罹患糖尿病與否對冠狀動脈繞道手術後病患的自我效能、治療遵從性及其預測因子差異之比較

Difference in Predictors of Self Efficacy and Compliance Between Diabetic and Non Diabetic Patients Who Underwent Coronary Artery Bypass Surgery

背景：冠狀動脈繞道手術後之糖尿病患者易發生合併症且預後較差，若能控制相關因子減少合併症發生，並了解手術病人是否同時合併糖尿病，以及其自我效能及治療遵從性的差異，對於患者於生活與疾病上的長期照護非常重要。目的：比較病患罹患糖尿病與否於冠狀動脈繞道手術後，其自我效能、治療遵從性預測因子之差異。方法：採橫斷研究方便取樣方法，以兩家醫學中心及一家區域教學醫院共350位病患為對象。研究工具包括基本資料問卷、慢性病自我效能及治療遵從性量表，以SPSS 17.0 for window進行資料建檔與統計分析。結果：研究顯示兩組之自我效能與治療遵從性皆呈顯著正相關（p < .001），不管罹患糖尿病與否，接受冠狀動脈繞道手術後的病患，自我效能越高，治療遵從性越高；無糖尿病組之自我效能較糖尿病組為佳（t = .273, p = .002），但治療遵從性較差（t = -2.51, p = .012）；兩組在自我效能及治療遵從性之預測因子皆有所差異，糖尿病組顯示性別、治療遵從性、教育程度、目前有無工作和婚姻狀況為自我效能之預測因子，總解釋力28.5%（p < .001），自我效能是治療遵從性的單一預測因子，可解釋7.8%之變異數（p < .001）。無糖尿病組自我效能之預測因子包括治療遵從性、照顧者、教育程度、手術後月數、性別及規則運動，總解釋力41.0%（p < .001），而自我效能、照顧者及手術前職業，可共同預測治療遵從性20.0%之變異數（p < .001）。結論：提供了解罹患糖尿病與否於冠狀動脈繞道手術後，病患基本屬性和自我效能、治療遵從性的關係與其預測力，醫護人員可依照病人具有預測力之基本屬性的特異性，來加強病人的自我效能及治療遵從性，持續增進相關的健康行為，提升長期之生活品質。

Background: Compared to their non-diabetic peers, diabetic patients who undergo coronary artery bypass surgery (CABG) face greater complications and poorer outcomes. Identifying related risk factors is essential to improving post-CABG outcomes in this vulnerable population. Improving self-efficacy and compliance can further improve patient outcomes over the long term.Purpose: This study compared differences in self-efficacy predictors and compliance between diabetic and nondiabetic patients who received coronary artery bypass surgeryMethod: We used a cross-sectional design with convenience sampling. A total of 350 patients were recruited from two medical centers and one teaching hospital. Instruments used included a demographics questionnaire, chronic disease self-efficacy questionnaire and compliance scale. SPSS 17.0 for Windows was used to analyze data.Results: Results found self-efficacy positively associated with compliance in both groups. The non-diabetic group had higher self-efficacy and lower compliance than the diabetic group. In the diabetic group, gender, compliance, education, employment status and marital status were all predictors of self-efficacy, with self-efficacy the single predictor of compliance. In the non-diabetic group, compliance, primary care provider, education, time since surgery, gender and exercise were predictors of self-efficacy. Self-efficacy, primary care provider, employee status prior surgery were all predictors of compliance.Conclusions: Results provide valuable information regarding the impact of diabetes on CABG patient outcomes and differences in predictors of self-efficacy and compliance between diabetic and non-diabetic patients. Healthcare providers can promote healthy behavior and enhance quality of life by providing patient support tailored to their characteristics and considering the factors associated with better self-efficacy vs. compliance.