고혈압과 당뇨병 환자의 건강행위지속에 관한 구조모형 구축 = A Structural Model Development for Health Behavior Adherence in Hypertensive or Diabetetic Patients

다국어 초록 (Multilingual Abstract)

Health care provider are expected to attempt to assist patients with hypertension or diabetes to adhere to health care regimens in order to maximize client health status. Generally adherence is effective and considered adequate for meeting therapeutic goal. However, nonadherence is common and problematic.
The purpose of this study was to develop and test a structural model for health behavior adherence in patients with hypertension or diabetes.
A hypothetical model was constructed on the basis of self determination theory developed by Deci and Ryan, and a review of studies in the literature related to health behavior adherence.
The model include 6 theoretical concepts and 12 paths.
Data were collected from January 9 to February 25, 2008 using self-report questionnaires. The sample was 222 patients with hypertension or diabetes who visited outpatient clinics of 1 general hospital and 2 health center in Gyeongnam.
The collected data were analyzed with SPSS Win 14.0 program for descriptive data analysis and AMOS 5.0 Win program for structural equation modeling analysis.
The results are as follows:
1. In the verification of the model, After model identification doesn't consist, and depression of whole one theoretical variables was removed.
2. Most of the fitness indices of the hypothetical model were found to be adequate except the RMR(Root-mean-square residual=0.08).
3. The hypothetical model was modified by deleting 3 paths considering the theoretical implications and stastistical significance of parameter estimates. The results showed the fitness indices were improved[x2(p)= 38.366(.141), /df= 1.279, GFI= .968, AGFI= .941, RMSEA= .034, RMR= .067].
4. All of the 9 hypothesized paths were supported in the modified model. The theoretical variables of the modified model explianed 82% of the health behavior adherence. The hypotheses supported by the final model were as follows:
1) Variables that have a direct effect on health behavior adherence were autonomous motivation(β=.48, p<.01) and competence((β=.62, p<.01). The internal locus of control(γ=.43, p<.01) and health provider' autonomy support(γ=.11, p<.05) had only indirect effect on health behavior adherence.
2) Variables that have a direct effect on autonomos motivation were health provider' autonomy support(γ=.18, p<.05) and internal locus of control(γ=.34, p<.01).
3) Variables that have a direct effect on competence were internal locus of control(γ=.36, p<.01) and autonomos motivation(β=.22, p<.01). The health provider' autonomy support(γ=.04, p<.05) had only indirect effect on competence.
Based on this result, the competence as well as the autonomous motivation were very important to improve health behavior adherence. The health provider's autonomy support plays an important role in autonomous motivation to maintain health behavior. The internal locus of control had a positive influence on health behavior adherence through an autonomous motivation and a competence. Nursing intervention considering these components will promote health and prevent complications.

목차 (Table of Contents)

• 서론 = 1
• 연구의 필요성 = 1
• 연구의 목적 = 4
• 용어의 정의 = 4
• 문헌 고찰 = 7
• 건강행위지속 = 7
• 자기 결정성 이론 = 9
• 내적 건강 통제위 = 16
• 우울 = 18
• 이론적 기틀 = 21
• 개념 틀 = 21
• 가설적 모형 = 23
• 연구 가설 = 25
• 연구 방법 = 26
• 연구 설계 = 26
• 연구 대상 = 26
• 연구 도구 = 27
• 자료수집 방법 및 절차 = 30
• 자료 분석 방법 = 31
• 연구 결과 = 33
• 대상자의 일반적 특성 및 질병관련 특성 = 33
• 연구변수에 대한 요인분석 = 35
• 연구변수에 대한 기술통계 = 36
• 연구변수 간의 상관관계 = 37
• 가설적 모형의 검정 = 40
• 모형의 수정 및 검정 = 44
• 연구 가설의 검정 = 50
• 논의 = 52
• 모형의 타당성 = 52
• 건강행위지속에 영향을 미치는 요인들 = 53
• 연구의 의의 = 57
• 결론 및 제언 = 59
• 참고 문헌 = 62
• ABSTRACT = 73
• 부록 = 75
• 감사의 글 = 88