社區精神分裂症病患吸菸與戒菸失敗之主觀經驗

Perception of Cigarette Smoking and Smoking Cessation Failure Experiences of Patients with Schizophrenia

研究背景：過去研究指出精神分裂病患的吸菸問題較一般人嚴重，且戒菸困難度極高，然而對於精神病患吸菸問題的探討多為量性研究，罕見質性研究深入了解其主觀經驗。研究目的：本文為探討社區精神分裂症病患的吸菸與戒菸經驗，萃取病患於吸菸與戒菸歷程的主觀感受，藉以瞭解其菸品使用經驗的觀點。研究方法：以立意取樣方式，針對北部社區復健機構的吸菸精神分裂症患者，透過半結構式指引，進行深度訪談與錄音收集資料，共十五位個案（男性73.3%，平均年齡49.67±5.74）。再以逐字稿將資料文字化，應用質性分析軟體NVIVO 8加以歸納與分析類目。研究結果：研究對象吸菸主觀感受呈現三個主題，分別為「正面知覺」、「負面知覺」與「中性知覺」；戒菸經驗的主觀感受呈現五個主題，分別為「無法解套的菸癮（頭）」、「無法延續成功的戒菸經驗」、「體認戒菸輔助方法的成效」、「衡量支付吸菸與戒菸的物品價格」與「建構持續吸菸行為的論述」。研究結論：本研究結果有助於心理衛生工作人員深入體會社區精神分裂病患面對香菸問題於其生活過程之主觀感受，期望能提供未來協助社區精神病患面對吸菸行為時，多些了解與尊重，於個案社區復建的過程中，扮演正向心理支持與資訊提供的角色，以協助其渡過戒菸困難，並藉此作為發展精神病患菸害防治方案之參考。

Background: Several studies have demonstrated that the problem of smoking among schizophrenic patients is much higher than in the normal population. Schizophrenics also have more difficulty with smoking cessation. Many previous quantitative studies investigated smoking problems with schizophrenics; few studies applied qualitative methods to explore schizophrenics’ own perceptions of smoking. Purpose: This study explored schizophrenics’ experience of cigarette smoking and smoking cessation. Methods: Qualitative techniques were applied using a purposive sampling method, followed by semi-structured interviews. Interviews with 15 schizophrenia patients (73.3% male, mean age: 49.67±5.74) were conducted at a community rehabilitation center. Interviews were recorded and transcribed for analysis of themes. Results: Three themes of cigarette smoking experiences emerged from the analysis: positive perceptions, negative perceptions, and borderline perceptions. We identified 5 themes in the smoking cessation experiences: hard to get over cravings, never had a successful experience with smoking cessation, realized the effectiveness the alternative of smoking cessation, judged the price in payment for smoking and quitting, and found reasons to continue smoking. Conclusions: The results will help mental health workers to understand schizophrenic patients’ tobacco issues, and how patients interpret the phenomenon of smoking and quitting. Community rehabilitation can play a positive role in mental health support and offer information to assist patients with the difficulties of quitting smoking.