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標題: | 在醫院進行簡短心理介入以減少重複自傷的可行性:病人感受之質性研究 The feasibility of a brief psychological intervention to reduce self-harm repetition at hospital: a qualitative study of patients' perceptions. |
作者: | Yi-Chun Chen 陳怡君 |
指導教授: | 張書森(Shu-Sen Chang) |
關鍵字: | 自我傷害,可行性研究,質性研究,訪談研究,行為介入,簡短介入, self-harm,feasibility study,qualitative study,interview study,psychological intervention,brief intervention, |
出版年 : | 2018 |
學位: | 碩士 |
摘要: | 背景與目的
自殺與自我傷害是全球重要公共衛生議題。自我傷害者之後死於自殺的風險約是一般人口的數十倍,但過去十年來自我傷害之後重複自傷的發生率並沒有下降,顯示急切需要有實證支持的介入方式,以減少自我傷害者之後重複自傷的風險。急診室提供了進行自殺防治介入的機會,因為它是許多自傷者首次接觸醫療服務的場域,然而,以往的介入方式大多需要大量人力資源與時間成本,不利於在急性場域進行。近來有國外學者基於心理學理論,發展出簡短心理介入──「自助技巧清單」,有助於形成行為改變的執行意圖,有初步證據顯示可以降低重複自我傷害的發生。本研究目的為發展中文化的「自助技巧清單」,並了解自傷病人使用此介入工具的經驗。 研究方法 本研究採用質性研究設計,招募14位來自精神科門診與病房的自傷病患,透過半結構式深度訪談,探索其過去的自傷經驗與其它因應方式。研究者初步將「自助技巧清單」翻譯為中文,並經過反譯(back translation),以確保翻譯的正確性。在訪談中,研究者提供網頁版以及紙本版中文「自助技巧清單」,請受訪者分享操作的經驗、感受與建議。訪談過程皆以錄音方式記錄,並謄寫成逐字稿,運用架構式分析法,在動態的分析過程中形成框架,並呈現與詮釋文本資料的意義。 研究結果 受訪者的平均受訪時間為60分鐘,女性9人,男性5人,以20-29歲的年輕族群最多(n=8),且大都位於行為改變階段的行動期(n=10)。研究者根據訪談資料,提出「危機因應模式」,呈現自傷者在危機情境下,選擇自傷與非自傷因應方式的相關因素。在危機情境下,某些因素使自傷者最後以自傷行為作為因應方式,這些因素包括:避免自殺、認知窄縮、求助污名、負面求助經驗,與擔心麻煩他人;其它因素則幫助病人採取非自傷的因應,包括:正面求助經驗、重視個人形象、有未完成的事、考量對他人的影響,以及對親密關係的期盼。 與「自助技巧清單」接受度有關的因素則包括:操作簡易、提供因應方式、閱讀理解困難、負面感受、對內容的不認同等。某些個案建議,急診室可能並非良好介入時機;較多受訪者偏好網頁版「自助技巧清單」。具體化策略、個人化策略、提高吸引力、提供資訊,以及提供關懷與聯繫,是使用者對「自助技巧清單」的建議與期望。最後,本研究綜合受訪者的回饋,提出修正版中文「自助技巧清單」。 結論 危機因應模式以自傷者主觀經驗為出發點,提供了自殺防治不同的觀點,服務提供者應慎重看待自傷者的主觀感受。在臺灣以「自助技巧清單」進行減少自傷的介入,應使內容容易理解、介面容易操作、避免文字內容可能造成的負面感受,並提供較具體、為個人設計、能銜接相關資源,且具吸引力的內容。我們根據研究結果修正與改善中文版「自助技巧清單」,將可應用於進一步的試驗研究。 Background and research aim Suicide and self-harm are major global public health issues. People who self-harm are tens of times more likely to die by suicide. However, there is no evidence that the incidence of self-harm repetition has decreased over the past 10 years. Therefore, there is an urgent need for evidence-based interventions to reduce risk of self-harm repetition. Emergency department, as the first contact point for many people who self-harm, provides a window of opportunity to intervene suicidal behaviors. However, existing treatments of reducing self-harm repetition mostly require intensive human resources and time costs and thus are unsuitable at the emergency department setting. The volitional help sheet (VHS) is a brief, theory-based intervention that can help people form implementation intentions and facilitate behavioral changes. There was preliminary evidence showing that it may reduce self-harm repetition. The aim of this study was to develop the Chinese version of volitional help sheet and explore user experiences about this intervention. Methods We conducted a qualitative study. Face-to-face semi-structured interviews were conducted with Taiwanese patients who self-harmed over the past year. Patients’ past experiences with self-harming and non-self-harming coping strategies were explored. The VHS was translated into Chinese and back translation was used to ensure the correctness of translation. A web-based version of VHS was also developed in addition to the paper version. The patients were asked to use the Chinese version of VHS, paper-based and web-based, and share their perceptions and feedback. All the interviews were audio-recorded and transcribed verbatim. The framework method was used for data analysis, with a framework being developed to summarize patients’ past experiences of coping with crisis. Results The 14 interviews conducted were in average 60 min in length. Nine female patients and five male patients were interviewed; eight of them were 20-29 years old. Most patients were in action stage for behavioral change. A framework of ‘crisis-coping model’ was developed to incorporate a range of factors that influenced patients’ self-harming or non-self-harming behaviors at times of crisis. At crisis, factors that may contribute to self-harm included – to avert suicide, cognitive restriction, stigma around help-seeking, negative experiences with help-seeking, and concerns about bothering others. By contrast, factors that facilitated non-self-harming behaviors included positive experiences with help-seeking, fear of the disfiguring effect of self-harming act, expectations toward intimate relationship, wishes to be fulfilled, and considerations about the impact on others. Factors associated with the acceptability with the VHS included easy use, provision of detailed coping strategies, difficulties in understanding the text used in the VHS, negative perceptions, and disagreeing with the situations and solutions included in the VHS. Some patients commented that emergency department (ED) may not be a suitable setting for the VHS intervention as at ED they were too distressed to engage in the task. More patients preferred the web-based version of VHS compared to the paper-based version. Patients provided the following suggestions about the VHS – to provide detailed, practical, and tailored coping strategies; to make the design more attractive; to provide information about resources; and to use caring words in the follow-up booster VHS. A modified Chinese version of VHS was developed based on patients’ feedback. Conclusion The crisis-coping model based on patients’ experiences provides a useful perspective for suicide prevention. Service providers should take into serious considerations patients’ subjective perceptions. In Taiwan, the VHS intervention for self-harm repetition should make its content easy to understand, make its design friendly and attractive for users, avoid wording that may bring negative feelings, and provide practical and tailored coping strategies and information about resources. The modified Chinese version of VHS can be used in a clinical trial to examine its effectiveness in reducing self-harm repetition. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/7424 |
DOI: | 10.6342/NTU201803900 |
全文授權: | 同意授權(全球公開) |
顯示於系所單位: | 健康行為與社區科學研究所 |
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