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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 吳造中(Chau-Chung Wu) | |
dc.contributor.author | Nien-Lin Yang | en |
dc.contributor.author | 楊念霖 | zh_TW |
dc.date.accessioned | 2021-06-17T04:37:26Z | - |
dc.date.available | 2020-10-11 | |
dc.date.copyright | 2018-10-11 | |
dc.date.issued | 2018 | |
dc.date.submitted | 2018-08-08 | |
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dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/70759 | - |
dc.description.abstract | 背景: 因為醫療的全球化及文化的多元性已是現代醫學的趨勢,醫師跨文化的能力(Cultural Competence)成為當前醫師必須具備的重要能力,希望藉由醫師的跨文化溝通能力的培養,以減少不同族群間的健康分歧。 目的: 試圖了解金山地區的慢性病患所感受到醫師跨文化的能力(Cultural Competence)如何,並探討病人所感受的醫師跨文化能力會不會影響病人的醫療從性(Adherence),藉此釐清不同疾病種類下,病人感受的醫師跨文化能力與健康成效間的關係。 研究方法: 研究對象為台大醫院金山分院家醫科門診慢性病患,採立意取樣,使用「消費者對醫療服務提供者評價調查計畫(CAHPS®)文化能力項目集」問卷作為病人感受之醫師跨文化能力評估工具,翻譯為中文後,利用探索性因素分析(Exploratory factor analysis)分析問卷至構面效度,Cronbach's alpha計算內部一致性信度(Internal consistency reliability),並利用雙相變項及多變項分析,了解影響病人感受之醫師跨文化能力各構面的因素。醫療依從性的評估則利用藥物持有率(Medication Possession Ratio, MPR),計算過去一年中,金山家醫科門診慢性病患領取處方的總天數所佔的比例,作為連續變項代表病人的醫療依從性,並利用多變項線性迴歸,在控制各項干擾因子後,不同疾病診斷下,病人所感受之醫師跨文化能力之各構面與醫療依從性的關係。 結果: 收案200例,因填答不完整及門診追蹤不滿一年,僅158例接受分析。「消費者對醫療服務提供者評價調查計畫(CAHPS®)文化能力項目集」原問卷包含八個層面,因本次收案之個案並未包含外籍病患,因此將語言翻譯服務層面排除後,剩下的七個層面做探索式因素分析,最終得到五個有意義之新構面,分別為:1.醫病溝通-良好互信2.共享醫療決策3.醫病溝通-關懷4.平等的醫療5.醫病溝通-健康提升(Kaiser-Meyer-Olkin Measure of Sampling Adequacy:0.729, p-value:<0.001,Total Variance Explained Cumulative percentage:73.67%)。內部一致性信度Cronbach’s alpha分別是0.824、0.962、0.602、0.840、0.842,總內部一致性信度為0.786。影響高血壓病人感受醫師跨文化能力的因素包括:年齡、宗教信仰、教育程度、性別、月收入、出生地、母親國籍、父親民族、病人自覺疾病嚴重度及慣用語言;影響糖尿病病患感受醫師跨文化能力的因素包括:信仰佛教、教育程度、婚姻狀態、保險種類及月收入。多變項線性迴歸分析發現,高血壓病患所感受的醫師跨文化能力與醫療依從性並無顯著相關性,而糖尿病病患所感受之平等的醫療構面,與較好的醫療依從性相關(B=1.413,p=0.026,Adjusted R-square:0.13),在以上兩個多變項分析中,高血壓及糖尿病病患的自覺疾病嚴重度皆與病人之醫療依從性有正向關係(B=50.504,p=0.012及B=103.67,p=0.004)。 結論: 糖尿病病患所感受之平等的醫療跨文化能力構面確實與醫療依從性有正向關係,但其他醫師跨文化構面在兩類疾病中皆未達統計顯著性,日後應就不同疾病及不同跨文化能力之構面分別探討。 | zh_TW |
dc.description.abstract | Background: Cultural competence is an essential ability for health providers to reduce health disparities between different cultural groups. Because of globalization of health care and cultural diversity of the modern world, cultural competence become more important. Aim: To explore relationships between patient-perceived cultural competence and medication adherence in patients with chronic disease at the family medicine outpatient clinics of National Taiwan University Hospital Jinshan branch. To establish correlations between confounder factors and patient-perceived cultural competence in Jinshan area. Method: The data were collected between May 2018 and June 2018 at the family medicine clinics of National Taiwan University Hospital Jinshan branch. Patients with hypertension(HTN), diabetes mellitus(DM), hyperlipidemia and gout were included, and at least one-year follow-up at Jinshan hospital was required. The Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Cultural Competence (CC) Item Set was adopted to evaluate patient-perceived health provider cultural competence. Exploratory factor analysis was conducted to examine the construct validity, and internal consistency reliability of Chinese version of CAHPS® CC item set. Medication adherence was measured using Medication Possession Ratio (MPR). Relationships between confounder factors and patient-perceived health provider cultural competence, and relationships between patient-perceived health provider cultural competence and medication adherence were analyzed with multivariate linear regression. Result: 200 participants were enrolled and 158 participants were analyzed. Five factors were extracted to evaluate patient-perceived health provider cultural competence. These five main factors include: 1) Doctor communication-positive behaviors and trust, 2) Share decision making, 3) Doctor communication-concerned behaviors, 4) Equitable treatment, 5) Doctor communication-health promotion (Kaiser-Meyer-Olkin Measure of Sampling Adequacy: 0.729, p-value:< .001, Total Variance Explained Cumulative percentage: 73.67%). The Cronbach’s alpha of these five factors were 0.824, 0.962, 0.602, 0.840 and 0.842, the total Cronbach’s alpha was 0.786. The factors correlated with patient- perceived health provider cultural competence of HTN patients