高血壓患者注意焦點的型態與個人生病行為的關係

The Patterns of Symptoms Focusing Attention and Illness Behaviors in Hypertension Adults

高血壓是常見慢性疾病，但因疾病初期具無症狀之特性，導致患者不明確的身體知覺與判斷偏差。研究目的欲探討高血壓患者焦點注意生病的線索時，偏向內在或外在的線索，對個人生病行為如認知評價、因應與遵從醫囑等行為以及情緒後果是否有不同的影響。本研究以立意取樣，選取本態型高血壓患者，經由質的資料收集與內容結構分析24位患者，發現第一種型態為注意內在線索的患者，以內因解釋高血壓，有身體化的擔心與沮喪情緒；因應方式較謹慎。第二種型態為注意內、外線索的患者，個案其會因對高血壓線索的確定性與嚴重性評估，影響個人對病症的擔心及服藥的焦慮；當個案對症狀或血壓的因素越明確，並接受客觀資訊時（例如血壓計的數值），個案就越容易聽從醫師的說明與醫囑。但是，當不確知的歸因線索越多時，加上症狀持續出現，個案會感到更多對身體的擔心，甚至在吃藥後都會擔心副作用，害怕醫師開的藥不適合。第三種型態係從外在尋找身體症狀之線索，因此，容易尋求外在調節與控制。第四種型態屬於不自覺型，這類型病人多半因為其他原因（如健檢、感冒等）在門診中被醫師發現，主動求醫的意願低，也因為他們無法根據具體線索解釋身體症狀，故因應意向是四種型態中最低的。研究建議為需參照個人注意收錄的內、外線索，以及相對於客觀醫療知識的正確觀念，個人對病症的確定性與嚴重性評估等社會認知訊息，才能更準確預測個人生病因應與情緒變化。

Hypertension is a common chronic disease, its because of asymptomatic characters, patients usually make wrongly somatic perceptions and inaccurate judgment. The purpose of this study was to assess the focusing attention on internal versus external illness cues, which could influence the individual's cognitive appraisal, coping behavior, adherence and emotional response in hypertension patients. Twenty-four patients with essential hypertension were purposively selected as our study participants. Patients were interviewed by a doctor of Family Medicine who was also a researcher in our study, and the interaction process was taped for qualitative analysis. The qualitative data revealed that there were four patterns of focusing attention among our research participants. They were : 1. Self-focused attention, they were internally directed attention to illness cues, experienced more somatic distress and coped with illness more passively. 2. Attention focus on both internal and external illness cues, patients had active coping if they certainly became aware of the correct somatic cues. Otherwise, they tended to worry and comply with medication for security because of uncertainty feeling and severity of hypertension. 3. Situation-focused attention, they tended to focus on environmental factors, not as much emotional distress as well, and tried to decrease blood pressure by managing the stress from situation. 4. Unaware of both the internal and external cues, patients weren't aware of any cues and needed to find the hypertension by others, tended to use defensive coping for hypertension. Our study suggests to know personal focusing attention pattern, meanwhile compares with the accurate objective medical knowledge, certainty and severity about illness, can predict patient's illness behavior more precisely.