폐결핵환자의 자아개념(Self-concept)과 건강신념(Health beliefs)이 치료적행위 이행에 미치는 영향

Abstract

[한글]

정부에서는 결핵관리사업을 보건정책의 주요사업으로 채택하여 꾸준히 추진한 결과 결핵유병율이 현저히 감소하고 있기는 하지만, 아직도 선진제국에 비교할 때 상당히 높은 수준에 머물러 있다. 특히 국가의 미래를 짊어진 대학생들의 이 질환에 대한 치료적행위 이행을 함에 있어서 자아개념과 건강신념이 어떤 영향을 미치는 가를 다각적인 변수를 통하여 식별하고 분류하여 그 이행정도를 미리 예측하여 봄으로써 대학생들의 건강관리지도 및 건강교육에 뒷받침이 될 것으로 사료되어 본 연구를 시도하게 되었다.

본 연구는 폐결핵환자의 자아개념, 건강신념 (민감성, 심각성, 유익성)과의 관계 파악 및 제변수간의 상관성과 이행에 관여하는 다각적인 변수들을 식별하고 분류하여 이행정도를 예측하여 환자들의 이행율을 높이는 데 그 목적이 있다.

연구대상은 1981년9월1일부터 1983년3월31일까지 1년 6개월 동안 Y대학교 보건진료소에 초기활동성폐결핵으로 등록된 남녀 대학생 88명이며 질문지와 면담방법을 사용하여 자료를 수집하였다.

연구도구는 최정훈의 지각향성검사도구 중 인지적자아 20문항과 Rosenberg의 평가적자아 10문항, 본인이 문헌을 기초로 작성한 건강신념척도를 이용하였다.

자료의 분석은 Descriptive Statistics, χ**2 -test, Pearson correlation, t-test, Discriminant Analysis의 통계방법을 이용하였다.

연구결과는 다음과 같다.

1. 가설검증

제 1가설 : "자아개념이 높은 폐결핵환자는 건강신념도 높을 것이다."

α= · 05유의수준에서 r=-, 0756, p > · 05로 기각되었다.

제 2가설 : "자아개념이 높은 폐결핵환자는 치료적행위이행정도도 높을 것이다."

α= · 05유의수준에서 r=· 1558, p > · 05로 기각되었다.

제3가설 : "폐결핵이환에 대한 민감성이 높은 환자는 치료적행위이행정도가 높을 것이다."

α= · 05유의수준에서 r=-, 1975, p < · 05로 부정적관계를 보여 기각되었다.

제 4가설 : "폐결핵이환에 대한 심각성이 높은 환자는 치료적행위이행정도가 높을 것이다."

α= · 05유의수준에서 r= · 1642, p > · 05로 기각되었다.

제 5가설 : "폐결핵치유를 위해 인지된 유익성이 높은 환자는 치료적행위이행정도가 높을 것이다. "

α= · 05유의수준에서 r=· 3129, p · 001로 채택되었다.

2. 제변수간의 상관성분석에서는 치료적행위이행과 민감성과는 부정적으로 유의한 관계를 나타내어 (r=- · 1975, p < · 05) 민감성이 낮아짐에도 치료적행위이행정도가 높아짐을 보였다. 자아개념과 민감성과도 부정적으로 유의한 관계를 나타내어 (r=- · 1790, p < · 05) 자아개념이 높을수록 민감성이 낮아짐을 보였고 자아개념과 유익성은 긍정적으로 유의한 관계를 나타내어 (r= · 1970, p < · 05) 자아개념이 높을수록 폐결핵치유를 위해 인지된 유익성이 높아짐을 보여주었다. 결과적으로 폐결핵에 대해 인지한 민감성이 낮았음에도 치료적행위이행정도와 자아개념이 높았음을 보여주었다.

3. 본 연구의 목적을 달성하기 위하여 18개의 독립변수를 식별하여 이 분석기준에 만족하는 7개의 독립변수로써 이행정도의 높고 낮음으로 구분짓는 분류함수를 통하여 각기 상응하는 그룹으로 분류하게 되었다.

본 연구에서의 이 분류함수의 적응은 이행정도가 낮은 그룹에 속하는 47명의 환자 중 74.5%인 35명이, 이행정도가 높은 그룹에 속하는 41명의 환자 중 87.8%인 36명이 제대로 분류되었다. 총괄적으로 80.7%가 바르게 분류되어 본 연구에서 이 분류함수의 높은 "예측도"를 보여주었다.

