본태성고혈압 군인의 사회심리학적 요인과 고혈압관련 생활양식 및 복약이행과의 관계

Abstract

[한글]본 연구는 Cox의 ‘대상자 건강행위의 상호작용 모델’을 바탕으로 본태성고혈압 군인의 사회심리학적 요인과 고혈압관련 생활양식 및 복약 이행과의 관계를 규명하기 위해 시도된 서술적 상관관계 연구이다. 자료 수집은 10개 군병원 및 의무실 내과 외래에서 본태성고혈압을 진단받고 항고혈압제를 복용하고 있는 군인을 대상으로 자가보고식 설문지를 이용하여 2009년 10월 16일부터 11월 30일까지 6주간 실시하였고 202부가 최종 분석되었다. 자료분석은 SPSS 12와 STATA 10 프로그램을 이용하였다. 본 연구 결과를 요약하면 다음과 같다. 1. 본태성고혈압 군인의 연령은 평균 47.15±6.46세이고 기혼이 191명(94.6%), 가족과 동거가 174명(86.4%)으로 나타났다. 직업적 특성으로 계급은 부사관이 99명(49.3%)로 가장 많았고 복무기간은 평균 24.92±6.76년, 사무·행정 위주의 업무형태가 154명(81.5%), 업무로 인해 귀가하지 못한 일수는 한 달 평균 3.14일로 나타났다. 2. 고혈압 유병기간은 평균 4.88±4.18년, 항고혈압제 복용기간은 평균 3.79±3.51년이었다. 현재 흡연을 하고 있는 대상자는 56명(28.0%)이고 음주는 보통 소주 1병 이상을 마시는 대상자가 109명(54.0%)로 나타났으며 평균 BMI는 26.03± 2.43이었다. 3. 자기효능감은 85점 만점에 평균 67.47±8.18점이고 건강관련 목표설정은 98명(48.5%)이 건강관련 목표를 가지고 있었다. 지각된 건강상태는 평균 3.07±.89점이고 지각된 심각성은 44점 만점에 평균 27.07±4.80점이었다. 직무스트레스는 100점 만점에 평균 37.35±10.06점으로 영역별 ‘직무요구’, ‘직무자율성 결여’,‘조직체계’, ‘관계갈등’, '보상부적절’, ‘직장문화’, ‘직무불안정’의 순으로 나타났다. 의료진과의 관계는 35점 만점에 평균 27.79±3.83점으로 영역별 ‘건강정보’, ‘전문·기술적 능력’ ‘전반적인 만족도’ ‘정서적 지지’, ‘의사결정 통제’의 순으로 나타났다. 4. 고혈압관련 생활양식은 92점 만점에 평균 63.39±8.85점이고 영역별 ‘병원방문 약속 이행’, ‘자기감시’, ‘스트레스 관리’, ‘식이조절’, ‘운동’, ‘기호식품 제한’, ‘정보추구’ 순으로 나타났다. 복약 이행은 72명(37.1%)이 이행으로 나타났고 구체적 불이행 사유에는 ‘혈압약 복용 깜빡 잊음’이 91명(46.9%)으로 가장 많았다. 5. 고혈압관련 생활양식은 연령(p=.004), 복무기간(p=.007), 항고혈압제 복용기간(p=.036), 동반질환 유무(p=.032)에 따라 유의한 차이가 있었고 자기효능감(r=.208, p=.003), 지각된 건강상태(r=.273, p>.001), 의료진과의 관계(r=.211, p=.003), 직무스트레스(r=-.148, p=.035)와 유의한 상관관계가 있었다. 6. 복약 이행은 복무기간(p=.046), 업무형태(p=.006), 고혈압 유병기간(p=.005), 항고혈압제 복용기간(p=.032)에 따라 유의한 차이가 있었고 의료진과의 관계(r=.182, p=.011), 건강관련 목표설정 유무(r=-.149, p=.037)와 유의한 상관관계가 있었다. 7. 고혈압관련 생활양식에 영향을 미치는 요인에 대한 단계적 다중회귀분석 결과 지각된 건강상태, 동반질환 유무, 의료진과의 관계, 연령이 유의한 영향요인으로 나타났고 의료진과의 관계를 포함하여 설명력은 15.5%였다. 8. 복약 이행에 영향을 미치는 요인에 대한 로지스틱 회귀분석 결과 고혈압 유병기간과 의료진과의 관계가

