住院照顧者之照顧意願如何轉化為幸福感？以中介序列模式探討照顧者掌握感與負荷之心理層面作用

How caregiving intention translates into well-being: a sequential mediation model of the psychological effects of caregiver mastery and burden on inpatient caregivers

目標：在住院人口持續大量增加、醫療照顧需求提升的情形下，家庭照顧者的負荷顯著增加。本研究探討台灣醫院住院患者主要照顧者之照顧意願、掌握感、照顧負荷與幸福感之間的關係。方法：採「牛津幸福量表」、「照顧者負荷量表」、「照顧者掌握量表」、「照顧意願量表」及「日常生活活動量表」問卷進行橫斷性調查，調查對象為台灣中部地區醫療體系轄下之地區醫院住院患者主要照顧者，運用SPSS PROCESS 6序列中介模型，依序探討掌握感與照顧負荷在照顧意願與幸福感間之中介關係。結果：共收案112人，序列中介模型顯示：照顧意願對幸福感無直接效果，但可以藉由提升照顧意願，接著依序透過增加掌握感來降低整體照顧負荷，最後正向影響照顧者之幸福感；在不同負荷類型中，情緒負荷對幸福感的直接影響不顯著，而生理負荷與束縛感負荷則通過掌握感表現出顯著的間接影響。結論：掌握感為影響幸福感的重要中介變項，能有效緩解負荷對幸福感的負面影響。因此，提供針對醫院主要照顧者的相關培力課程與心理支持，以提升掌握感，作為政策與實務之參考方向。（台灣衛誌2025；44（3）：285-305）

Objectives: With the continual and substantial increase in the population of inpatients and the increasing demand for medical care, the burden placed on family caregivers has increased considerably. Accordingly, this study explored the relationships among caregiving intention, sense of mastery, caregiver burden, and well-being in primary caregivers of inpatients admitted to Taiwanese hospitals. Methods: A cross-sectional survey was conducted using the Oxford Happiness Questionnaire, Caregiver Burden Scale, Caregiver Mastery Scale, Caregiving Intention Scale, and Activities of Daily Living Scale. Primary caregivers of inpatients admitted to district hospitals in central Taiwan were recruited as participants. A sequential mediation analysis was conducted using SPSS PROCESS Model 6 to sequentially explore the mediating roles of sense of mastery and caregiver burden in the relationship between caregiving intention and wellbeing. Results: A total of 112 participants were included in the study. The sequential mediation model revealed that caregiving intention had no direct effect on well-being. However, when caregiving intention was enhanced, overall caregiver burden was progressively reduced through an increased sense of mastery, ultimately leading to a positive influence on caregivers’well-being. Among different types of burden, emotional burden did not have a significant direct effect on well-being, whereas physical burden and confinement burden demonstrated significant indirect effects mediated by sense of mastery. Conclusions: Sense of mastery is a crucial mediating variable influencing well-being and can alleviate the negative impact of burden on well-being. Therefore, offering relevant empowerment courses and psychological support specifically for primary hospital caregivers to enhance their sense of mastery is recommended as a direction for policymaking and practice. (Taiwan J Public Health. 2025;44(3):285-305)