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| 題名: | 臺灣乳癌病人健康識能研究－疾病別健康識能工具之發展與初探(含治療之心臟毒性影響)
Health Literacy Assessment in Taiwanese Breast Cancer Patients-Development of Disease-Specific Assessment Tools with Special Emphasis on Treatment-Related Cardiotoxicity |
| 作者: | 徐綵娟
HSU, TSAI-CHUAN |
| 貢獻者: | 醫務管理學系碩士班
邱瓊萱 |
| 關鍵詞: | 乳癌;心臟毒性;健康識能;工具發展;Nutbeam
Breast Cancer, Cardiotoxicity, Health Literacy, Quesstionnaire, Nutbeam |
| 日期: | 2023-07-19 |
| 上傳時間: | 2023-12-11 13:21:35 (UTC+8) |
| 摘要: | 背景：近年來乳癌發生率攀升並且是女性最常發生的癌症，全球有超過226萬例乳癌新發病例及超過68萬死亡病例，根據調查HDI指數越高的國家，其乳癌發生率越高、死亡率越低，2019年主計處公告台灣指數已超過0.9，屬於高HDI國家，同年的乳癌發生率較前一年高出5%。在疾病發生率較高的情況下，對病症認識程度、副作用發生機率及資訊的判斷極度重要，過去外國學者Nutbeam表示：健康識能有功能性、溝通性及批判性三個構面，好的識能可以做到對訊息的批判及應用。研究也顯示具備足夠識能能力的患者對自身生理狀態、療程及癒後情況都較識能不足的患者良好。因此想以Nutbeam學者的理論作為核心發展問卷工具量測臺灣乳癌患者對疾病和副作用等認識程度。
目的：發展乳癌健康識能量測工具，並了解乳癌患者對疾病的識能及知識程度
方法：本研究參考文獻設計健康識能及知識題目，在重大副作用－心臟毒性部分透過檢驗左心室射出率(Left Ventricular Ejection Fraction)並使用MD Anderson授權問卷Symptom Inventory for heart failure (MDASI)及Brief Fatigue Inventory (BFI)了解患者近期生理狀態。採立意取樣，請醫院個管師協尋符合條件經同意後以一對一方式填答問卷，並於收案完成後以統計軟體SAS 9.4及SPSS 19分析結果
結果：問卷工具使用KR20分析健康識能及健康知識整體信度0.637、0.655；教育程度與健康識能、知識分數有差異(p<0.0001, 0.032)，其中大學與高中職程度對識能分數有明顯差異。
結論：雖然年齡部分在統計分析沒有顯著差異，但是收案過程發現年齡較大的患者對於長篇閱讀的題目填寫速度較慢且錯誤率相對較高；大學和高中職教育程度的差異體現在識能分數上。值得一提的是，由於收案對象為即將進行第一次化療的病人，因此在心毒性相關症狀的分數並沒有衰竭現象，未來在病患開始化療之後，可以進行相關識能與知識的介入，以提升病患對疾病的認知以及自我照護意識的提升。
Background: In recent years, the incidence of breast cancer has been increasing and it is the most common cancer among women. Globally, there are over 2.26 million new cases of breast cancer and over 680,000 deaths reported. According to surveys, countries with higher Human Development Index (HDI) tend to have higher breast cancer incidence but lower mortality rates. In 2019, Taiwan's HDI index exceeded 0.9, categorizing it as a high HDI country. In the same year, the breast cancer incidence rate increased by 5% compared to the previous year, indicating a higher prevalence of the disease.In the context of a high disease occurrence, it is crucial to have a good understanding of the condition, the likelihood of side effects, and the ability to judge information accurately. Nutbeam, a renowned scholar, proposed that health literacy consists of three dimensions: functional, communicative, and critical. Good health literacy enables individuals to critically evaluate and apply information. Studies have shown that patients with sufficient health literacy are better equipped to understand their physiological condition, treatment options, and post-recovery situations compared to those with lower health literacy levels.Therefore, it is proposed to develop a questionnaire tool based on Nutbeam's theoretical framework to assess the level of disease and side effects awareness among breast cancer patients in Taiwan.
Objective: Developing a measurement tool for breast cancer health literacy and assessing the level of disease understanding and knowledge among breast cancer patients.
Method: This study referenced literature to design health literacy and knowledge-related questions. In the section regarding major side effects - cardiac toxicity, left ventricular ejection fraction (LVEF) was assessed, and the MD Anderson Symptom Inventory for heart failure (MDASI) and the Brief Fatigue Inventory (BFI) were utilized to understand patients' recent physiological status. Purposive sampling was employed, and asked hospital case managers for help to identify eligible breast cancer who met the criteria and obtain their consent for individualized questionnaire completion. The data were analyzed using statistical software SAS 9.4 and SPSS 19 after the completion of data collection.
Results: The questionnaire tools were analyzed using KR20 to assess the overall reliability of health literacy and health knowledge, yielding reliability coefficients of 0.637 and 0.655, respectively. There were significant differences observed between education level and health literacy and knowledge scores (p < 0.0001, 0.032). Specifically, individuals with a university education exhibited notable differences in their literacy scores compared to those with a high school or vocational education.
Conclusion: Although there were no significant differences in age during statistical analysis, it was observed during the enrollment process that older patients had slower completion speeds and relatively higher error rates when it came to long reading comprehension questions. The differences between individuals with a university education and those with a high school or vocational education were reflected in their health literacy scores. It is worth noting that since the enrolled participants were about to undergo their first chemotherapy session, there were no signs of cardiac-related symptoms decline in the scores. In the future, interventions related to health literacy and knowledge can be implemented after patients start chemotherapy to enhance their disease awareness and promote self-care consciousness. |
| 描述: | 碩士
指導教授:邱瓊萱
委員:石崇良
委員:趙祖怡
委員:邱瓊萱 |
| 資料類型: | thesis |
| 顯示於類別: | [醫務管理學系暨研究所] 博碩士論文
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