以社區為基礎的慢性病老人從事身體活動之研究

A Community-Based Study on Physical Activity for Elderly with Chronic Diseases

林艷君(Yen-Chun Lin)

指導教授 ： 黃璉華

國立臺灣大學/醫學院/護理學研究所/博士(2007年)

https://doi.org/10.6342/NTU.2007.03188

摘要

本研究目的為：（1）發展社區慢性病老人對執行身體活動之態度、知覺社會影響、知覺行為控制問卷（以下簡稱老人身體活動態度問卷）；（2）瞭解社區慢性病老人從事身體活動的種類、頻率、時間與耗能；（3）探討社區慢性病老人執行身體活動之相關因素。
本研究之架構乃參考計畫行為理論修正而訂。研究對象為居住於台北市信義區，年滿65歲且至少罹患一種慢性疾病，但身體活動能力與認知功能完整者。第一階段針對20位個案進行質性訪談，根據此資料發展「老人身體活動態度問卷」初稿。專家效度處理後之問卷以立意取樣方式，請30位個案接受面對面訪談，並經修改後完成老人身體活動態度問卷。正式施測時，於信義區舉辦各里三合一篩檢活動時以立意取樣方式收案，有206位個案接受訪談，回答以下三份研究工具的問題：（1）個人基本資料表（2）老人身體活動態度問卷（3）修正後的CHAMPS身體活動問卷。所得資料以SPSS 12.0版進行描述性統計、卡方檢定、獨立t檢定、單因子變異數分析、皮爾遜積差相關、複迴歸分析及邏輯迴歸分析。
結果顯示，老人最常從事的身體活動依序為散步，輕鬆家務、輕度體操、爬山及太極拳、氣功等。男性老人較女性老人從事較多休閒式的身體活動。合乎衛生署建議的333活動量標準者佔25.7%。年齡、性別、居住狀況、健康自評對老人從事身體活動或休閒式身體活動有顯著影響。以複迴歸分析結果發現，社區慢性病老人每週身體活動與休閒式身體活動的頻率、時間與耗能各有不同顯著的預測因子。將老人每週從事休閒式身體活動的時間當作依變項，最佳迴歸模式的解釋力為27%，顯著的預測因子為性別、對身體活動之感受與環境控制信念。對於男性老人而言，將休閒式身體活動的頻率當作依變項，最佳預測模式的解釋力達34%，顯著預測因子為居住狀況、對身體活動之感受與環境控制信念。對於女性老人而言，將休閒式身體活動的時間當作依變項，最佳預測模式的解釋力達30%，顯著的預測因子為行為結果信念、對身體活動之感受、社會支持與個人控制信念。
未來健康專業人員進行社區慢性病老人身體活動促進計畫前，應針對不同性別、年齡群與獨居者的需求設計不同的措施，提供更多的訊息與資源，改善整體活動環境，以提升老人對身體活動正向的感受，增加活動機會。對女性老人則應鼓勵休閒式身體活動，提供社會支持，提高個人對身體活動的自信心。

關鍵字

身體活動 ； 社區老人 ； 計畫行為理論

並列摘要

The purposes of this study were: (1) To develop the “attitude, perceived social influences, perceived behavior control questionnaire for community elderly with chronic diseases” (Attitude to PA Questionnaire for elderly). (2) To explore the types and three components (frequency, duration, caloric expenditure) of physical activity (PA) and leisure time physical activity (LTPA) among community elderly with chronic diseases. (3) To identify the related factors on PA and LTPA among community elderly with chronic diseases.
The framework of this study was modified from the theory of planned behavior. Purposive convenience sampling was used to recruit participants. Inclusion criteria were living in Xinyi District of Taipei, aged 65 and older, with at least a diagnostic chronic disease, being independent concerning activity of daily living, with intact cognitive function. In stage I, qualitative data were generated from a total of 20 in-depth interviews. Based on the qualitative results, the 50-item, initial version of the “Attitude to PA Questionnaire for elderly” was proposed. The content validity of the questionnaire was established by initially reviewing the items with a group of five experts. Ongoing instrument refinement and testing were conducted in a sample of 30 community elderly in stage II. For stage III, a purposive convenience sample was recruited from the “three-in-one on-spot screen test activity. A total of 206 elderly agreed to participate this study and complete three questionnaires: (1) Demographic Information and Health Status; (2) Attitude to PA Questionnaire for elderly; (3) Modified Community Healthy Activities Model Program for Seniors (CHAMPS) physical activity Questionnaire. Data were analyzed using SPSS 12.0 statistical computer software with descriptive statistics, Chi-square, independent t-test, ANOVA, Pearson’s correlation, multiple regression, and logistic regression.
The descriptive statistic results showed that walking leisurely was the most frequent PA for participants, followed by light housework, light calisthenics, hiking uphill and various forms of Chinese Kung Fu, such as Tai Chi or Chi Kung. More men were engaged in LTPA than women. When the 333 standard of exercising was applied (including three or more times per week for at least 30 minutes activity of moderate intensity per session), only 25.7% participants reported to have met the criteria.
The age, gender, living arrangement, and self-reported health status were associated factors of PA and LTPA. The findings also showed the different determinants on different components of PA among community elderly. Based on the multiple regression analysis results, the duration of the LTPA model was shown as the best predictive model. The significant variables included gender, affective feeling for PA, and environmental control. All the independent variables could explain 27% of the total variance in the duration of LTPA. When comparing different gender participants, the multiple regression analysis showed that the best predictive model for male participants was the frequency of LTPA. The significant variables included living arrangement, affective feeling for PA, and environmental control. All the independent variables could explain 34% of total variance in the frequency of LTPA. For female participants, the best predictive model was the duration of LTPA. The significant variables included behavioral belief, affective feeling for PA, social support, and personal control. All the independent variables could explain 30% of total variance in the duration of LTPA.
An effective PA program could be designed by different gender, age and living arrangement among community elderly. Health professionals could provide more information and community resources for older adults, improve PA environment, increase their positive attitudes toward PA, and increase their PA opportunities. For older female, a stronger emphasis on LTPA, providing more social support, and enhancing their confidence of performing PA could be valuable directions for future interventions.

並列關鍵字

physical activity ； community elderly ； theory of planned behavior

參考文獻

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