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A study of participation in health-related decision and self-care competency in patients with chronic disease

만성질환자의 건강관련 의사결정에 대한 참여 정도와 자가간호역량에 관한 연구

  • Received : 2020.02.26
  • Accepted : 2020.06.05
  • Published : 2020.06.30

Abstract

This study investigated the correlation between the participation in health-related decisions and self-care competency and the factors influencing self-care competence of patients with chronic disease. The participants were 518 patients with chronic illnesses who were admitted to a public health center. Using a structured-questionnaire, the data was collected from January 1, 2019 to 31, 2019. The data was analyzed using descriptive statistics, t-tests, ANOVA, Scheffé tests, Pearson correlation coefficients and multiple linear regression with the IBM SPSS/WIN 22.0 program. The mean scores on the participation in health-related decisions and self-care competency were 3.62±0.20 and 4.57±0.34, respectively. The main variables that distinguish significant differences between participation in healthcare decisions and self-care capabilities are gender, age, education level, diagnosis, and subjective health status. Self-care competency was positively correlated with the participation in health-related decisions (r=.66, p=.043). Factors influencing self-care competence were education (β=-2.23, p<.001), health concerns (β=0.14, p=.003), subjective health statues (β=2.57, p=.011), and age (β=-0.36, p=.048). The input variables explained .56 of self-care competence. The results of the study indicate that approaches focusing on enhancing the participation in health-related decisions could potentially improve self-care competency of patients with chronic disease.

본 연구는 만성질환자를 대상으로 건강관련 의사결정에 대한 참여 정도와 자가간호역량의 관계를 확인하고 자가 간호역량에 영향을 미치는 요인을 파악하기 위한 서술적 조사연구이다. 자료수집은 2018년 1월 1일부터 1월 31일까지 경기도 소재 보건소에서 만성질환으로 진료를 받는 만성질환자 518명을 대상으로 시행되었다. 자가 보고식 설문지를 사용하였으며, IBM SPSS/WIN 22.0을 이용하여 기술통계, t-test, ANOVA, Scheffé test, Pearson correlation coefficients, multiple linear regression으로 분석하였다. 연구결과 건강관련 의사결정에 대한 참여 정도와 자가간호 역량의 평균점수는 각각 3.62±0.20, 4.57±0.34였고, 건강관련 의사결정에 대한 참여 정도와 자가간호역량과 유의한 차이를 타나낸 주요 변수는 성별, 연령, 학력, 진단받은 질환명, 주관적 건강상태이다. 건강관련 의사결정에 대한 참여 정도와 자가간호역량 간에 유의미한 양의 상관관계(r=.66, p=.043)를 나타냈다. 대상자의 자가간호역량에 영향을 미치는 요인으로는 학력(β=-2.23, p<.001), 건강에 대한 관심정도(β=0.14, p=.003), 주관적인 건강상태(β=2.57, p=.011), 연령(β=-0.36, p=.048)으로 확인되었으며, 자가간호역량의 전체 설명력이 .56 으로 확인되었다. 이상의 결과는 만성질환자 간호 시 대상자 특성을 헤아려야 하며, 만성질환자의 자가간호역량을 높이기 위해 건강관련 의사결정 시 능동적인 태도를 독려해야 할 필요성을 제시하였다. 또한 추후 연구에서 만성질환자의 능동적인 참여를 이끌어낼 수 있는 가이드라인을 제시하는 연구를 시도해 볼 것을 제언한다.

