腎臟移植是治療末期腎衰竭病人的方法之一，然而病人術後仍需持續面臨許多慢性疾病併發的威脅，甚至危及生命。由文獻得知，執行健康行為能增加移植器官與病人的存活率，然而有關腎臟移植病人健康行為執行現況之研究不多欠缺完整性。本研究採橫斷式調查研究設計，針對南台灣某醫學中心接受腎臟移植後門診追蹤之腎友，進行問卷調查，以深入瞭解腎臟移植病人執行健康行為的狀況。問卷採專家效度及內在一致性Cronbach’s α進行效度及信度檢定。問卷調查結果以描述性統計、t檢定、變異數分析、卡方檢定、皮爾森相關、逐步迴歸、邏輯迴歸分析及無母數相對應統計方法進行分析。
自2008年5月至10月共收案191位，平均年齡47.13(±10.57)歲、男女比率相當（男性佔49.2%）。研究結果顯示，腎移植患者適度飲酒、不抽菸、服藥、飲食行為、排斥及感染徵象監測與處理執行最佳，以5分法計分，平均得分為4.89 (SD = 0.45), 4.81 (SD = 0.85), 4.73 (SD = 0.38), 4.19 (SD = 0.55) , 4.19 (SD = 0.57)；而以預防感染、壓力處理、運動行為、其他保健行為（防日曬、定期測血糖、定期癌症篩檢、正常作息）得分較低，平均得分為3.80, 3.76, 3.53, 2.81。雖然整體健康行為得分為4.02(SD = 0.43)，整體執行程度達76%，但38項健康行為中仍有18項有三成以上腎移植病人的得分≦3分，可見有很大的改善空間。腎友表達困難執行健康行為種類的前五項為規律運動、避免感染、健康飲食、良好壓力處理、辨識排斥症狀；而困難執行的原因前五項依序為缺乏動機、環境/情境、認知、時間及體能因素。醫護支持方面，結果顯示醫療團隊提供的訊息及情緒支持有助於腎友執行良好的健康行為；腎友主要的照護知識82%來自醫療團隊，然而有34%的個案認為醫療團隊提供的訊息及情緒支持偏不足，希望獲得更多的照護知識。與整體健康行為相關的因素為年齡較低、男性、無偶、經濟較低、移植後時間越長（＞2年）、醫護支持程度較低者其健康行為得分較低；健康行為越好其生活品質滿意度高。整體健康行為可由年齡、醫護支持及性別來預測，其總變異量(R2)達31.7%，其中年齡為最大之預測變項(R2=15.6%)。
結論：腎移植個案多數能執行良好健康行為，但仍有近半數的健康行為有超過30%的腎友未能良好執行。建議依本研究健康行為建立一評核表格對腎移植個案做持續性評估，了解其困難執行原因，協助養成健康行為的習慣，尤其針對年齡＜30歲、男性、抗排斥藥使用＞3種、腎移植後＞2年之個案應特別注意，可利用電腦系統協助臨床人員快速篩檢對象。

Patients who receive kidney transplantation continuously face the possible complication of chronic diseases, so that the threat to their life still exists. It is reported that certain health behaviors could increase the graft survival rate and consequently decrease the mortality rate. To date, there have been few studies on the health behaviors of kidney recipients, and those that do exist generally do not offer a thorough investigation of the topic. The purpose of this study was to investigate factors related to individual health behaviors among patients who had suffered from chronic kidney disease and then received a kidney transplant. The elements investigated included: diet control, adherence to medication regimen, regular physical exercise, graft rejection monitoring, prevention of infection, stress management, quitting smoking, moderate drinking, and other health behaviors, such as avoiding direct sunlight, and submitting to regular blood sugar monitoring, cancer screening and lifestyle. A cross-sectional research design and purposive sampling was used to recruit subjects who had received kidney transplantation and had been discharged for more than three months from a medical center in southern Taiwan. Structured questionnaires and face-to-face interviews were used to collect the data, and the validity and reliability of questionnaires were tested by content validity and Cronbach’s α for internal consistency. SPSS/PC software version 10.0 was used to apply descriptive and inferential statistics to the data analysis.
A total of 191 subjects were recruited, the average age was 47.13 (±10.57) years old, and 50.8% were female. The results showed that average scores for subjects’ moderate drinking, non-smoking, adherence to medication regimen, diet control and graft rejection monitoring behaviors, as rated on a five-point Likert Scale, were higher, at 4.89 (SD = 0.45), 4.81 (SD = 0.85), 4.73 (SD = 0.38), 4.19 (SD = 0.55), and 4.19 (SD = 0.57), respectively. In contrast, the scores for infection prevention, stress management, regular exercise and other behaviors were lower, at 3.80, 3.76, 3.53, 2.81, respectively. Although, the total average score of health behavior was 4.02 (SD = 0.43). But, for the 18 out of 38 behaviors that received lower performance scores, more than 30% patients didn’t do well for these actions.
Regular exercise, infection prevention, diet control, stress management, and identifying rejection signs and symptoms were the top five health behaviors that were reported to be the most difficult to undertake, while the top five reasons reported for difficulties in following such behavior were lacks of motivation, related knowledge, time and a convenient environment, as well as physical constraints. The findings suggest that more strategic health education and instruction on the 12 health behavior factors examined in this study are needed for kidney transplant recipients.
The correlative results indicate that significantly lower performance with regard to health behaviors was more likely in individuals who were younger, male, unmarried, had lower economic status and social support and for whom it had been more than two years since their transplant surgery. Moreover, a higher score with regard to the health behaviors examined in this study was associated with better quality of life. In summary, three factors explained 31.7% of the variance in total health behavior: age (R2=15.6%), social support (R2=8.5%), and gender (R2=7.5%).
The findings of this study suggest that most kidney transplant recipients are able to perform the recommended actions, although about half of the specific behaviors were found to require more effort. More support is recommended from healthcare providers to improve the health behaviors of kidney recipients, and the results suggest that, patients undergoing renal transplantation need to be continuously monitored with regard to their motivation and barriers in order to receive appropriate education to overcome the difficulties they face. In addition, the 12 health behaviors suggested in this study can be designed as a follow-up checklist for health care professionals to provide integrity and continuity care.

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