基于焦点小组访谈法的患者针刺期望的质性研究

Patients' Expectations Regarding Acupuncture: A Qualitative Research Based on Group Interview

目的 从患者角度探索针刺期望的理论内涵,明确患者针刺期望的构成要素,并建立患者针刺期望构成要素间的关系模型。方法 采取目的抽样和滚雪球抽样法在北京中医药大学东直门医院、北京中医药大学东方医院、北京中医药大学房山中医院针灸科门诊选取20名以针刺为主要疗法的患者,将患者分为4组进行焦点小组访谈,其中,无针刺经历1组,有针刺经历3组。采用焦点小组访谈法,基于主题分析,利用NVivo 12.0质性研究软件对访谈文本进行词频分析与编码分析。采用NVivo 12.0软件中的“关系”工具初步绘出主题间的相互关系,借助“探索”工具中的模型功能,建立患者针刺期望的概念模型。结果 通过对4个焦点访谈小组的访谈文本逐级编码,析出740个初始代码,提炼出4个患者针刺期望的核心主题,包括感知反应、效价、知识、物质环境。感知反应涉及15个概念要素,包括针刺反应、医患信任、医生技术、接触程度、选择动机、接触渠道等;效价包括治疗效果、适宜病症、个体差异、治疗费用、见效时间、不良反应等9个要素;知识包括作用机制、理论体系、致病因素3个要素;物质环境涉及4个要素,包括针的材质、针的长度、医院环境、治疗环境。患者针刺期望构成要素间的关系模型基于如下假设:感知反应是影响患者针刺期望的关键因素,效价、知识、物质环境等均会对针刺的感知反应产生直接或间接影响。结论 患者针刺期望是一个多层次、多维度的概念,其核心构成要素包括感知反应、效价、知识和物质环境,这四个核心要素间的关系模型初步建立为3条核心假设作用路径,即感知反应路径、行为结果路径及自我效能路径,其中关键的调节变量包括感知、结果和效能。

Objective To explore the theoretical connotation of acupuncture expectations from the perspective of patients,clarify the elements of patients'expectations of acupuncture,and establish a relationship model among the elements.Methods With purposive sampling and snowball sampling,20 patients receiving acupuncture as the main therapy were selected from Dongzhimen Hospital,Dongfang Hospital,and Fangshan Hospital of Beijing University of Chinese Medicine.The patients were divided into four focus groups for interview,with three acupuncture-experienced groups and one naïve group.After the focus group interview,NVivo 12.0 software was used for word frequency analysis and text coding based on thematic analysis.The“relational”model of NVivo 12.0 software was used to initially draw the relationship between the theme nodes,and the“explore”model with modeling capacity was taken to establish the conceptual model of patients'expectations of acupuncture.Results Through the step-by-step coding of the interview texts of the four focus groups,740 initial codes were obtained involving four core themes of patients'expectations of acupuncture,which were sensory response,valence,knowledge,and material environment.Sensory response involved 15 conceptual elements,including acupuncture response,doctor-patient trust,doctor's skill,contact degree,choice motivation,contact channel,and others.Valence included 9 elements such as treatment effects,suitable diseases,individual differences,treatment costs,effective time,and adverse reactions.Knowledge included three elements which were mechanism of action,theoretical system,and pathogenic factors,while the material environment involved four elements including the material of the needle,the length of the needle,the hospital environment and the treatment environment.The relationship model among the elements of patients'expectations on acupuncture obeyed the assumptions that sensory response is a key factor affecting patients'expectations on acupuncture,and valence,knowledge,and material environment will all have a direct or indirect impact on acupuncture sensory responses.Conclusion Patients'expectation on acupuncture is a multi-level and multi-dimensional concept,whose core elements are sensory response,valence,knowledge,and material environment.The relationship model among these four elements is preliminarily established as three core hypothetical pathways,that is the sensory response path,the behavioral outcome path,and the self-efficacy path,in which the key moderator variables include sensation,outcome,and efficacy.