慢性病患者之自我監控覺察、健康焦慮、疾病監控/控制與身心變動的關係

Abstract

研究目的：為探究慢性病患者疾病自我調適歷程中個體特質、認知因素及疾病自我調適的關係，本研究目的包括:1.探討疾病客觀訊息與個體一般性自我監控覺察特質交互作用時，對患者的疾病認知監控與控制的影響；2.驗證疾病背景訊息、特質變項中之一般性自我監控覺察與健康焦慮，疾病監控與疾病控制認知因素與疾病後身心變化的關係。並先以前行研究確定慢性病患者在疾病監控與疾病控制判斷中所涵括的認知因素，接著在研究中再進行對研究假設的驗證，以及結果的討論。

研究方法：邀請233名慢性病患者(平均年齡為61.03)填寫完成基本資料調查表、疾病現況調查表、自我監控覺察量表、疾病監控覺察與知覺疾病控制量表、健康焦慮量表與疾病後身心變化量表。定期客觀測量與一般性自我監控覺察的差異對疾病監控與疾病控制的影響使用多變量分析(MANOVA)，一般性自我監控覺察、疾病監控、疾病控制、健康焦慮對疾病後身心變化的影響，以及健康焦慮可能在疾病監控、疾病控制與疾病後身心變化之間的干擾，則進行階層迴歸分析。

研究結果：(1)定期客觀測量與一般性自我監控覺察的差異僅在疾病監控中症狀監控的覺察確認身體症狀有交互作用效果，在其餘的認知因素中僅有主要效果。(2)慢性病患者覺察確認身體症狀越多、依賴外在訊息監控越少、自行調藥處置越多、飲食與生活控制越多、從事健康行為越少並擔憂健康與疾病傾向越高，越會預測到較大的疾病後身心變化。(3)健康焦慮傾向分別在被動求醫動機、自行調藥處置、調整心情想法、知覺內在限制或知覺外在限制與疾病後身心變化之間有正向中介作用效果。

研究討論：(1)定期客觀測量與一般性自我監控覺察雖然只在覺察確認身體症狀上有交互作用效果，但有測量血壓/血糖、自我監控覺察較高的個體，在疾病監控與疾病控制正向判斷上仍有較高的表現，定期客觀測量與一般性自我監控覺察的差異仍對疾病監控與疾病控制有影響。(2)自我照護策略越少，個體越可能知覺到越多疾病後身心變化的困擾，須考慮適當合宜的監控與控制才能增進疾病自我調適。(3)疾病監控與疾病控制的認知判斷會受到健康焦慮傾向的干擾而影響疾病後身心變化，探討個體認知因素在疾病自我調適中的影響性，擔憂健康與疾病的焦慮傾向在其中的負向影響值得進一步討論。Aim: For trying to discover the relationship among chronic patients’ trait factors, cognitive factors and self-regulation of illness, our research purposes were: 1. To test the interaction effect between illness objective messages and self-monitoring awareness may impact the cognitive illness monitoring and illness control variables. 2. The research frame and hypotheses were established by purpose and paper review, and the relationship of disease background factors , self-monitoring awareness, health anxiety, illness monitoring/ control and life change was examined. A pilot study was accomplished to ensure the cognitive factors in illness monitoring/ control among chronic patients, results were examined with discussion.

Method: 233 chronic patients (age=61.03) completed demographic data, illness-related information questionnaire, Self-monitoring Awareness Questionnaire, Illness Monitoring/ Control Awareness Questionnaire, Health Anxiety Questionnaire (HAQ), and Life Change Questionnaire. Effect of interaction between illness objective message and self-monitoring awareness on illness monitoring/ control was examined by MANOVA. The prediction of life change by self-monitoring, health anxiety, illness monitoring/ control and the mediating effect of health anxiety between illness monitoring/ control and life change were examined by hierarchical regression.

Results: (1) Interaction effect between illness objective message and self-monitoring awareness was showed on body message awareness, and the main effects were showed on the other cognitive factors. (2)The more body message awareness, irregular medication, life and diet control and the lesser objective message monitoring, health behavior patient has, the greater life change is. (3)The mediating effect of health anxiety was showed between each of cognitive variables(includingpassive seeking help, irregular medication, emotion adjustment, internal constraint perception, or external constraint perception) and life change.

Discussion: (1) The interaction effect between illness objective message and self-monitoring awareness was showed on body message awareness, but patient who has more objective message and higher self-monitoring awareness still has higher illness monitoring/ control performance. (2)The lesser self-care strategies patient has, the greater life change is, and patient needs to consider appropriate monitoring and control in order to promote self-regulation of illness. (3) Cognitive judgments of illness monitoring/ control were mediated by health anxiety to impact life change, and the effect of health and illness worry of health anxiety was discussed.