만성 심부전 남성 노인의 건강정보이해능력, 신체활동 및 악력이 자가간호이행에 미치는 영향

Abstract

This is an investigational descriptive study to verify the correlation between Male Elderly with health literacy , physical activity and Hand Grip Strength on self-care compliance of chronic heart failure. The subject of this study is 106 outpatients diagnosed with chronic heart failure among male elderly patients aged 65 or older who visited a 1,000-bed national hospital for people of national merit in Seoul for cardiological treatment. The data was collected from Feb 7, 2022 to Apr 10, 2022. As measurement tools, health literacy was measured using the health literacy measurement tool developed by Shim Jeong-eun(2021) for cardiovascular disease patients, the Global Physical Activity Questionnaire(GPAQ) for physical activity, and hand grip strength using a dynamometer(T.K.K.-5401, Japan), and the European Heart Failure Self-care Behavior(EHFScB) was used for self-care compliance measurement. With the use of SPSS/23.0 program, real numbers, percentages, and standard deviations of the collected data were calculated, and t-test, ANOVA, Scheffé, χ2-test, Fisher’sexact test, Pearson’s correlation coefficient, hierarchical multiple regression analysis were conducted. The internal reliability of the tools was analyzed with Cronbach’s α coefficient.

The results are as follows.

1. The subject’s health literacy was 67.50±8.22 out of 88. In terms of the sub-category, health literacy and exploration was 12.76±2.22 out of 16, interaction with the medical workers was 13.50±2.43 out of 16, utilization of health information supporting resources was 18.22±3.13 out of 24, and active selection and evaluation of health information was 23.07±3.50 out of 32. The average level of their physical activities was 1676.42±1596.94MET, with 28 people in the high physical activity group (26.4%), 50 people in the moderate physical activity group (54.7%), and 20 people in the low physical activity group (18.9%). Their average grip strength was 23.9±6.95, with 64 people in the muscle mass decrease group (60.4%) and 42 people in the normal group (39.6%). The level of self-care compliance was 42.21±6.03 out of 60. The average score was 3.44 out of 5, and by sub-category, self-care regarding administration of medicine was the highest with 4.75±0.76, influenza vaccination was 4.37±0.87, rest was 4.35±0.88, exercise was 3.68±1.15, and the lowest was limitation in water intake, which was 2.39±1.00.

2. Health literacy according to the general and clinical characteristics of the subject showed a significant difference in regular exercise (t=3.50, p<.001), and physical activities showed a significant difference in regular exercise (X2=20.75,p=.<001). Grip strength showed a statistically significant difference in last educational background (F=5.13, p=.008) and self-care compliance showed a significant difference in economic activities (t=-2.19, p=.031), caregiver (t=3.57, p<.001), drinking (t=2.65, p=.009), and regular exercise (t=1.98, p=.050).

3. The subject’s health literacy had a statistically significant correlation with physical activities (r=0.27, p=.006), grip strength (r=0.21, p=.033), and self-care compliance (r=0.50, p<.001), and physical activities had a positive correlation with grip strength (r=0.23, p=.017) and self-care compliance (r=0.28, p=.004). There was no significant correlation between grip power and self-care compliance (r=0.02, p=.804).

4. The result of hierarchical multiple regression analysis showed that health literacy, drinking, and physical activities, caregivers are the predictors influencing self-care compliance, with 45% explanation. The most influential factor was health literacy (β=.46, p<.001).

These results identified that health literacy, physical activities and self-care compliance were in connection with each other. Health literacy and physical activities were identified as the factors influencing self-care compliance while the demographic characteristics of economic activities, caregiver, drinking, and regular exercise were controlled. Through the above study, it was confirmed that an educational strategy to promote self-care compliance is necessary by periodically identifying health literacy and physical activities of the male elderly with chronic heart failure. It can be used as basic data to develop disease control programs and educational materials that can improve self-care compliance. |본 연구는 만성 심부전 남성노인들의 건강정보이행능력, 신체활동, 악력 및 자가간호이행의 관계를 규명하기 위한 서술적 상관관계 조사연구이다. 본 연구의 대상은 서울 소재 1,000병상 규모의 유공자 대상 국공립 병원 순환기내과에 내원한 만 65세 이상의 남성 노인 환자 중 만성 심부전 진단을 받은 외래 환자 106명을 대상으로 하였고 자료수집기간은 2022년 2월 7일부터 4월 10일까지였다. 측정도구로 건강정보이해능력은 심정은(2021)이 개발한 심혈관질환자의 건강정보이해능력 측정도구, 신체활동은 GPAQ(Global Physical Activity Questionnaire), 악력은 악력계(T.K.K.-5401, Japan)를 사용, 자가간호이행은 EHFScB(European Heart Failure Self-care Behavior)를 사용하였다. 수집된 자료는 SPSS 23.0 프로그램을 이용하여 실수와 백분율, 평균과 표준편차, t-test, ANOVA, Scheffé, χ2 -test와 Fisher's exact test, Pearson’s correlation coefficient, Hierarchical multiple regression analysis를 실시하였으며, 도구의 내적 신뢰도는 Cronbach’s α 계수로 분석하였다

