衛生教育對中風病患主要照顧者疾病認知、社會支持及照顧負荷之影響

The Effects of Health Education on Disease Cognition, Social Support, and Burden of Main Caregivers of Stroke Patients

本研究之目的在於探討中風病患主要照顧者接受衛生教育後，其疾病認知、社會支持、照顧負荷之變化情形。研究採縱貫性研究法，以立意取樣方式選取某醫學中心神經內科診斷為腦中風病患之主要照顧者143位，分別在衛生教育前、衛生教育後出院前、出院後一個月、六個月和一年，以結構性問卷分五期重複評估，統計方法採用多變項和單變項重複量數分析，其結果為(1)主要照顧者對疾病知識的認識，在衛生教育後有顯著進步，出院後一年與出院前比較雖有退步，但與衛生教育前比較仍有顯著進步；(2)衛生教育後，主要照顧者情緒性、資訊性社會支持程度有顯著提高；(3)主要照顧者心理功能負荷在出院後一個月、六個月及一年比衛生教育前有顯著減輕。研究結果建議未來應結合急性醫院之出院準備與社區照護，藉由衛生教育提高照顧者之疾病認知、社會支持，再輔以實質的工具性支持，以降低照顧者負荷。

The major purpose of this study was to explore the changes of disease cognition, social support, and burden of caregivers of stroke patients before and after receiving health education. The design was longitudinal and used purposive sampling. One hundred forty-three (143) main caregivers of stroke patients were recruited at a neuro-medical ward of a medical center in northern Taiwan. A structured questionnaire and assessment tool was used to collected data at five time intervals: pre-education, pre-discharge, and the first month, the sixth month, and the first year post-discharge. Multivariate and univariate repeated measures were used to analyze the data. The results were as follows. First, the main caregivers' knowledge about stroke improved significantly after health education, but declined one year post-discharge. However, the knowledge score after one year was still higher than at pre-education. Second, the function of emotional and informational social support improved steadily after health education. Finally, when compared with the pre-education time, the psychological burden declined significantly at the first month, the sixth month, and the first year post discharge. Results suggested that cooperation on discharge planning between acute hospitals and community care agencies is necessary to improve caregivers' knowledge of stroke and social supports. Moreover, instrumental support for health education needs to be implemented to decrease the burden of caregivers.