心臟衰竭病人對飲食控制知識、自我效能、遵從障礙與飲食控制行為之相關性探討

Abstract

心臟衰竭是許多心臟病之共同結局，是非常普遍的一種慢性、嚴重、需長時間治療之複合性症狀，影響病人的身體、心理及社交功能，使住院頻繁且增加社會及醫療成本，在導致頻繁的住院原因中，以對飲食控制處方的不遵從為最主要，近年來，國內外對於心臟衰竭之飲食控制研究，多包含於病人的自我照顧及遵從行為中，研究顯示病人對飲食控制的表現不理想，且心臟衰竭病人對飲食控制之知識程度與遵從行為間的相關性並不一致，由於資料的取得只能來自病人的自我報告（self-reports），使得無法確實評估病人飲食控制遵從行為，故本研究利用心臟衰竭飲食控制行為、飲食控制知識、飲食控制自我效能及自覺飲食控制障礙等量表收集主觀資料，並利用客觀工具測試病人實際的鹹口味，以探討知識與遵從行為之間的相關性，並找出真正影響飲食控制遵從行為的主因，以期對日後心臟衰竭病人的臨床照護有幫助。 本研究為描述相關性研究，採橫斷式（cross-sectional）量表及鹹口味測量法，於北部某一醫學中心心臟內科門診與一般病房，以立意取樣方式對心臟衰竭病人進行收案，訪談人數98位，以SPSS for windows 16.0及IBM SPSS statistics 19套裝軟體，分析病人的人口學特性、臨床相關特性、飲食控制遵從行為、飲食控制知識、自我效能、自覺遵從障礙程度與飲食口味。 研究結果發現：（1）教育程度、居家飲食狀況及受教導者為飲食控制知識的主要預測因子。（2）居家飲食狀況及對飲食控制知識了解程度為飲食控制行為自我效能的主要預測因子。（3）居家飲食狀況為自覺飲食控制障礙的主要預測因子。（4）飲食控制知識與飲食控制行為呈正相關（r = 0.32，p＜.01 ），顯示飲食控制知識越好時，飲食控制的行為也越好；飲食行為自我效能與飲食控制行為呈正相關（r = 0.56，p＜.001 ），顯示飲食控制行為的自我效能越好則飲食控制的行為越好；自覺飲食控制的障礙與飲食控制行為呈負相關（r = -0.24，p＜.05 ），顯示自覺飲食控制的障礙程度越高，飲食控制行為越差；而飲食控制行為的自我效能、是否接受個案管理及涉獵疾病相關飲食控制知識興趣程度為飲食控制行為的主要預測因子。（5）心臟衰竭嚴重度/美國紐約心臟協會心臟功能分級（New York Heart Association Functional class, NYHA Fc）及自覺飲食控制的障礙可有效預測飲食鹹口味，即心臟衰竭嚴重度/NYHA Fc為重度者及自覺飲食控制障礙程度低者的飲食鹹口味較低。

Heart failure is the end stage of many heart diseases. It is a serious chronic and long-term condition. It affects physical, psychological and social function. Patients may have frequent hospital admission, which increases medical expenditure. A major factor that precipitates hospitalization for heart failure is non-adherence with sodium and/or fluid restriction. Recent domestic and foreign studies on heart failure patients that focused on diet control, revealed that most patients do not adhere well to diet control regimens. Previous research revealed an inconsistency between the knowledge level and diet control behavior. Clinicians also have difficulty assessing adherence objectively so they depend on patients’ self-reports. Knowledge of the major determinants of diet-control behavior is important for clinicians to take good care of heart failure patients. This study used a heart-failure diet-control behavior and knowledge questionnaire, a dietary control self-efficacy scale, and subjects perceived barriers to following a diet control regimen to obtains subjective data, and also create objective parameters to evaluate patient’s preferences. A cross-sectional study was designed and 98 subjects were recruited in a medical center in northern Taiwan using purposive sampling. Data were collected using a questionnaire with face-to-face interview. In addition, salty turnip soup with five different levels of salt was used to test patient’s taste perception. SPSS version 16.0 and IBM SPSS statistics 19 was used for data analysis. Descriptive statistic pearson-product moment correlation, multiple regression, logistic regression were completed. The results showed that : (1) Educational level, dietary condition and the person who received the instructions were the main predictors of the diet control knowledge. (2) Diet preparing condition and level of knowledge about diet control were the main predictors of self-efficacy in diet control behavior. (3) Diet preparing condition was main predictor of the perceived barriers of following a diet control regimen. (4) There was a positive correlation between diet control knowledge and diet control behavior (r = 0.32, p <.01), and patients who had a higher score in diet control knowledge, showed better diet control behavior. There was a positive correlation between self-efficacy in diet control behavior and the diet control behavior (r = 0.56, p <.001); the higher self-efficacy in diet control behavior, the better the subject was able to control his diet. There was a negative correlation between the perceived barriers of following a diet control regimen and diet control behavior (r = -0.24, p <.05), the higher the perceived barriers in diet control, the worse the diet control behavior. Self-efficacy in diet control behavior and receiving care from case manager and interested to searched for diet control knowledge were the main predictors of diet control behavior. (5) heart failure severity/ New York Heart Association ( NYHA) Functional classification and the perceived barriers of following a diet control regimen may predict the patients’ dietary salt taste effectively. Patients with severe heart failure according to the NYHA functional classification may consume lower level of salt in their diet.