본 연구 결과는 다음과 같다. 1. 대상자의 건강정보이해능력 정도는 88점 만점에 67.50±8.22점이었다. 하위영역별로 건강정보이해 및 탐색은 총 16점 만점에 12.76±2.22점, 의료진과의 상호작용은 총 16점 만점에 13.50±2.43점, 건강정보지지자원 활용은 총 24점 만점에 18.22±3.13점, 능동적 건강정보의 선별 및 평가는 총 32점 만점에 23.07±3.50점이었다. 신체활동 수준은 평균 1676.42±1596.94METs로 고신체활동군이 26.4%(n=28), 중신체활동군은 54.7%(n=50), 저신체활동군은 18.9%(n=20)이었다. 평균 악력은 25.7±7.1kg으로 근감소군은 46.2%(n=49), 정상군은 53.8%(n=57)이었다. 자가간호이행 정도는 60점 만점에 42.21±6.03점으로 최대 5점에 평균 3.44점으로 하위항목별로 투약 관련 자가행위가 4.75±0.76점으로 가장 높았고, 독감예방접종 4.37±0.87점, 휴식 4.35±0.88점, 운동 3.68±1.15점 순이었고 가장 낮은 항목은 수분섭취제한 2.39±1.00점이었다. 2. 대상자의 일반적 특성 및 임상적 특성에 따른 건강정보이해능력은 규칙적 운동(t=3.50, p<.001)에 유의한 차이가 있었고 신체활동은 규칙적 운동(X2=20.75, p=.<001)에 유의한 차이가 있었다. 악력은 최종학력(F=5.13, p=.008)에 유의한 차이가 있었고 자가간호이행은 경제활동(t=-2.19, p=.031), 돌봄제공자(t=3.57, p<.001), 음주(t=2.65, p=.009), 규칙적 운동(t=1.98, p=.050)에서 유의한 차이를 나타내었다. 3. 대상자의 건강정보이해능력은 신체활동(r=0.27, p=.006)과 악력(r=0.21, p=.033), 자가간호이행(r=0.50, p<.001)에 통계적으로 유의한 양의 상관관계를 보였고, 신체활동은 악력(r=0.23, p=.017), 자가간호이행(r=0.28, p=.004)와 정적 상관관계가 있었다. 악력과 자가간호이행의 상관관계는 유의하지 않았다(r=0.02, p=.804), 4. 위계적 다중회귀분석 결과 심부전 환자의 건강정보이해능력과 음주, 신체활동, 돌봄제공자가 45%의 설명력으로 자가간호이행에 영향을 미치는 예측 요인임을 확인하였고 이중 가장 큰 영향력이 있는 요인은 건강정보이해능력(β=.46, p<.001)이었다.

본 연구 결과, 건강정보이해능력, 신체활동 및 자가간호이행은 관계가 있음을 확인하였다. 경제활동, 돌봄제공자, 음주, 규칙적 운동의 인구학적 특성을 통제한 상태에서 건강정보이해능력과 신체활동은 자가간호이행에 영향을 미치는 요인으로 확인되었다. 이상의 연구를 통해 만성 심부전 남성 노인의 건강정보이해능력과 신체활동 수준을 주기적으로 파악하여 자가간호이행 증진을 위한 교육전략이 필요함을 확인하였고 자가간호이행을 향상시킬 수 있는 질병관리프로그램 및 교육자료를 개발하는데 기초자료로 활용될 수 있을 것이다.