口腔衛生教育介入對伴有智能障礙者口腔清潔成效及其照護者口腔保健認知行為之相關研究---以南台灣某身心障礙教養機構為例

背景：身心障礙者的口腔健康普遍不佳，口腔衛生也是有待加強的，除了受限於自身能力外，照護者口腔保健知識的缺乏，也是其中的主要原因之一。目前國內的口腔保健推廣大多以幼稚園和小學為主，並無ㄧ套適合身心障礙照護者口腔健康保健的教材。研究目的：本研究是藉由製作身心障礙照護者口腔衛教之教材，針對某身心障礙機構之照護者進行口腔衛生教育介入，再探討介入後機構照護者(保育員)口腔衛生知識、態度和行為的變化以及伴有智能障礙者(家民)口腔清潔的改變成效及其影響因素。研究方法：本研究選定高雄市政府社會局無障礙之家的21名保育員和居住在此機構的61名家民。由身心障礙者牙科的專業人員先後對保育員進行4小時的口腔衛生課程和13小時的臨床實際潔牙教學。研究工具為家民生活習慣問卷、口腔檢查表和保育員的口腔保健認知行為問卷。研究時間長達近5個月。保育員問卷調查分別於教學前、教學後立即和三個月後施測。家民口腔清潔狀況也在衛教後的第1、第7和第14個星期進行檢驗。統計方法有描述性統計、t檢定、卡方檢定及迴歸分析。結果：不論在衛教介入後的立即檢測或14星期後的測試，保育員口腔衛生知識、態度的分數和家民口腔清潔成效的改變都達統計上的正面顯著差異(p<.0001)。保育員的口腔衛生行為在潔牙次數和方法也有明顯的增加和改變。迴歸分析後，只有性別和保育員口腔衛生知識的改變有相關。保育員態度的變化以及家民口腔清潔的改變主要在於教育介入與其背景資料無關。結論：此次的口腔衛生教育介入是有成效，課程設計可提供身心障礙者口腔保健工作推廣之參考。口腔預防保健包含居家照護和定期檢查，所以照護者和牙科專業人員同等重要，兩者必須互相配合，才能維持身心障礙者良好的口腔衛生狀況。

關鍵字

身心障礙機構；照護者；教育介入

並列摘要

Background： Oral health condition of the handicapped is usually poor, and their oral hygiene needs to be improved. While this is largely due to their own physical limitations, care givers who lack proper oral health knowledge may also be attributable for this unfavorable condition. Oral health education is commonly promoted in kindergartens and elementary schools in Taiwan. However, we lack proper oral health education for the care givers of the handicapped. Study objective： The aim of this study is to intervene on the oral health education for the care givers in one handicapped institution. An intervention study is then investigated based on the changes of knowledge, attitude and behavior of the care givers, as well as on the changes of oral cleaning effect of the handicapped. The contributing factors of these changes are also investigated. Method： The objects of this study are the 21 care givers and 61 handicapped residents in the “Home for the Disabled, Social Affairs Bureau, Kaohsiung City Government”. All care givers will receive 4 hours of training in oral hygiene instruction and 13 hours of teaching regarding clinical tooth brushing techniques by expertise in Special Care Dentistry. Research protocols include surveys on: lifestyles of the residents, oral examination charts, and the knowledge, attitude and behavior of care givers on oral health education. Duration of the research lasts about 5 months. Surveys were collected from the care givers before the education, immediately after the education and 3 months after the education. Oral cleaning conditions were also investigated in the first, seventh and fourteenth week. Statistical methodology includes the t-Test, Chi-Square test, and Multi-Regression Analysis. Results： In surveys collected immediately after and 14 weeks after the oral hygiene intervention, statistically significant differences (p<0.0001) were demonstrated in care givers’ score in oral hygiene knowledge and attitude; and in changes in the oral cleaning effect of the residents. The tooth brushing technique and frequency of tooth brushing of the care givers also improved significantly. After Multiple Regression Analysis was performed, only gender of the care givers were related to the changes of the care givers’ oral hygiene knowledge. On the other hands, changes in attitude of the care givers and changes in the oral cleaning effects of the residents were mainly caused by oral hygiene intervention, and were not related to their backgrounds. Conclusion： Statistical analysis demonstrates that oral hygiene intervention was effective, and that this education program can be a reference to the promotion of Special Care Dentistry in the future. Preventive Dentistry includes both home care and routine oral examination; therefore, care givers and dental professionals are equally important. Cooperation will be necessary to help the handicapped to maintain a good oral hygiene condition.