醫師提供運動諮商之行為意圖調查

An Exploration of Physicians’ Intention to Provide Exercise Counselling

林安民(An-Min Lynn)

指導教授 ： 黃俊豪

國立臺灣大學/公共衛生學院/公共衛生碩士學位學程/碩士(2017年)

https://doi.org/10.6342/NTU201703538

摘要

目的：本研究針對與運動諮商較相關之科別的醫師，使用計劃行為理論 (Theory of Planned Behavior, TPB) 為基礎研發之量性問卷，探討其提供運動諮商之意圖與相關因素。
方法：以TPB為架構，針對其構念之直接與間接測量，發展量性問卷，並驗證其信效度，再使用此問卷工具，針對與運動諮商相關之科別的門診醫師進行調查研究，使用描述性統計、雙變項分析與多變項羅吉斯迴歸模型進行統計分析。
結果：共發出1,128份問卷，扣除未回收與填答不完整之無效問卷，納入統計分析計1,016份問卷。本研究發現，42.8%之醫師有較高意圖提供病患運動諮商。研究工具發展部分，將間接測量之27個題組納入探索性因素分析後，發現五類因素，分別為：正面行為結果評價、負面行為結果評價、一般主觀規範、有利情境下之自覺行為控制以及阻礙情境下之自覺行為控制，其內部一致性信度Cronbach’s α，除負面行為結果評價外 (0.67)，其餘均介於 0.70-0.90。構念效度驗證上，五類因素與其相關變項之結果解釋上，皆與過去相關實證研究或臨床場域之實務觀察具一致性。
TPB之直接測量的羅吉斯迴歸模型顯示：行為態度、主觀規範及自覺行為控制之高低，皆與提供運動諮商意圖高低，呈顯著正相關。間接測量部分，正面行為結果評價愈正向、一般主觀規範愈感受到支持，及自覺行為控制則以有利情境下之自覺控制愈高，會有較高之提供運動諮商意圖。人口學資料與醫師特質：性別、學歷、醫師專科、工作區域、年資無顯著相關性，而與執業場所及門診人數有關。個人運動相關變項：具運動習慣者且運動頻率較多者、接受過運動相關教育者，會有較高提供運動諮商之意圖。
結論：本研究係使用TPB為基礎，針對台灣醫師給予病患運動諮商之意圖及其相關因素，進行問卷調查。本研究之問卷經多項信效度檢視與驗證，具完整且良好之工具發展過程與結果。結果發現，本身具固定運動習慣、接受過運動相關教育，或知道如何幫助病患行為改變之醫師，具較高之意圖提供病患運動諮商。同時，TPB中之主要構念，亦即正面行為結果評價愈正向、一般主觀規範愈支持，以及有利情境下之行為控制愈高時，醫師提供運動諮商之意圖顯著較高。

關鍵字

運動諮商 ； 醫師 ； 計劃行為理論 ； 調查研究

並列摘要

Objectives: The study utilized a quantitative questionnaire and the theory of planned behavior (TPB) to investigate the intention to provide exercise counseling with respect to specialties for which exercise counseling was more relevant.
Methods: Using the TPB framework, a quantitative questionnaire which focused on the single-item measures and multiple-item scales of TPB constructs was developed. The reliability and validity of the questionnaire was tested, after which it was used to study the provision of exercise counseling among clinical physicians in specialties for which exercise counseling was more relevant. Descriptive statistics, bivariate analyses and multivariate logistic regression models were used to carry out the statistical analyses.
Results: In total, 1128 questionnaires were administered and 1016 effective questionnaires were collected after the exclusion of unreturned questionnaires or those with invalid responses. It was found that 42.8% of the physicians had a higher intention of providing exercise counseling. With respect to research tool development, 27 individual TPB items underwent exploratory factor analysis, resulting in the identification of these five factors: attitude toward behavior (ATB) about positive outcomes, ATB about negative outcomes, general subjective norm (SN), perceived behavioral control (PBC) under facilitating conditions, PBC under constraining conditions. With the exception of the ATB about the negative outcomes (0.67), the other factors had an internal consistency (Cronbach's α) of 0.70-0.90. A test of construct validity showed that the five factors and their variables were consistent with the data from past studies and clinical observations. The multivariate logistic regression model, applying the single-item measures of the TPB constructs, indicated significant positive correlations between positive ATB, SN, and PBC, and the provision of exercise counseling. For multiple-item scales of TPB constructs, ATB about positive outcomes, general SN (perceived support), and PBC under facilitating conditions were found to be positively correlated to the intention to provide exercise counseling. Demographic information and physicians' characteristics: no significant correlations were observed with respect to gender, education level, medical specialty, work area, and length of professional experience, while correlations were found for accreditation and number of patients per clinic. Individual exercise-related variables: physicians who exercise regularly and received educational training in sports and exercise were more willing to provide exercise counseling to their patients.
Conclusions: Using TPB, this study carried out a questionnaire survey on the intention (and the related factors) of physicians in Taiwan to provide exercise counseling to patients. The questionnaire used in this study underwent various types of reliability and validity tests, thus ensuring that it was a complete and effective tool for data collection. The results showed that physicians who exercise regularly, physicians who received educational training in sports and exercise, and physicians who understood how they could help change the behaviors of patients, showed a stronger intention to provide exercise counseling to patients. At the same time, the higher the level of these main TPB constructs, namely ATB about positive outcomes, general subjective norm (perceived support), and PBC under facilitating conditions, the stronger the intention of physicians to provide exercise counseling to patients.

並列關鍵字

Exercise counseling ； Physicians ； Theory of Planned Behavior ； Survey research

參考文獻

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