The rapid growth in opioid therapy for non-cancer pain has occurred without an adequate appreciation of the consequences of this growth. Few studies provide patient-centered evidence that can be used to inform the current proposed standards for efficacious (safe and effective) opioid prescribing in non-cancer pain. Furthermore, different terms may be used interchangeably in the literature to refer to opioid-taking behaviors, resulting in imprecise or vague interpretation of existing evidence. We therefore sought to explore patterns of opioid-taking behavior and their biopsychosocial-spiritual determinants in African-American adults with sickle cell disease (SCD). Many questions surround opioid use for non-cancer pain, but little has been published about behavioral patterns of taking opioids in these conditions. The main objective of this study was to develop a disease-specific scale for describing prescribed opioid taking in patients with sickle cell disease (SCD). As part of a multiphase, mixed-methods study, we used an adaptation of several published methods to construct 9 sequential, chronological steps for developing a new scale. We report here wide-ranging quantitative and semi-structured, qualitative interviews of 13 male and 11 female African-American adults with SCD, average age 36 years, from various socioeconomic and educational levels. We used grounded theory, priori and posteriori procedures to analyze the qualitative data, and to conduct an appraisal of translational validity. Scale development results have led to inclusion in the draft scale of new concepts namely momentary medication-taking behavior. The scale also captures concrete patterns of adherence for as-needed and scheduled medication and allows for several discovered conceptual domains that explain observed opioid-taking behaviors. These concepts challenge the current theories and models of medication-taking behavior and adherence. In summary, we found that contextual factors may drastically affect opioid-taking behaviors. Together, These uncovered phenomena raise new hypotheses that may challenge current theories and models of medication-taking behaviors and methods of assessing adherence. These hypotheses call for a new round of research on opioid-taking behavior, and need to be rigorously tested in future research

N世代青年族群是開始以網路為主，資訊傳遞翻轉的新興世代，本研究藉由資訊-動機-行為技能模式（簡稱IMB模式）瞭解影響青年族群正確用藥行為的因子，探討青年族群醫藥素養、個人態度、用藥自我效能、行為障礙感知、醫藥傳播資訊暴露程度及正確用藥行為的發展現況，藉此發現喚起病人或家屬對病人安全及醫療風險認知的切入點，並增加警覺及主動積極性行為，與醫藥人員共同合作。為自己的健康狀態把關。 本研究所採用的方法是網路問卷調查，針對1977年到1997年出生的N世代青年族群蒐集資料，共獲得1,198份有效問卷。 本研究發現青年族群整體的用藥行為偏向經常做到，其中實踐程度由高至低依序為堅持正當藥品取得方式、主動告知身體狀況、看清楚用藥標示和主動諮詢專業。青年族群九成九以上有高醫藥素養，有六成以上的受訪者得到滿分。大部分青年族群偏向「同意」有正向的用藥態度；自我效能整體的認同度偏向於「同意」。受訪者對於用藥行為障礙感知程度整體偏向「不同意」有用藥行為障礙。 多數青年從媒體獲得醫藥資訊的頻率偏向「每月1~2次」為主。整體面向暴露由高至低為專業管道、傳統大眾媒體及新興網路。青年族群前三大醫藥資訊暴露管道依序為Facebook、電視、醫護人員，而BBS、大眾運輸工具看板、海報、傳單、宣傳手冊、產品包裝等是接著依序常用的管道。 醫藥素養只對堅持正當藥品取得方式有統計顯著正向預測力。個人態度和自我效能與用藥行為的四項依變項主動告知身體狀況、看清楚用藥標示、堅持正當藥品取得方式和主動諮詢專業，在相關分析及階層複迴歸分析都顯示有統計顯著正向相關。行為障礙感知與用藥行為的四項依變項主動告知身體狀況、看清楚用藥標示、堅持正當藥品取得方式和主動諮詢專業，在相關分析及階層複迴歸分析都顯示有統計顯著負向相關。 傳統大眾媒體與主動告知身體狀況、看清楚用藥標示和主動諮詢專業，在相關分析顯示有統計顯著正向相關，但階層複迴歸分析都未有統計顯著預測力；堅持正當藥品取得方式在相關分析及階層複迴歸分析都是顯著負向相關。新興網路與主動告知身體狀況和主動諮詢專業，在相關分析及階層複迴歸分析顯示都有統計顯著正向相關；新興網路與看清楚用藥標示，在相關分析顯示有統計顯著正向相關，但階層複迴歸分析未有統計顯著預測力；新興網路與堅持正當藥品取得方式在相關分析及階層複迴歸分析都是顯著負向相關。專業管道與主動告知身體狀況、看清楚用藥標示和主動諮詢專業，在相關分析及階層複迴歸分析顯示都有統計顯著正向相關；專業管道與堅持正當藥品取得方式在相關分析是顯著負向相關，但階層複迴歸分析中是無統計顯著預測力。 本研究的主要貢獻是證實藉由IMB模式的各項因子，都能有效預測部分或全部的正確用藥行為，尤其是個人態度、自我效能及行為障礙感知這三面向，並且呼應行為技能是影響行為的重要關鍵。因此往後如果有醫藥行為要推廣或宣傳時，就可以藉助IMB模式的因子為原型、大綱，相信會有更好的效果產生，也希望有人可以做後續相關研究，證實IMB模式的可行性。 / The Net Generation is the first generation to grow up in the digital world. The goal of this study is to understand the medical behavior of the Net Generation using the information-motivation-behavioral skills (IMB) model and the conditions of health literacy, personal attitudes, medical self-efficacy, the perception of behavioral barriers, the level of media exposure and medical behavior. To emphasize patient safety and medical risks, we tried to find the way to improve the awareness and active behavior to cooperate with medical professionals and to maintain self-health. The 1,198 effective samples were collected from people who were born between 1977 and 1999 through a web questionnaire. The study found that the Net Generation usually had correct medication-taking behavior. The frequency of the behavior from high to low was obtaining medicine through official channels, actively telling self-conditions, clearly reading medication labels, and actively consulting medical professionals. Over 99% of the participants had high health literacy and over 60% got full scores. Most of the participants tended to agree that they had positive personal attitudes and self-efficacy but disagreed they had the perception of behavioral barriers. Most of the participants obtained medical information through media once or twice a month. The exposure to media from high to low was professional channels, traditional mass media, and internet. The exposure to media channels in order were: Facebook, television, medical professionals, BBS, public transportation boards, and advertising brochures. Health literacy could only positively predict actively telling self-conditions. Personal attitudes and self-efficacy could positively predict four dependent variables of correct medication-taking behavior including obtaining medicine through official channels, actively telling self-conditions, clearly reading medication labels, and actively consulting medical professionals. And, the perception of behavioral barriers could negatively predict them. There were some statistically positive correlations between traditional mass media and correct medication-taking behavior including actively telling self-conditions, clearly reading medication labels, and actively consulting medical professionals. However, there was no prediction in hierarchical regression. There was a statistically negative correlation in Pearson’s correlation and hierarchical regression between traditional mass media and obtaining medicine through official channels. There were statistically positive correlations in Pearson’s correlation and hierarchical regression between internet and actively telling self-conditions or actively consulting medical professionals. However, there was a statistically negative correlation between internet and obtaining medicine through official channels. There was a statistically positive correlation between the internet and clearly reading medication labels but there was no prediction in hierarchical regression between them. There were statistically positive correlations in Pearson’s correlation and hierarchical regression between professional channels and actively telling self-conditions, clearly reading medication labels, or actively consulting medical professionals. There was a statistically negative correlation between professional channels and obtaining medicine through official channels but there was no correlation in hierarchical regression. The main contribution of this study was to support the argument that the IMB model could predict correct medication-taking behavior, especially when personal attitudes, self-efficacy and the perception of behavioral barriers are looked at. Therefore, behavioral skills were the key to correctly using medication. If someone wants to do medical behavior promotions, then the concept of the IMB model could be very effective.