日間留院精神分裂病患實施反菸衛生教育團體成效探討

Effectiveness of Anti -smoking Educative group Psychotherapy in Day-ward Schizophrenic patients

菸害是二十世紀威脅人類健康的最大公敵之一，根據統計精神病患吸菸率較一般民眾高出數倍，且戒菸成功率較一般民眾低。本研究旨在探討精神病患在實施反菸衛生教育團體後菸害知識、吸菸態度與行為之改善情形，與對團體滿意度研究，以作為後續反菸教育團體之參考。本研究對象為日間留院精神分裂病患，選擇有吸菸習慣之固定團體成員10名，進行封閉型團體衛生教育。在第一次團體衛教進行前及第四次團體結束後，進行菸害知識、吸菸態度與行為及團體滿意度調查，以瞭解團體衛教的立即效果；並於間隔一個月後進行末測，以瞭解團體衛教的持續效果。研究資料有關前、後及末測之比較以無母數統計方法進行分析。病患在菸害知識、吸菸態度及吸菸量，後測較前測達顯著性進步；一個月後在菸害知識、吸菸態度及吸菸量較後測雖有退步，但相較於前測仍達顯著進步。團體活動評估方面「吸菸與精神病」、「戒菸與飲食」的課程對病患最有幫助；討論議題以「吸菸公害」、「形象塑造從戒菸做起」、「拒菸技巧的演練」、「生活安排與心情調適」最有幫助。病患對「團體人數」、「講師及治療者溝通表達能力」、「團體討論方式」非常滿意，最不滿意是「團體單元次數太少」，建議能多增加課程內容及議題討論次數。結論：日間留院精神病患實施反菸衛生教育團體後對菸害知識、吸菸態度及行為的改善是有效的，但是一個月的持續效果略有降低；因此反菸團體衛教應以持續性或階段性的方式進行，以逐步減少吸菸量的方式來協助精神病患減菸、戒菸。

The aims of this research were to explor whether the scores of know-ledge of risk, attitude and behavior of smoking would change after the inrervertion of anti-smoking educative group psycho-therapy and this intervention would be satisfactory to group members. 10 day-ward-schizophrenic patients who habit of smoking attended the group, which reject new members to participate. Besides the questionnaire for satisfaction to group activity after last section of group, there were 3 exams for evams for evaluating the knowledge of risk, attitude, and behavior of smoking group mem-before the beginning of 1ST section, just after theend, & 1 month after last section of group. These data of exams named as pre-test post-test & 1-month-follwing test were analyzed by methods of mom-parametric statistics. The scores of knowledge of risk and attitude of smoking, which were still were found to be higher degree in pre-test than that in post-test and the dosage of smoking in the fromes decreased in comparison with that in the latter(P<0.05). In 1-month-following test the scores, which were still higher than that in pre-test(p<0.05), were found down to lower degree than that post-test(p<0.05) and the dosage of smoking, which were still less than that in pre-test(p=0.058), is found escalated(p=0.085). The courese such as ''smoking and psychosis '' and ''abstinence of smoking and diet'' seem to be the most useful to them in the content of the group. And the topics about ''smoking as public dangers'', ''modeling of image since abstinence of smoking '', ''social skill training for refusing smoking'' and ''arrangement of daily life and stress coping'' worth discussing. Patients were very satisfied with the group in the viewpoint of ''group members'', ''the communicative abilities of the lecturer and the therapist'' and ''discussion style of group'', However the viewpoint of ''numbers of section'' was the least satisfying in this intervention. This antismoking educative group psychotherapy in day-ward schizophrenic patients was effective about improving knowledge of risk, attitude and behavior of smoking, but persistent effectiveness decade a little after 1 month. We suggest this group should be practiced in a stepwise and continuous way to help schizophrenic patients decrease dosage of smoking gradually and finally stop smoking.