유방암 환자를 대상으로 한 항암화학요법 부작용 자기관리 모바일 애플리케이션 개발 및 적용 효과 = The Development and Evaluation of a Mobile Application for Self-Management of Chemotherapy Side Effects in Breast Cancer Patients

다국어 초록 (Multilingual Abstract)

This study was aimed to develop and evaluate an app for the self-management of side effects of chemotherapy based on the Information-Motivation-Behavioral Skills (IMB) model. The IMB model posits that enhancing information, motivation, and behavioral skills related to self-management can improve self-management behaviors, thereby enhancing patients' health status and quality of life. In this study, we enrolled female patients with breast cancer to test the effectiveness of the app. The ADDIE model was used, which encompasses five stages: analysis, design, development, implementation, and evaluation. The effectiveness of the app was assessed by measuring changes in information, personal motivation, social motivation, and behavioral skills, with a focus on * A thesis for the degree of Doctor in August 2024. self-management adherence, quality of life, and the severity of side effects. The patients were scheduled for at least four consecutive cycles of Adriamycin plus cyclophosphamide (AC) or docetaxel plus cyclophosphamide (TC) chemotherapy at 3-week intervals post-surgery. Data for the control group were collected from October 15, 2021, to July 20, 2022, and for the experimental group, from October 13, 2023, to May 13, 2024. Based on the selection criteria, 33 patients were included: 16 in the experimental group and 17 in the control group. A non-equivalent control group pretest-posttest non-synchronized design was used to verify the effects. The experimental group used the app for 9 weeks, while the control group received standard education. Data collection for the experimental and control group was conducted before app use and standard education, 3 weeks after use and standard education (before the second cycle injection), and 9 weeks after use and standard education (before the fourth cycle injection). Homogeneity tests were performed using independent t-tests, Mann-Whitney U tests, chi-square tests, and Fisher’s exact tests. To verify the effectiveness of self-management for chemotherapy side effects, changes in self-management knowledge, health attitude, social support, and quality of life over time within groups were analyzed using repeated measures analysis of variance or generalized estimating equations. Mann-Whitney U tests were used to analyze self-efficacy, self-management behaviors, side-effect severity, and physiological indicators. After 9 weeks of intervention, the severity of chemotherapy side effects and physiological indicators were not significantly different, while self-management knowledge (Wald χ2 = 6.42; p = .040), health attitude (Wald χ2 = 9.21; p < .001), social support (Wald χ2 = 75.62; p < .001), self-efficacy (U = 25.50; p < .001), self-management behaviors (U = 41.00, p = .001), and quality of life (Wald χ2 = 138.10; p < .001) showed significant differences. The improvement in self-management knowledge, health attitude, social support, self-efficacy, self-management behaviors, and quality of life in the experimental group indicate the effectiveness of the developed app for self-management of side effects of chemotherapy. These results demonstrate the potential use of the app for self-managing chemotherapy side effects. Keywords: Mobile Applications, Smartphone, Chemotherapy, Breast Neoplasms, Self-Management, knowledge, behavior, Attitude to Health, Social Support, Self Efficacy, Drug-Related Side Effects and Adverse Reactions, Physiological Effects of Drugs, Quality of Life.

목차 (Table of Contents)

• I . 서 론 1
• 1. 연구의 필요성 1
• 2. 연구 목적 4
• 3. 용어 정의 5
• II . 문헌 고찰 11
• 1. 유방암의 항암화학요법 11
• 2. 모바일 애플리케이션을 활용한 자기관리 프로그램 15
• 3. 정보-동기-행동기술 모델 19
• 4. 항암화학요법 부작용 자기관리와 정보-동기-행동기술 모델 23
• 1) 정보: 항암화학요법을 받는 환자의 자기관리 지식 23
• 2) 동기 30
• (1) 건강태도 30
• (2) 사회적 지지 32
• 3) 행동 기술 35
• (1) 부작용 증상일지 35
• (2) 자기효능감 36
• 4) 행동: 자기관리 행위 39
• 5) 건강결과 42
• (1) 항암화학요법 부작용의 중증도 및 생리적 지표 42
• (2) 삶의 질 44
• III . 연구의 개념적 기틀 및 가설 48
• 1. 연구의 개념적 기틀 48
• 2. 연구 가설 51
• IV . 연구방법 52
• A. 항암화학요법 부작용 자기관리 애플리케이션의 개발 52
• 1. 분석 단계 53
• 2. 설계 단계 54
• 3. 개발 단계 57
• 4. 구현 단계 58
• 5. 평가 단계 58
• B. 항암화학요법 부작용 자기관리 애플리케이션 적용 효과평가 60
• 1. 연구 설계 60
• 2. 연구 대상 60
• 3. 연구 도구 63
• 4. 자료수집 방법 67
• 5. 자료 분석 방법 72
• 6. 연구의 윤리적 고려 73
• V. 연구결과 74
• A. 항암화학요법 부작용 자기관리 애플리케이션 개발 74
• B. 항암화학요법 부작용 자기관리 애플리케이션 효과 101
• VI. 논의 127
• 1. 항암화학요법 부작용 자기관리 애플리케이션 개발 127
• 2. 항암화학요법 부작용 자기관리 애플리케이션 효과 130
• 3. 연구의 의의 138
• VII. 결론 및 제언 140
• Reference 143
• Appendix 195