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系統識別號 U0007-0808201106350600
論文名稱(中文) 用藥配合度問卷之發展:臺灣版莫力斯基八問項用藥配合度問卷與臺灣閩南語版藥物治療滿意程度的問卷調查於門診病人之適用性評估
論文名稱(英文) Development of Medication Adherence Questionnaires: A Pilot Study of the MMAS-8 Taiwan Version and TSQM Taiwanese Version in Outpatients
校院名稱 臺北醫學大學
系所名稱(中) 藥學研究所
系所名稱(英) Graduate Institute of Pharmacy
學年度 99
學期 2
出版年 100
研究生(中文) 林育璿
研究生(英文) Yu-Syuan Lin
學號 M301097010
學位類別 碩士
語文別 中文
口試日期 2011-06-23
論文頁數 231頁
口試委員 委員-陳榮基
委員-闕壯卿
委員-許光陽
共同指導教授-袁瑞昱
指導教授-何意
中文關鍵字 用藥配合度  服藥遵從性  臺灣版莫力斯基八問項用藥配合度問卷  臺灣閩南語版用藥滿意程度的問卷調查 
英文關鍵字 Medication adherence  medication compliance  Taiwan version Morisky Medication Adherence Scale (Taiwan version MMAS)  Taiwanese version Treatment Satisfaction Questionnaire for Medication (Taiwanese version TSQM) 
學科別分類
中文摘要 病患用藥配合度 (或稱服藥遵從性) 不足之問題亟待解決。欲改善用藥配合度首先需要評估工具以調查病人用藥行為,莫力斯基八問項用藥配合度問卷 (8-item Morisky Medication Adherence Scale, MMAS-8) 與精簡版藥物治療滿意程度的問卷調查 (Abbreviated Treatment Satisfaction Questionnaire for Medication, TSQM-9) 在國外高血壓族群展現良好信效度,深具潛力予臺灣使用。臺灣約五分之一人口不會國語僅會臺灣閩南語 (俗稱臺語),且有視力較弱族群,因此需要同時發展國語與臺灣閩南語版本之訪談式問卷。本研究旨在發展可用於調查臺灣病人用藥配合度之問卷、評估受訪者是否能瞭解經國語及臺灣閩南語翻譯 (合稱臺灣版) MMAS-8與經臺灣閩南語翻譯之TSQM之內容意涵,並探索可能影響受訪者瞭解度之因素。
本研究以專家審查法決定預試問卷內容後,訪員於北部二間區域醫院神經內科門診收案進行問卷預試,將受訪者依慣用語言分為國語36人,臺灣閩南語組35人二組後,以半結構式一對一訪談法評估受訪者對問卷內容是否瞭解:先播放慣用語言版本MMAS-8題目錄音檔給受訪者聽,於臺灣閩南語組,若受訪者同意,便接著播放臺灣閩南語版TSQM。收案當天完成訪問,事後進行病歷回顧,以橫斷式研究法分析資料,並回顧預試結果以修改問卷,最後由專家審查法定稿。國語組33位與臺灣閩南語組32位受訪者完成預試用臺灣版MMAS-8測試並被納入分析,結果第二題「有些人有時候並不是因為忘記,而沒有吃他們的藥,請想想看在過去二個禮拜,你是不是有任何幾天沒有吃藥?」、第八題「你有多常會感覺到,要記得吃你所有的藥會有困難?」 (內容皆以國語版代表) 以及各選項均需修改;年齡超過65歲、教育程度國中以下或併存疾病複雜 (有血管性併發症如中風病史) 者,選項瞭解度較低 (p < 0.001, p < 0.001和p < 0.01) ,且臺灣閩南語組中,不通或略通國語者,選項瞭解度較低 (p < 0.05)。七位受訪者完成預試用臺灣閩南語版TSQM之測試,結果半數問項 (題目連選項) 與指示句需修改。二問卷經修改後之版本具有可接受之專家效度。預試結果顯示,預試用臺灣版MMAS-8與臺灣閩南語版TSQM均需修改。修改後之臺灣版MMAS-8與臺灣閩南語版TSQM具有良好的內容效度,具臨床或相關研究應用潛力,未來需要驗證二問卷之信效度於不同族群,並注意年齡、教育程度、語言能力差異與併存疾病之影響。
英文摘要 Patients’ low adherence or compliance to medication calls for immediate solution, and to improve patients’ adherence to medication, a tool assessing medication adherence is first needed. The 8-item Morisky Medication Adherence Scale (MMAS-8) and Abbreviated Treatment Satisfaction Questionnaire for Medication (TSQM-9) have shown desirable psychometric properties among hypertensive populations in America, having great potential for Taiwan to adopt. In Taiwan, about one-fifth people don’t understand Mandarin speak Taiwanese, and some people have visual impairment, so an interview version questionnaire needs to be developed in Mandarin and Taiwanese at once. This study aims to develop a medication adherence questionnaire interview version that suits Taiwanese patients; to evaluate whether the patients can understand the Mandarin and Taiwanese translated (together called Taiwan version) MMAS-8 and Taiwanese translated TSQM and explore the possible factors influencing patients’ comprehensibility. This study used expert review to determine the questionnaires for pilot study. In pilot study, interviewers recruited participants from neurology clinics in two regional hospitals, and assigned subjects to the Mandarin group (N = 36) and Taiwanese group (N = 35) according to their language preference, then conducted semi-structured one-on-one in-depth interview to evaluate whether the subjects understand the questionnaires: the interviewer played the question part of voice-recorded Mandarin or Taiwanese translated MMAS-8 to the subjects, and for the Taiwanese group, if the subject agreed, interviewer then played the voice recorded Taiwanese translated TSQM. The interview completed within one day, followed by chart review. Data were analyzed with cross-section survey method and reviewed. Revision of the questionnaires was made if necessary and final manuscripts were determined by expert review. Thirty-three subjects in the Mandarin group and 32 subjects in the Taiwanese group completed the testing of the Taiwan version MMAS-8 for pilot study and were included for analysis. Question two“People sometimes did not take the medicines not because they forgot. Try your best to recall: Did you miss taking your diabetes medicines for some days in the past two weeks?”; question eight“How often did you find it difficult to remember taking your medicine?”and every response choices needed to be revised. Age over 65 years, education less than 12 years or complex comorbid condition (with vascular complication such as history of stroke) related to lesser comprehensibility of response choices (p < 0.001, p < 0.001 and p < 0.01, respectively), and subjects in Taiwanese group who were not familiar with Mandarin had lower comprehensibility of response choices (p < 0.05). Seven subjects completed the testing of the Taiwanese version TSQM for pilot study; half of the items (question along with response choices) and the instruction needed to be revised. Both questionnaires were revised and the final manuscript had an acceptable expert validity.
Both the Taiwan version MMAS-8 and Taiwanese version TSQM for pilot study needed to be revised. The modified Taiwan version MMAS-8 and Taiwanese version TSQM both have good content validity, having the potential to be adopted in clinical practice or research, but further research is needed to test their psychometric properties in different patient groups, and the effect of age, year of education, language ability and comorbid conditions should be monitored carefully.