Keywords

References

  1. Minisry of Health and Walfare. Current status of chronic disease [Internet]. Minisry of Health and Walfare, c2020. [cited 2020 January 22], Available from: http://www.index.go.kr/potal/main/EachDtlPageDetail.do?idx_cd=1438 (accessed Feb. 10, 2020)
  2. National Health Insurance Service. 2018 Statistic yearbook of health insurance [Internet]. National Health Insurance Service, c2019. [cited 2019 Nov. 5], Available from: https://www.nhis.or.kr/menu/boardRetriveMenuSet.xx?menuId=F3321 (assessed Jan. 20, 2020)
  3. S. Lee, H. Kim. "Structural equation modeling on self-care behavior and quality of life in older adults with diabetes using citizen health promotion centers", Journal of Korean Academy of Nursing. Vol.47, No.4, pp514-25, Jul. 2017. DOI: https://dx.doi.org/10.4040/jkan.2017.47.4.514
  4. Committee of Korean Diabetes Association, 2019 Treatment guideline for diabetes, p95, Korean Diabetes Association, 2019, pp21-34. Korea Centers for Disease Control and Prevention. 2018 National health and nutrition survey [Internet]. Korea Centers for Disease Control and Prevention, c2020. [cited 2020 January 17], Available from: https://knhanes.cdc.go.kr/knhanes/sub03/sub03_02_02.do (accessed Feb. 19, 2020)
  5. P. J. Elmer, E. Obarzanek, W. M. Vollmer, D. Simons-Morton, ..., L. J. Appel. "Effects of comprehensive lifestyle modification on diet, weight, physical fitness, and blood pressure control: 18-month results of a randomized trial", Annals of Internal Medicine, Vol.144, No.7, pp485-95, Apr. 2006. DOI: https://dx.doi.org/10.7326/0003-4819-144-7-200604040-00007
  6. D. L. Hartweg, J. Pickens. "A concept analysis of normalcy within Orem's self-care deficit nursing theory", Self-care, Dependent-Care & Nursing, Vol.22, No.1, pp4-13, Spring 2016.
  7. H. S. So. "Testing construct validity of Self-As-Carer Inventory and its predictors" Journal of Korean Academy of Adult Nursing, Vol.4, No.2, pp147-161, 1992.
  8. N. Zizzo, E. Bell, A. Lafontaine, E. Racine. "Examining chronic care patient preferences for involvement in health-care decision making: the case of Parkinson's disease patients in a patient-centered clinic", Health Expectations, Vol.2, No. 4, pp655-664, Aug. 2017. DOI: https://dx.doi.org/10.1111/hex.12497
  9. H. Beckwith, L. Henderson, E. Craig, A. L. Littlefield. "Smart patients; Professional portfolio; Perioperative nursing data set; Forensic nursing", AORN Journal, Vol.84, No.4, pp687-690, Oct. 2006. https://doi.org/10.1016/S0001-2092(06)63949-5
  10. L. Ambrosio, J. M. S. Garcia, M. R. Fernandez, S. A. Bravo, S. A, ... M. C. Portillo. "Living with chronic illness in adults: a concept analysis", Journal of clinical nursing, Vol.24, No.17-18, pp2357-2367, Sep. 2015. DOI: https://dx.doi.org/10.1111/jocn.12827
  11. A. Cappuccio, F. Bugliaro, S. M. E. Caimmi, V. Caldarelli, ..., P. Giorgio. "Consensus communication strategies to improve doctor-patient relationship in paediatric severe asthma", Italian Journal of Pediatrics, Vol.45, No.1, pp1-7, Mar. 2019. DOI: http://dx.doi.org.access.ewha.ac.kr/10.1186/s13052-019-0623-0
  12. J. H. Lee, E. J. Shin, J. H. Park, M. Y. Kim, H. Moon. "Nurses' communication strategies for trust-satisfaction improvement of outpatients", Asia-pacific Journal of Multimedia Services Convergent with Art, Humanities, and Sociology, Vol.17, No.1, pp619-633, Jan. 2017.
  13. N. Z. MSc, E. Bell, A. Lafontaine, E. Bacine. "Examining chronic care patient preferences for involvement in health-care decision making: the case of Parkinson's disease patients in a patient-centred clinic", Health Expectation, Vol.20, No.4, pp655-664, Aug. 2016. DOI: https://dx.doi.org/10.1111/hex.12497
  14. T. Bodenheimer, K. Lorig, H. Holman, K. Grumbach. "Patient self-management of chronic disease in primary care", JAMA, Vol.288, No.19, pp2469-2475, Nov. 2002. https://doi.org/10.1001/jama.288.19.2469
