尿失禁婦女求醫行為意向及其影響因素

Abstract

【目的】 本研究探討尿失禁婦女的求醫行為意向及其影響因素，研究架構係以常識模式理論(Common Sense Model, CSM)為基礎，再根據文獻推導增加若干重要變項，以瞭解尿失禁婦女求醫行為意向的影響因素以及其間的機制。 【方法】 本研究以年滿20歲，有應力性、急迫性或混合性尿失禁的社區女性為研究對象。以便利抽樣方式取得334個有效樣本。資料的取得採問卷調查，所得量化資料主要以多項式logistic迴歸 (multinominal logistic regression )分析進行假設驗證。 【結果】 本研究主要研究結論歸結如下： 一、尿失禁婦女中，40.1%有求醫行為意向；其中看中西醫(38.8%)的行為意向比例相近於看西醫(37.3%)的，看中醫行為意向的比例則是23.8%；此可呼應國內多位學者表示民眾有複向求醫的傾向。 二、以常識模式理論解釋尿失禁婦女求醫行為意向是適當的，即疾病心理表徵是求醫行為意向的重要影響因素，當婦女越確認尿失禁是生病現象、尿失禁會帶來嚴重影響、治療可以控制尿失禁，則越有求醫行為意向；而越認為尿失禁是慢性者，越沒有求醫行為意向。此結論與先前許多學者的研究結果是一致的。 三、影響尿失禁婦女求醫行為意向的因素中，以治療的可控性認知對看西醫和看中醫的影響程度最具一致性，皆呈現顯著正向的影響關係，表示婦女對治療可以控制尿失禁的認知是婦女建立求醫行為意向的重要關鍵；可見由影響婦女對尿失禁治療的認識來引導婦女求醫行為應是具體可行的途徑。 四、尿失禁種類和嚴重度對求醫行為意向沒有直接或間接的影響。而不可忽略的是有近半數重度尿失禁婦女沒有求醫行為意向。 五、本研究提出之新命題獲得證實，即尿失禁衝擊對求醫行為意向沒有直接的影響，是透過疾病心理表徵中確認疾病認知、治療可控性認知、病程認知，以及求醫鼓勵中的家人鼓勵而間接影響看西醫或中西醫的行為意向。可藉由改變婦女對尿失禁的疾病心理表徵，以及推動家人鼓勵來改變婦女的行為。 六、家人曾鼓勵求醫是尿失禁婦女看西醫和中西醫行為意向的重要影響因素，顯示出在東方文化強調家人凝聚氛圍下，家人鼓勵求醫在尿失禁婦女求醫行為意向上是具有舉足輕重的影響。 七、對尿失禁婦女求醫行為意向的機制之具體發現是：在控制年齡、教育程度和因應尿失禁的有效性後，尿失禁種類和嚴重度對求醫行為意向沒有直接或間接的影響，而尿失禁衝擊是透過疾病心理表徵中確認疾病認知、治療可控性認知、病程認知，以及求醫鼓勵中的家人鼓勵間接影響看西醫或中西醫的行為意向。 八、在疾病心理表徵方面，婦女「同意」尿失禁是生病現象、是個人和治療可以控制的、是可以理解的以及是慢性的；「不同意」尿失禁會有嚴重的後果影響、會造成情緒認知困擾、是反覆性的。在原因認知方面，比起外因造成尿失禁，婦女同意是由愈多內因造成尿失禁。

【Purpose】 This research is to investigate the factors influencing intention of treatment seeking among women with urinary incontinence. In order to comprehend the influential causes and mechanism behind such type of women, the framework of this study is based on common sense model as well as some important variables according to the deduction of the literature. 【Methods】 Participants are community women who are more than 20 years old in conjunction with stress, urge or mixed urinary incontinence. There are 334 valid samples recruited through convenient sampling. Data corrected by structured questionnaire investigation. The quantitative data is primarily analysis by multinominal logistic regression. 【Conclusions】 The results of this research given as following: 1. Among the women, 40.1% of them have the intention of treatment seeking; the proportion 38.8% to seek both Chinese and western medical treatment is close to that 37.7% to seek simply western medical treatment. Seeking simply Chinese medical treatment is at the proportion of 23.8%. Hence this result is congruent with the scholars’ attention to the tendency of the people to harmonize Chinese and western medical treatment. 2.While it is appropriate to assist the intention of treatment seeking among women with urinary incontinence based on common sense model, the important factors to influence them is illness representation. When women perceived that urinary incontinence is an illness, may cause serious consequence, treatment controllable, the more they have intention to seek medical treatment. On the contrary, if they perceived urinary incontinence is chronic, then there is less intention to seek medical treatment. This result is congruence with scholars who concluded earlier. 3.The factor to influence women to seek either Chinese or western medical treatment is the recognition of the effect of treatment control. Hence the recognition by itself is pivotal, therefore this is a practical approach to construct the knowledge of treatment in order guide them. 4.There is no direct or indirect influence between either variety or severity of urinary incontinence, and the intention to seek medical treatment. It can’t be neglected that nearly half of the women who have serious urinary incontinence have no intention to seek medical treatment. 5.The new theory proposed by this study is verified. The impact of urinary incontinence doesn’t influence the intention to seek medical treatment directly, but only through the recognition of illness, the controllability of treatment, timeline and the encouragement of family members. To change woman’s behaviors is possible by constructing illness representation and the encouragement of family members. 6.It shows a heavy weight for family members to encouragement the woman to seek medical treatment under the milieu of oriental culture background. 7.Under controlling age, education and effective of coping strategies, the mechanism of women with urinary incontinence who is intention to seek medical treatment is that there is no direct or indirect influence between either variety or severity of urinary incontinence, and the impact of urinary incontinence doesn’t influence the intention to seek medical treatment directly, but only through the recognition of illness, the controllability of treatment, timeline and the encouragement of family members. 8.With respect to the illness representation, women agree that urinary incontinence is an illness, may be controlled by individual and treatment, comprehensible and chronic. They disagree that it is recyclical, may cause serious consequence and emotional disturbance. They tend to consent that internal factors are more influential than external causes.