included age, religion, education, gender, income, birth place, language, mother’s nation, father’s ethnicity and patient-perceived disease severity. The factors correlated with patient-perceived health provider cultural competence of DM patients included religion, education, marital status, insurance type and income. The full model multivariate regression revealed no significant correlation between patient-perceived health provider cultural competence and medication adherence in HTN patients group, but positive effect was found between equitable treatment and medication adherence in DM patients group (B=1.413, p=0.026, Adjusted R-square: 0.13). In addition, patient-perceived disease severity had positive effect on medication adherence in both groups (B=50.504, p=0.012 in HTN group; B=103.67, p=0.004 in DM group). Conclusion: The patient equitable treatment of perceived health provider cultural competence had positive effect on medication adherence in DM patient group, but there was no significant correlation between patient-perceived health provider cultural competence in other factors and different diseases. Further study should include closer examination of these issues separately. | en |
dc.description.provenance | Made available in DSpace on 2021-06-17T04:37:26Z (GMT). No. of bitstreams: 1 ntu-107-R05457003-1.pdf: 3724444 bytes, checksum: ee123bd713669b1dc3192675e8c16348 (MD5) Previous issue date: 2018 | en |
dc.description.tableofcontents | 目 錄 口試委員會審定書……………………………………………………………..….i 誌謝………………………………………………………………………………..ii 中文摘要…………………………………………………………………………..iii 英文摘要…………………………………………………………………………..vi 第一章 研究問題……………………………………………………………..1 第二章 研究動機與目的……………………………………………………..1 第三章 文獻回顧……………………………………………………………..2 第一節 提倡醫師跨文化能力的緣起………………………………..……...2 第二節 跨文化能力的定義與架構………………………………………….5 第三節 醫師跨文化能力之評估…………………………………………...10 第四節 醫師之跨文化能力與病人之健康成效…………………………...14 第五節 醫療依從性………………………………………………………...17 第六節 疾病與醫療依從性………………………………………………...25 第七節 文化議題與醫療依從性…………………………………………...30 第四章 研究方法與計………………………………………………………..34 第一節 收案設定………………………………….………………..………34 第二節 收案對象…………………………………………………………...34 第三節 抽樣方法…………………………………………………………...35 第四節 樣本數……………………………………………………………...35 第五節 定義變項…………………………………………………………...36 第六節 統計分析…………………………………………………………...42 第五章 預期成果與獻………………………………………………………..44 第六章 研究結果……………………………………………………………..45 第一節 人口學分佈………………………………..…………………….....45 第二節 問卷信效度……………………………..……………………….....46 第三節 影響病人感受醫師跨文化能力的因素.…………………………..49 第四節 病人所感受的醫師跨文化能力與醫療依從性之相關性…….......53 第七章 結果討論……………………………………………………………..55 第一節 影響病人感受的醫師跨文化能力之因素………………………...55 第二節 病人所感受的醫師跨文化能力與醫療依從性之相關性………...59 第八章 研究限制……………………………………………………………..60 第一節 場域限制…………………………………………………………...60 第二節 統計限制…………………………………………………………...60 第三節 測量工具的限制…………………………………………………...61 第九章 結論…………………………………………………………………..62 參考文獻…………………………………………………………………….……64 表目錄……………………………………………………………………………..73 表一 各疾病人數…………………………………………………………...73 表二 各疾病人口學分佈…………………………………………………...73 表三 問卷探索性因素分析………………………………………………...77 表四 影響高血壓病患感受醫師跨文化能力之變項(簡單線性回歸)...78 表五 影響高血壓病患感受各構面醫師跨文化能力之因素(多變項線性回歸)……………………………………………………………………….83 表六 影響糖尿病病患感受醫師跨文化能力之變項(簡單線性回歸)...88 表七 影響糖尿病病患感受各構面醫師跨文化能力之因素(多變項線性回歸)……………………………………………………………………….93 表八 高血壓病患感受之醫師跨文化能力及各項干擾因子與醫療依從性之相關性(Spearman's and Pearson’s Correlation Coefficient)………….97 表九 高血壓病患感受之醫師跨文化能力及各項干擾因子與醫療依從性之關係(多變項線性迴歸)……………………………………………….98 表十 糖尿病病患感受之醫師跨文化能力及各項干擾因子與醫療依從性之相關性(Spearman's and Pearson’s Correlation Coefficient)………….99 表十一 糖尿病病患感受之醫師跨文化能力及各項干擾因子與醫療依從性之關係(多變項線性迴歸)…………………………………………...100 | |
dc.language.iso | zh-TW | |
dc.title | 病人所感受的醫師跨文化能力與醫療依從性的關係 | zh_TW |
dc.title | The Association between Patient Perceived Cultural Competence of Physicians and Medication Adherence. | en |
dc.type | Thesis | |
dc.date.schoolyear | 106-2 | |
dc.description.degree | 碩士 | |
dc.contributor.oralexamcommittee | 陳彥元(Yen-Yuan Chen),陳慧玲(Huey-Ling Chen) | |
dc.subject.keyword | 文化差異,健康分歧,健康成效,文化能力,跨文化溝通,醫療依從性, | zh_TW |
dc.subject.keyword | Cultural difference,health disparities,health outcome,cultural competence,cross-cultural communication,medical adherence., | en |
dc.relation.page | 100 | |
dc.identifier.doi | 10.6342/NTU201802630 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2018-08-08 | |
dc.contributor.author-college | 醫學院 | zh_TW |
dc.contributor.author-dept | 醫學教育暨生醫倫理研究所 | zh_TW |
顯示於系所單位: | 醫學教育暨生醫倫理學科所 |
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