運用自學式手冊於醫學生健康諮詢相關能力之初探性介入研究

楊智琳

指導教授 ： 劉潔心

國立臺灣師範大學/教育學院/衛生教育學系/碩士(2003年)

摘要

摘 要
本研究主要目的在探討「自學式健康諮詢手冊」對醫學生健康諮詢態度、健康諮詢技巧及健康諮詢自我效能之影響，並進一步探討醫學生對本研究手冊的評價。
本研究採「實驗組控制組前測後測設計」，以台灣大學醫學系、陽明大學醫學系、長庚大學醫學系、輔仁大學醫學系之四年級醫學生為研究對象。實驗組接受一週的自學式健康諮詢手冊介入，對照組則未接受任何教育介入，在實驗介入前，研究對象同時接受前測，後測則在介入後一週進行。所取得的資料以t檢定、卡方檢定及單因子便異數分析等方法進行統計分析，所得到的結果如下：
一、「自學式健康諮詢手冊」介入之後，實驗組醫學生的「健康諮詢行為結果信念」與「健康諮詢結果評價信念」的後測得分顯著高於前測且達統計上的顯著差異。
二、「自學式健康諮詢手冊」介入之後，實驗組醫學生的「醫病溝通之人際互動技巧」與「動機式晤談技巧」的後測得分顯著高於前測且達統計上的顯著差異。
三、「自學式健康諮詢手冊」介入之後，實驗組醫學生的「執行健康諮詢能力自我效能」與「執行5A諮詢指引自我效能」的後測得分顯著高於前測且達統計上的顯著差異。
四、「自學式健康諮詢手冊」介入之後，在控制前測得分下，實驗組醫學生之「健康諮詢行為結果信念」與「健康諮詢結果評價信念」的後測得分高於對照組且達統計上的顯著差異。
五、「自學式健康諮詢手冊」介入之後，在控制前測得分下，實驗組醫學生之「醫病溝通之人際互動技巧」與「動機式晤談技巧」的後測得分高於對照組且達統計上的顯著差異。
六、「自學式健康諮詢手冊」介入之後，在控制前測得分下，實驗組醫學生之「執行健康諮詢能力自我效能」與「執行5A諮詢指引自我效能」的後測得分高於對照組且達統計上的顯著差異。
七、約有八成七的醫學生表示手冊能有助於其建立更正向的健康諮詢態度，七成八的醫學生認為本手冊能幫助其增加對健康諮詢及衛生教育的技巧，約六成的醫學生認為此手冊能使其更有自信於從事健康諮詢及衛生教育，且有高達九成以上的醫學生願意依照手冊教導的去做。
整體而言，藉由自學式手冊為教育介入方式，能有效的提昇醫學生健康諮詢的相關能力。因此，建議未來在推動醫學生或臨床醫師的健康諮詢教育時，可以自學式手冊為管道，教導醫學生或臨床醫師於健康諮詢相關能力的學習，如此不僅能引發醫學生學習的興趣，更能提高學習的效果。

關鍵字

自學式手冊 ； 醫學生 ； 健康諮詢 ； 醫學教育

並列摘要

Abstract
The purpose of the subject is to discuss the influence of “Health Consultation Handbook” on health consulting attitude, health consulting skill and health consulting self-efficacy for medical school students. Also the study reveals the acceptance of the handbook for the medical school students.
The study includes pre/post questionnaires of effectiveness evaluation of the program and the subjects of study consists the 4th-year medical school students in Nation Taiwan University, Yang Ming University, Chang Gung University and Fu Jen Catholic University. The group of participants is divided into two groups--the control and experimental group. The experimental group takes health consulting handbook intervention for one week while the control group remains in their original status. The information collected from this experiment is to be analyzed by pair-test, Chi-square test, one-way ANOVA and one-way ANCOVA. The findings are listed as follows:
1. After the intervention of the “Health Consultation Handbook”, the students in experimental group apparently get higher scores in the post-test than in the pre-test on “attitudes about offering health consultation” and “evaluation of outcomes of offering health consultation”. Obviously the difference is significant.
2. After the intervention of the “Health Consultation Handbook”, the students in experimental group apparently get higher scores in the post-test than in the pre-test on “doctor-patient communication skills” and “motivational interviewing skills”. Obviously the difference is significant.
3. After the intervention of the “Health Consultation Handbook”, the students in experimental group apparently get higher scores in the post-test than in the pre-test on “self-efficacy for offering health consultation” and “self-efficacy for offering The five A’s construct”. Obviously the difference is significant.
4. While controlling the pre questionnaire, the students in the experimental group get higher scores than those in the control group on “attitudes about offering health consultation” and “evaluation of outcomes of offering health consultation”. Obviously the difference is significant.
5. While controlling the pre questionnaire, the students in the experimental group get higher scores than those in the control group on “doctor-patient communication skills” and “motivational interviewing skills”. Obviously the difference is significant.
6. While controlling the pre questionnaire, the students in the experimental group get higher scores than those in the control group on “self-efficacy for offering health consultation” and “self-efficacy for offering The five A’s construct”. Obviously the difference is significant.
7. Approximately 87% of these medial school students indicated that the “Health Consultation Handbook” could really be contributive to positive health consulting attitude. About 78% of the students indicated that “Health Consultation Handbook” leads to more improvements in health consulting skill and health education. About 60% of students indicated that they have more confidence in health consultation and health education. Furthermore, almost 90% of the students are willing to do the instructions in the “Health Consultation Handbook”.
Briefly speaking, the abilities of heath consultation could be greatly enhanced through the intervention of the “Health Consultation Handbook”. Therefore in the future education of health consultation, we suggest that a handbook like this should be used as a media to conduct medical school students and physicians about the health consulting skill more effectively.

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