유의한 영향요인으로 나타났고 고혈압 유병기간이 1∼5년의 대상자보다 11년 이상인 대상자가 6.305배 복약 이행할 확률이 높았고 의료진과의 관계가 1점 좋아질수록 1.145배 복약 이행할 확률이 높았다. 음주량과 BMI가 높은 것은 고혈압 군인의 절주 및 체중조절이 중점적으로 관리되어야 하고 복약 이행율이 37.1%로 치료에 기본이 되는 규칙적인 혈압약 복용이 강조되어야 할 것으로 사료된다f. 또한, 의료진과 대상자의 긍정적인 상호작용은 고혈압관련 생활양식 및 복약 이행을 높이기 위한 효과적인 전략으로 확인되었으며 이를 활용한 고혈압관리 프로그램이 개발되어야 할 것이다.

[영문]Descriptive correlational design was used in this study to measure the

relationships between psychosocial factors and hypertension-related lifestyle behaviors and medication adherence based on Cox's Interaction model of client health behaviors to provide basic information for hypertension management programs development for hypertensive military personnel.

Data were collected from patients with previously diagnosed of

hypertension and had taken the antihypertensive medication in 9 army hospitals and one army medical clinic. A self-reporting questionnaire was done between October 16th to November 30th, 2009. The questionnaire contained demographic information, health-related factors, self efficacy, health-related

goal setting, perceived health status, occupational stress, patient-provider relationship, hypertension-related lifestyle and medication adherence. A total of 202 questionnaires were analyzed by SPSS 12 and STATA 10 programs using descriptive statistics, t-test, analysis of variance, x2 test, Pearson correlation

coefficient, Phi and Cramer's V, Point biserial correlation coefficient, stepwise multiple regression, and logistic regression. The results of this study are summarized as follows:

1. The mean age for participants was 47.15 years. Participants were predominantly married(94.6%) and living with family members(6.4%). About half of participants(49.3%) were in the lieutenants, and the mean working period was 24.92±6.76 years. Majority of participants(81.5%) were working in offices or in administration, and the mean overtime working days which participants had to stay overnight were 3.14 days a month.

2. The mean years for having hypertension were 4.88±4.18 years, and the mean years for taking anti-hypertensive medication were 3.79±3.51 years. A total of 56(28.0%) were currently smoking, 109(54.0%) were drinking more than one bottle of Soju at one times, and the mean body mass index was 26.03±2.43 kg/m2.

3. The mean score for self efficacy was 67.47±8.18 from total of 85 points and 98(48.5%) participants answered they had at least one health-related goal. The mean score for perceived health status was 3.07±.89 on a 5-point Likert scale. The mean score for occupational stress was 37.35±10.06 from total of 100 points and most stress was from job demand. The mean scores for the patient-provider relationship was 27.79±3.83 from total of

35 points with health information being the most important factor among categories.

4. The mean score for hypertension-related lifestyle was 63.39±8.85 from total of 92 points with hospital visit adherence scoring the highest points among categories. Among participants, only 72(37.1%) were in good medication adherence. The most reason for medication non-adherence was forget to take medication(46.9%).

5. The degree of hypertension-related lifestyle was significantly differentiated according to the age(p=.004), working period(p=.007), years for taking anti-hypertensive medication(p=.036) and co-morbidity(p=.032), and significantly correlated with Self efficacy(r=.208, p=.003), perceived health

status(r=.273, p>.001), patient-provider relationship(r=.211, p=.003) and occupational stress(r=-.148, p=.035).

6. Significant association was found between medication adherence and working period(p=.046), occupational type(p=.006), length of having hypertension(p=.005) and years for taking anti-hypertensive medication (p=.032), and significant correlation was found between the medication adherence and patient-provider relationship(r=.182, p=.011), and health-related goal setting (r=-.149, p=.037).

7. 15.5% of variance of hypertension- related lifestyle was accounted for perceived health status, co-morbidity and patient-provider relationship.

8. The predictors for medication adherence were found to be the length of having hypertension and patient-provider relationship. Participants who had hypertension over 11 years tended to adhere to medication prescription compared to participants who had hypertension between 1 to 5 years, and participants tended to adhere to medication prescription 1.145 times more when the scores for patient-provider relationship goes 1 point higher.

These findings suggest that hypertensive military personnel need more drinking restriction and weight management, and improving medication adherence is most important factor. Collaborative patient-provider relationship will be a effective strategy to improve hypertension-related lifestyle and medication adherence, and these factors should be considered when designing programs.