動機式晤談及行動社群網路支持介入對於男性冠心病病人戒菸成效之探討

Effects of Motivational Interview and Mobile Social Network Support on Smoking Cessation in Male Patients With Coronary Heart Disease

背景：冠心症病人若能戒菸，則其心臟病的再發率及死亡率會比持續吸菸病人低，然而男性冠心病病人出院後吸菸率仍偏高。目的：探討男性冠心病病人接受動機式晤談及行動社群網路支持介入的戒菸成效及其他的戒菸預測因素。方法：採實驗研究設計，以方便取樣，於北部某醫院心臟科病房收案，隨機分配個案至實驗組（n＝57）或對照組（n＝64）。住院時每位個案於心導管檢查後先填寫問卷，包括基本資料、尼古丁成癮度測量表及思變階梯量表，之後實驗組接受床旁動機式晤談，再填寫自我效能及思變階梯量表，最後加入行動社群網路支持持續3個月；而對照組則接受常規照顧和一份戒菸手冊，再填寫自我效能及思變階梯量表。戒菸狀態採intention-to-treat分析，在個案出院後三個月以網路LINE或電話追蹤，且以尿液cotinine的濃度確認。結果：兩組皆能提升戒菸動機；而動機式晤談介入後動機程度顯著高於對照組。接受動機式晤談及三個月的行動社群網路支持的實驗組戒菸率（35.09％）高於對照組（17.19％），在控制兩組前測有差異的變項後則是趨於顯著差異（OR：2.34；p＝.055）。在控制組別影響後，戒菸狀態的預測因素為個案開始吸菸的年齡、是否初診斷冠心病與自我效能。結論／實務應用：建議臨床上可使用動機式晤談來提高個案的戒菸動機及提升戒菸自我效能來提高戒菸率。

Background: Patients with coronary heart disease (CHD) who quit smoking exhibit lower rates of heart attack recurrence and mortality than their peers who continue smoking. However, most male patients with CHD resume smoking after hospital discharge. Purpose: To explore the effectiveness of motivational interventions and mobile social network support on smoking cessation and other predictors of smoking cessation in male patients with CHD. Methods: An experimental design was used, and a convenience sample was recruited from a cardiology ward of a hospital in northern Taiwan. The participants were randomly assigned to the experimental group (n = 57) and control group (n = 64). During hospitalization, each participant completed a questionnaire after undergoing cardiac catheterization. The questionnaire included a demographic datasheet, the Fagerström Test for Nicotine Dependence, and the contemplation ladder. Afterward, the experimental group received motivational interventions, filled out a self-efficacy scale and the contemplation ladder, and joined an online mobile social group (LINE) for three months. The control group received regular care and a smoking cessation booklet, and then filled out the self-efficacy scale and contemplation ladder. An intention-to-treat analysis was adopted to evaluate smoke cessation status. Information on post-discharge smoking status was collected from the participants via the Line communications app or phone calls at three-months after hospital discharge and was further confirmed using urinary cotinine levels. Results: The results revealed that both groups registered improvements in motivation to quit smoking. This motivation was relatively higher in the experimental group after the intervention than in the control group. The smoking cessation rate in the experimental group (35.09%) was higher than that in the control group (17.19%). However, the intergroup difference in the cessation rate only approached statistical significance (OR: 2.34; p = .055) after controlling for the baseline difference between the two groups. Controlling for the effects of the intervention, age of smoking initiation, first diagnosis of CHD, and self-efficacy were identified as predictors of smoking cessation. Conclusions/ Implications for Practice: Healthcare providers are encouraged to provide motivational interviews to enhance the motivation of their patients to quit smoking as well as to incorporate self-efficacy into related interventions to increase the smoking cessation rate.