따라서 이를 이용하여 이행정도를 미리 예측해 볼 수 있으므로, 낮은 그룹에 속하는 대상자에 대한 건강관리지도 및 교육을 강화할 수 있게 된다.

[영문]

The proportion of people who contacted pulmonary T.B. in Korea has drastically decreased as a result of the incessant effort of the Korean government welch adopted a policy of "drive out T.B." as its foremost health policy. However, the proportion still remains relatively high compared with that of developed countries. This study attempts to find some means for guiding and educating college students who have T.B. in their health care by (1) first determining the effect of their self-concept and health beliefs on their behavior in regard to their disease and (2) then predicting the level of compliance of the new patients to the treatment suggested by the health specialist, before the commencement of the treatment.

This thesis aims at increasing the level of compliance of new patients by (1) finding the relationship between patients' self-concept and their health beliefs, i.e., susceptibility, severity and benefit of treatment, (2) finding the correlation between their compliance and the variables mentioned above and finally

(3) determining the factors which affect compliance and predicting the level of compliance of new patients in advance.

The subjects of this study consisted of 88 male and female students at Y University who were diagnosed as minimal pulmonary T.B. patients and registered at the health clinic of Y University during the period between September 1, 198l and

March 31, 1983. Data were collected from them by means of questionnaire and interview.

The instruments used for this study were (1) a part of Junghoon Choi's "Perceptual Orientation Scale" for measuring self-perception of patients' and (2) Rosenberg's questionnaire for measuring patients' evaluation of self-esteem, and (3) an instrument for measuring patients' health beliefs which was developed by this researcher utilizing information available from references. The collected data were analyzed using descriptive statistics, chi-square test, Pearson correlation coefficient, t-test and discriminant analysis.

The findings were as follows :

1. Test of hypotheses

1) Hypothesis 1: Patients with high self-concept will be high in health beliefs.

For testing this hypothesis a calculation of Pearson correlation coefficient(r) between the patients' self-concept and their health beliefs was carried out. The result of this test was -.0756 which was not significant at α=.0 5 and hence hypothesis 1 was not supported.

2) Hypothesis 2: Patients with a high self-concept will tend to be high in compliance with the suggested treatment.

Again a Pearson correlation coefficient was calculated between the two variables in the hypothesis. The calculated coefficient r was. 1558 which was not significant at α=.05.

Hence hypothesis 2 was rejected.

3) Hypothesis 3: Patients with high susceptibility will have a high compliance level .

The correlation coefficient between the two variables was -.1975, which was significant at α=.05 but due to the negative sign hypothesis 3 could not be accepted.

4) Hypothesis 4: Patients who take their disease seriously will have a higher compliance level.

The calculated correlation coefficient between the variables in this hypothesis was. 1642 which was not significant at α=.05 and hence hypothesis 4 was rejected.

5) Hypothesis 5: Patients with a high sense of the benefit of treatment will have a high level of compliance.

The computed correlation coefficient was .3129 which was significant at a α=.05 and hence hypothesis 5 was accepted.

2. Findings from the correlation analyses were as follows :

1) Patients' susceptibility and their compliance to treatment was negatively correlated (r=-.1975) which was significant at α=.05. This implies that as the patients' level of susceptibility increases their compliance level decreases.

2) Patients' susceptibility and their self-concept were negatively correlated (r=-.1790) which was again significant at α=.05. The implication of this is that as the patients' self-concept increases their susceptibility to disease decreases.

3) Patients' self-concept and their sense of benefit derived from the treatment was positively correlated (r=.1970) which was significant at α=.05. That is, patients with a high self-concept perceived a great sense of benefit from the treatment.

To summarize, patients who are low in susceptibility have a high level of compliance and self-concept.

3. To achieve the objectives of this research a discriminant analysis was carried out. Seven variables were selected from a pool of 18 variables because only the seven satisfied the selection criteria. then classification rules were made, utilizing those seven variables to classify patients into two groups: one group was composed of those of a high compliance level and the other group, those with a low compliance level. They were tested on actual data with the following results: 74.5%

of the total 47 patients with a low compliance level were correctly classified and 87.8% of the total 41 patients with a high compliance level were correctly classified. Overall, 80.7% of the total 88 patients were correctly classified and this showed the strength of out classification function. thus it is feasible to predict the compliance levels of new patients and hence we can intensify guidance and education of health care of the patients with predicted low compliance level.