  15. L. C. Bratzke, R. J. Muehrer, K. A. Kehl, K. S. Lee, ..., K. L. Kwekkeboom. "Self-management priority setting and decision-making in adults with multimorbidity: A narrative review of literature", International Journal of Nursing Studies, Vol.52, No.3, pp744-755, Mar. 2015. DOI: http://dx.doi.org.access.ewha.ac.kr/10.1016/j.ijnurstu.2014.10.010
  16. J. M. Padilha, P. A. F. Sousa, F. M. S. Pereira. "Nursing clinical practice changes to improve self-management in chronic obstructive pulmonary disease", International Nursing Review, Vol.65, No.1, pp122-130, Mar. 2018. DOI: https://dx.doi.org/10.1111/inr.12366
  17. S. I. van Dongen, K. de Nooijer, J. M. Cramm, A. L. Francke, ..., J. A. Rietjens. "Self-management of patients with advanced cancer: A systematic review of experiences and attitudes", Palliative Medicine, Vol.34, No.2, pp160-178, Feb. 2020. DOI: https://dx.doi.org/10.1177/0269216319883976
  18. H. J. Oh, B. K. Lee. "The effect of computer-medicated social support in online communities on patient empowerment and doctor-patient communication", Health Communication, Vol.27, No.1,pp30-41, Feb. 2012. DOI: https://doi.org/10.1080/10410236.2011.567449
  19. J. Ende, L. Kazis, A. Ash, M. A. Moskowitz. "Measuring patients' desire for autonomy", Journal of general internal medicine, Vol.4, No.1, pp23-30, 1989. https://doi.org/10.1007/BF02596485
  20. N. Zizzo, E. Bell, A. Lafontaine, E. Racine. (2016) "Examining chronic care patient preferences for involvement in health-care decision making: the case of Parkinson's disease patients in a patient-centered clinic", Health Expectations, Vol.2, No. 4, pp655-664, Aug. 2017. DOI: https://dx.doi.org/10.1111/hex.12497
  21. S. Jang, K. Lee. "Information seeking by older people and their desire for participation in decision-making regarding treatment of disease", Korean Gerontological Nursing Society , Vol.7, No.1, pp54-62, Jun. 2005.
  22. Y. Park, E. H. Jang, J. O. Kim. "Association of resilience and depression with self-care competence in adult patients with diabetes mellitus", The Korean Academy Society of Adult Nursing, Vol.30, No.5, pp555-564, Oct. 2018. DOI: https://dx.doi.org/10.7475/kjan.2018.30.5.555
  23. J. P. Yi-Frazier, R. E. Smith, P. P. Vitaliano, J. C. Yi, ..., K. Weinger. "A person-focused analysis of resilience resources and coping in patients with diabetes", Stress and Health, Vol.26, No.1, pp51-60, Feb. 2010. DOI: https://dx.doi.org/10.1002/SMI.1258
  24. C. D. Spies, C. M. Schulz, E. Weib-gerlarch, B. Neuner, ..., G. Elwyn. "Preferences for shared decision making in chronic pain patients compared with patients during a premedication visit", Acta Anaesthesiologia Scandinavia, Vol. 50, No.8, pp1019-1026, Sep. 2006. DOI: https://dx.doi.org/10.1111/j.1399-6576.2006.01097.x
  25. L. Madrigal, C. Escoffery. "Electronic health behaviors among US adults with chronic disease: Cross-sectional survey", Journal of Medical Internet Research, Vol.21, No.3, pp1-15, Mar. 2019. DOI: https://dx.doi.org/10.2196/11240
  26. G. Y. Cho, M. N. Ha. "Medicating effects of health belief on the correlations among disease-related knowledge, eHealth literacy, and self-care behaviors in outpatients with hypertension", The Journal of Korean Academic Society of Adult Nursing, Vol.31, No.6, pp638-649, Dec. 2019. DOI: https://dx.doi.org/10.7475/kjan.2019.31.6.638
  27. N. Son, J. Yang. "Factors influencing self-care behaviors related to insulin therapy in elders with diabetes mellitus", Journal of Korean Academy of Fundamentals of Nursing, Vol.20, No.1, pp27-36, Feb. 2013. DOI: https://dx.doi.org/10.7739/jkafn.2013.20.1.27
  28. L. Årestedt, C. Martinsson, C. Hjelm, F. U. Uhlin, A. C. Eldh. "Patient participation in dialysis care-A qualitative study of patients' and health professionals' perspectives", Health Expectation, Vol.22, No.6, pp1285-1293, Dec. 2019. DOI: https://dx.doi.org/10.1111/hex.12966
  29. B. Tennant, M. Stellefson, V. Chaney, D. Chaney, ..., J. Alber. "eHealth literacy and web 2.0 health information seeking behaviors among baby boomers and older adults", Journal of Medical Internet Research, Vol.17, No.3, pp1-16, Mar.2017. DOI: https://doi.org/10.2196/jmir.3992