本研究基於管理角度，探討缺血性腦中風患者與相關醫療人員，對於次級預防之想法。研究者以健康信念模型 (health belief model, HBM)，探討缺血性腦中風的患者的自我評估與次級預防行為；並以知識態度實踐/行為模型 (knowledge-attitude-practice/behavior model, KAP/KAB)，分析相關醫療人員對於次級預防的醫療服務。並以質性研究方法中的詮釋學，基於HBM與KAP模型，各自設計半結構式個別深度訪談指引，總共收錄11位患者與11位相關醫療人員。
受訪患者於初次腦中風後，殘留嚴重不一的後遺症，大部分有想過可能再次腦中風，也擔心再次腦中風後會加重行動不便與經濟困難，所以在初次腦中風後，願意服用藥物與控制危險因子，包含飲食、運動、少碰菸酒、情緒控制、作息正常、量測並控制血壓等，並強調意志力與決心的重要。自身腦中風的後遺症與他人的關心，會增強患者的次級預防意圖。尚未退休的患者，提到需要抵擋他人或環境的障礙與誘惑，比如請菸。
醫療人員認為腦中風次級預防最重要的是危險因子的控制與服藥遵從性，並提到衛教、整合醫療與社會資源的知識與行為，與個案管理之重要性與對此之期待。為了提高患者的次級預防，部分醫療人員使用規避損失與夥同照護者之方法。雖然5位醫師與1位護理師抱持輕微負向態度，但仍希望患者對自身健康負起責任與做出合適的調整，而持續執行醫療與健康行為。
本研究提出三點可行之改善方法：衛教宣傳、醫病之間的溝通與互動、個案管理，提供給有興趣之患者與相關醫療人員參考。
腦中風所伴隨而來的後遺症，帶給患者、旁人與社會龐大的負擔。本研究在此針對腦中風次級預防，提出三項可行之方法，盼志同道合的夥伴們共同努力！
關鍵詞：缺血性腦中風、缺血性腦中風次級預防、健康信念模型、認知態度實踐/行為模型、個案管理。

This study, from a management perspective, explores the perspectives of ischemic stroke patients and related medical personnel on secondary prevention. The researcher uses the Health Belief Model (HBM) to examine self-assessment and secondary prevention behaviors in ischemic stroke patients. Additionally, the Knowledge-Attitude-Practice/Behavior Model (KAP/KAB) is used to analyze medical providers' attitudes toward secondary prevention services. Employing an interpretive approach within qualitative research, based on the HBM and KAP models, semi-structured individual in-depth interview guides were designed, encompassing 11 patients and 11 medical personnel.
Interviewed patients, dealing with varying degrees of residual effects post-initial stroke, express concern about recurrence and its implications for mobility and finances. Consequently, they are inclined to adhere to medication and control risk factors.
Medical professionals consider controlling risk factors and medication adherence vital for stroke secondary prevention. They emphasize the significance of health education, integrating medical and social resources, understanding, and case management.
The study proposes three feasible improvement methods: health education promotion, doctor-patient communication and interaction, and case management. Stroke's aftermath brings substantial burdens to patients, caregivers, and society. This study offers three practical methods for stroke secondary prevention, hoping for collaborative efforts among like-minded partners.
Keywords: ischemic stroke, secondary stroke prevention, Health Belief Model (HBM), Knowledge-Attitude-Practice/Behavior model (KAP/KAB), case management.

目 錄
論文審定書………………………………………………………………………………………… i
論文公開授權書………………………………………………………………………………………… ii
誌謝…………………………………………………………………………………… iii
中文摘要……………………………………………………………………………… iv
Abstract……………………………………………………………………………… v
目錄…………………………………………………………………………………… vi
圖次與表次…………………………………………………………………………………… viii
第 一 章 緒論……………………………………………………………………………………… 1
第一節 研究背景與動機…………………………………………………………… 1
第二節 研究目的……………………………………………………………………… 3
第 二 章 文獻探討………………………………………………………………………………………. 4
第一節 腦中風的簡介………………………………………………………………… 4
第二節 腦中風於全球與中華民國的衝擊……………………………………… 11
第三節 影響腦中風患者次級預防的因素………………………………………… 14
第四節 相關醫療人員的知識態度實踐/行為…………………………………… 16
第五節 國內外相關文獻……………………………………………………………… 18
第六節 本章小結…………………………………………………………………… 27
第 三 章 研究方法………………………………………..……………..…………… 28
第一節 研究設計……………………………………………………………………… 28
第二節 研究對象與工具……………………………………………………………… 30
第三節 資料分析……………………………………………………………………… 34
第四節 研究品質……………………………………………………………………… 36
第五節 研究倫理……………………………………………………………………… 36
第六節 研究過程……………………………………………………………………… 37
第 四 章 結果………………………………………………………………………… 38
第一節 受訪者基本資料……………………………………………………………… 38
第二節 以HBM模型分析患者………………………………………………………… 42
第三節 以KAP模型四分析相關醫療人員………………………………………… 49
第四節 本章小結……………………………………………………………………… 56
第 五 章 討論………………………………………………………………………… 61
第一節 衛教宣傳…………………………………………………………………… … 62
第二節 醫病之間的溝通與互動…………………………………………………… 66
第三節 個案管理……………………………………………………………………… 68
第四節 本研究限制…………………………………………………………………… 70
第五節 本研究貢獻…………………………………………………………………… 71
第六節 未來展望……………………………………………………………………… 71
第 六 章 結論……………………………………………………………………… 72
參考文獻…………………………………………………………………………….. 74
附錄………………………………………………………………………………….. 84

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