論文目次 致謝......................................................................................................................... I
摘要....................................................................................................................... III
ABSTRACT ............................................................................................................ V
縮寫對照表.......................................................................................................... VII
目錄.................................................................................................................... VIII
表目錄..................................................................................................................... X
圖目錄.................................................................................................................. XII
附件目錄............................................................................................................ XIII
第一章 緒論.......................................................................................................... 1
1.1 研究背景與研究動機.......................................................................................... 1
1.2 研究目的 ............................................................................................................. 2
第二章 文獻回顧.................................................................................................. 3
2.1 用藥配合度低係臨床重要議題 ......................................................................... 3
2.2 用藥配合度調查方式.......................................................................................... 4
2.3 訪填式問卷與臺灣閩南語用藥配合度問卷之需求.......................................... 8
2.4 問卷的選用........................................................................................................ 10
2.5MMAS-8 與TSQM 於不同語言版本之發展 .................................................. 18
2.6 臺灣閩南語問卷的發展與呈現方式................................................................ 23
2.7 可能影響問卷適用性與受訪者問卷內容瞭解度之因素................................ 34
第三章 研究方法................................................................................................ 37
3.1 研究架構............................................................................................................ 37
3.2 研究方法 ........................................................................................................... 39
3.3 研究設計............................................................................................................ 40
3.4 研究對象與場所 ............................................................................................... 46
3.5 研究工具 ........................................................................................................... 47
3.6 研究活動流程 ................................................................................................... 50
3.7 收案方式 ........................................................................................................... 53
3.8 名詞解譯與操作型定義 ................................................................................... 54
3.9 統計方法 ........................................................................................................... 60
ix
第四章結果........................................................................................................ 64
4.1 問卷的翻譯及反面翻譯與定稿........................................................................ 64
4.2 量尺語詞之決定................................................................................................ 69
4.3 問卷試測............................................................................................................ 80
4.4 問卷預試............................................................................................................ 81
4.4.3 預試用臺灣閩南語版TSQM 測試結果 ..................................................... 123
第五章 討論...................................................................................................... 132
5.1 問卷之翻譯 ..................................................................................................... 132
5.2 量尺語詞之選擇 ............................................................................................. 133
5.3 試驗設計 ......................................................................................................... 135
5.4 預試用臺灣版MMAS-8 測試結果討論 ....................................................... 139
5.5 預試用臺灣閩南語版TSQM 測試結果討論 ................................................ 152
第六章 結論與建議.......................................................................................... 158
6.1 結論............................................................................................................... 158
6.2 研究創新與限制.............................................................................................. 159
6.3 建議及展望...................................................................................................... 160
參考文獻.............................................................................................................. 162
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