研究背景:
吸藥依從性不佳是慢性肺阻塞患者疾病自我管理存在已久的難題，除了人口學背景、疾病嚴重度、吸藥操作技巧、治療方針及生活品質等外在因素，患者本身對疾病的態度、對於管理疾病的信心程度及不同社會角色對患者的影響力等內在因素，皆有可能影響患者的吸藥行為。目前，以慢性肺阻塞患者吸藥依從性作為計畫行為理論模型預測因子的研究甚少，此為國內首篇運用計畫行為理論探討影響台灣慢性肺阻塞患者吸藥依從性行為意圖的研究，希望藉由此研究找出影響慢性肺阻塞患者吸藥意圖的內外在因素。

研究目的:
一: 以吸藥依從性作為預測因子並驗證慢性肺阻塞族群的模型適用性。
二: 應用計畫行為理論模型找出影響慢性肺阻塞患者吸藥依從性的因素。
三: 探討人口學變項及臨床特徵與計畫行為理論各構面間的相關性。

研究方法:
本研究根據計畫行為理論編制慢性肺阻塞吸藥依從性行為意圖問卷，最主要的研究目的是分析計畫行為理論模型於台灣慢性肺阻塞患者吸藥依從性的適用性。透過嚴謹的驗證性因素分析及信效度檢驗以確保測量模型的內外在品質，並使用結構方程模型(Structural Square Model ,SEM)進行模型整體適配度檢驗及路徑分析，試圖了解慢性肺阻塞疾病吸藥依從性模型各構面間之因果關係、中介效應及模型整體預測能力。

研究結果:
本研究總共收入235位受訪者，平均年齡為73.16±16.7歲，男性受訪者占93.6%，慢性肺阻塞疾病嚴重度多為低風險族群(Group A 71.9%,Group B占20.9%)，有效問卷回收率為100%。本研究使用對角加重最小二乘 (Diagonally Weighted Least Squares , DWLS)估計法進行模型適配度檢驗，驗證性因素分析及結構方程模型分析的各項適配指標結果均達到優良標準(Comparative Fit Index=1.0, Tucker-Lewis Index=1.0, Root Mean Square Error of Approximation=0.00, Standardized Root Mean Square Residual=0.05)。結構模型路徑分析結果可發現，主觀規範對於行為意圖具有最大的直接影響力(路徑係數為0.340,P=0.001)，態度次之(路徑係數為0.241,P<0.001)，而知覺行為控制對於行為意圖及實際行為則無顯著影響直接影響力(路徑係數為0.032, P=0.446)。最終結果發現，計畫行為理論結構模型對於慢性肺阻塞患者確實吸藥的行為意圖及吸藥依從性的整體解釋力分別為27.4 %及10%。

結論:
本研究結果發現，以吸藥依從性作為預測因子的計畫行為理論模型部分適用於台灣慢性肺阻塞疾病患者，使用貼近本國慢性病肺阻塞疾病臨床狀況設計的行為意圖問卷，並挑選具有良好信效度且專門測量慢性肺阻塞吸藥依從性的中文版TAI問卷作為研究工具，除了較能反映真實的臨床現象也盡可能解決不同文化差異的干擾，期盼本研究結果能作為臨床醫師訂定醫療策略的依據，試圖達到提升本土慢性肺阻塞疾病患者的吸藥依從性及疾病品質控制的目標。

Our study found that the Theory of Planned Behavior model with inhalation adherence as a predictor was partially applicable to patients with the chronic pulmonary obstructive disease (COPD). The study's results found that the attitude and subjective norms of patients with COPD toward drug inhalation might directly associate with inhalation intentions; moreover, the intention of inhalation might directly associate with the final behavior. In contrast, the perceived behavioral control was not significantly associated with behavioral intentions and inhalation adherence, and a possible reason is the ceiling effect. In this study, the behavioral intention questionnaire was designed based on the Theory of Planned Behavior and aimed to meet the clinical situations. The present study's findings fit the clinical phenomenon of patients with COPD in Taiwan. It is anticipated that the results of this study can provide clinicians with the basis for formulating medical strategies to improve the inhalation adherence and disease control quality of patients with COPD in Taiwan.

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