菸史有显着相关，与疾病症状(症状严重度及症状困扰)、慢性肝炎相关烙印有显着负相关；在调整相关因素後，以多元逻辑斯回归分析发现婚姻、抽烟史、症状严重度及慢性肝炎相关烙印是自我照顾效能的显着解释因素。
藉由研究结果建议如下：(1) 慢性肝炎病患的烙印感受多源於害怕公开病情及负向自我评价，临床医护人员在照护慢性肝炎病患时，可给予卫教及心理谘商，提升慢性肝炎病患的正向经验及建立疾病的正面形象，倾听并协助改善病患的症状困扰，并进一步筛检有D型人格特质的病患，加强其卫教及心理支持，以减少烙印对病患生心理的影响；(2) 慢性肝炎病患普遍缺乏对日常保健的信心，针对日常保健对健康的益处需加强宣导；(3)临床照护上除了鼓励病患接受治疗以改善疾病症状，减少病患的烙印感受有助於增加自我照顾效能、促进病患自我照顾能力；(4) 虽然D型人格在本研究中无法显着解释自我照顾效能，但有将近30%的慢性肝炎病患拥有此人格特质，并且与烙印、自我照顾效能等心理健康有显着相关，D型人格已知与健康行为及特定疾病预後有关，在慢性肝炎病患的影响则值得更多研究。研究结果可帮助未来降低慢性肝炎相关烙印、提升病患自我照顾效能的相关临床照护、护理教育及护理研究。

关键字：慢性肝炎、烙印、自我照顾、自我效能、人格特质、症状

并列摘要〈TOP〉

Chronic hepatitis B and C are common in Taiwan and also the leading cause of liver cirrhosis, hepatocellular carcinoma and liver failure. Although effective therapies have recently emerged for the disease, not all patients receive treatment and the outcome is not always successful. As the majority of patients have to live with a long-term condition, the role of self-care which focuses on indivisual-centered is increasingly critical for them to manage disease, prevent disease progression and have better quality of life. Self-efficacy is believed to have a great impact on self-care behavior. In addition to manage physical change of chronic illness, patients living with hepatitis also cope with perception of stigma due to infectious and fatal of the disease. However, no study regarding hepatitis-related stigma or self-care efficacy has been carried out in Taiwan. The current study attempted to explore the current status of hepatitis-related stigma and self-care efficacy and their association factors in a group of chronic hepatitis B or C. The purposes of this study were to: (1)explore the status of hepatitis-related stigma among chronic hepatitis patients; (2) explore the relationships among demographic and disease-related, liver disease symptoms, personality factors and hepatitis-related stigma; (3) explore the status of self-care efficacy among chronic hepatitis patients; and(4) understand the demographic and disease-related, liver disease symptoms, personality and hepatitis-related stigma factors associated with self-care efficacy and explore significant explanatory factors.
We conducted a cross-sectional, structured questionnaire survey with purposive sampling to recruit eligible participants from outpatient settings in six sites, including three gastroenterology departments of two medical centers and a free hepatitis screening activity held in July 2015 in northern Taiwan, one metropolitan hospital and two public health centers in southern Taiwan. The inclusion criteria were chronic hepatitis B or C patients and who still receiving standard antiviral therapy or suffering from liver cirrhosis or liver cancer were excluded. Research materials included demographic and disease-related information, liver disease symptoms and distress assessed with the Liver Disease Symptom Index 2.0, personality assessed by the Type D scale-14 Taiwanese version-revised, hepatitis-related stigma assessed with the Stigma Scale of Chronic Hepatitis Patients, self-care efficacy measured with the Self-care Efficacy Scale of chronic hepatitis patients. Data were analyzed by descriptive statistics and logistic regression methods. A total of 207 patients in this study and average age was 56.4. The results indicated that: (1) The overall mean scores of hepatitis-related stigma favored a lower perception, however, the degree of nondisclosure and negative self-estimation were relative high; (2) The factors of transfusion etiology, liver disease symptoms (include symptom severity and symptom distress) and type D personality (include negative affection and social inhibition) were associated with stigma degree; (3) The overall mean score of self-care efficacy was around the high-level, but the degree of health-care efficacy (include exercise, diet, regular lifestyle and self-monitor symptoms) was relative low; (4) The factors of marital status, smoking history,liver disease symptoms (include symptom severity and symptom distress), type D personality (include negative affection and social inhibition) and hepatitis-related stigma were associated with self-care efficacy degree. After adjusted association factors with multiple logistic regression, marital status, smoking history, symptom severity and hepatitis-related stigma were significant determinants of self-care efficacy.
In conclusion and suggestion: (1) the perception of hepatitis-related stigma centralize on the level of nondisclosure and negative self-estimation. The care for chronic hepatitis could focus on promotion of positive experience and image of disease, listening and assist patients to cope with symptom distresses with education and psychological consultation. And screening of type D personality among patients to reinforce education and give mental support for them could help to reduce negative impact of physical and mental health by stigma; (2) The level of confidence with health-care needs to be enhanced by reinforcing its benefits; (3) In addition to improve disease symptoms by encouraging patients to accept treatment, help patients to reduce perception of hepatitis-related stigma are beneficial to enhance self-care efficacy and self-care ability. (4) Although type D personality not significantly explained the study outcome variables after adjusting other factors, nearly 30 percent of patients had this personality and associated with psychological variables such as stigma and self-care efficacy in the current study. As type D personality is suggested to impair health behavior and health outcomes with specific disease, more studies need to be carried out in this particular group. This study provides valuable information about hepatitis-related stigma and self-care efficacy and it is helpful in clinical care, education and future research in nursing.

Key words：Chronic hepatitis, Stigma, Self-care, Self-efficacy, Personality, Symptom.

参考文献 ( 197 ) 〈TOP〉

Aljasem, L. I., Peyrot, M., Wissow, L., & Rubin, R. R. (2001). The impact of barriers and self-efficacy on self-care behaviors in type 2 diabetes. The Diabetes Educator, 27(3), 393-404.
连结：
Amy Janke, E., McGraw, S., Garcia-Tsao, G., & Fraenkel, L. (2008). Psychosocial Issues in Hepatitis C: A Qualitative Analysis. Psychosomatics, 49(6), 494-501. doi: http://dx.doi.org/10.1176/appi.psy.49.6.494
连结：
Balfour, L., Cooper, C., Kowal, J., Tasca, G. A., Silverman, A., Kane, M., & Garber, G. (2006). Depression and cigarette smoking independently relate to reduced health-related quality of life among Canadians living with hepatitis C. Canadian Journal of Gastroenterology, 20(2), 81.
连结：
Bandura, A. (1977). Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev, 84(2), 191-215.
连结：
Barkhuizen, A., Rosen, H. R., Wolf, S., Flora, K., Benner, K., & Bennett, R. M. (1999). Musculoskeletal pain and fatigue are associated with chronic hepatitis C. The American journal of gastroenterology, 94(5), 1355-1360.
连结：

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