社區長者跌倒預防知識、信念及行為之研究—以健康信念模式為基礎

The Study of Fall Prevention Knowledge, Belief, & Behavior for Community-Dwelling Elderly—Utilization of the Health Belief Model

蕭伃伶(Yu-Ling Hsiao)

指導教授 ： 張佳琪

共同指導教授 ： 陳靜敏(Ching-Min Chen)

臺北醫學大學/護理學院/護理學研究所/博士(2011年)

https://doi.org/10.6831/TMU.2011.00093

摘要

本研究以類所羅門四組實驗研究設計，以健康信念模式為基礎架構，發展「長者跌倒預防行為模式」研究概念模式，介入為期2個月的教育與運動之防跌課程，以探討於社區長者之防跌相關適能和防跌知識、個人信念、行為的成效。
共收案474名社區長者，平均年齡為70.75(SD=7.20)歲，實驗組A(完成前後測)有147人，控制組A(完成前後測)有96人，實驗組B(僅後測)有125人，控制組B(僅後測)為106人，研究工具含基本資料表、簡易身體項目評估表和防跌知識、信念與行為問卷，前測在介入開始的前一週完成，研究介入為2個月內完成12回防跌衛教與運動課程，課程完成後一週進行後測。
結果顯示實驗介入組個案於腰圍(t=-2.07, p=.04)、屈膝起立(t=4.96, p=.000)、上肢柔軟度(χ2=62.86, p=.02)、起身行走(χ2=39.57, p=.000)與平衡(睜眼左足站立χ2=36.35, p=.002)等多項跌倒預防相關適能項目都有顯著改善；於防跌知識(t=4.42, p=.000)、障礙性覺知信念(t=2.21, p=.03)、效能覺知信念(t=2.24, p=.03)、自覺效能(FES)(t=-3.67, p=.000)與採行防跌行為(t=3.48, p=.001)上亦有顯著進步。進一步分析發現防跌行為成效受性別、教育程度、有無配偶、有無工作、有無疾病及有無吸菸等因子之影響。多元回歸分析發現研究的介入是防跌知識、個人信念和防跌行為改善的顯著預測變項，同時，社區長者防跌個人信念愈高者愈能夠採行跌倒預防行為，驗證了以健康信念模式為基礎之「長者跌倒預防行為模式」。本研究結果顯示藉由防跌教育與運動課程之執行，能有效改善社區長者跌倒之危險因素，並加強長者對預防跌倒之認知、信念及行為。期望該介入能有效降低社區長者跌倒事故之發生，進而達到老年健康促進之目標。

關鍵字

預防跌倒 ； 社區長者 ； 類所羅門研究設計

並列摘要

The purpose of the study was to examine the effects of fall prevention and exercises programs which were developed based on Health Belief Model on fall-related fitness, fall prevention knowledge, belief and behavior of community-dwelling elders.
A total of 474 community-dwelling elders participated in this quasi- Solomon four group design: experimental group A (with both pre-and post-tests) with 147 , control group A (with both pre-and post-tests) with 96 , experimental group B (post-test only) with 125 persons, and control group B (post-test only) with 106 subjects. The mean age of subjects was 70.75 (SD=7.20).
Measurements included demographic data, physical assessment and questionnaire of fall prevention knowledge, belief, and behavior. Pretest was performed one week before the intervention. The fall prevention and exercises programs contained 12 lecture sessions and 12 exercise sessions within two months. Posttest was carried out one week after the completion of the programs.
The results of this research showed that participants in experimental groups improve significantly on waist circumference (t=-2.07, p=.04), squat down-stand up test (t=4.96, p=.000), upper extremity flexibility (χ2=62.86, p=.02), timed up-and-go test (χ2=39.57, p=.000), and balance (χ2=36.35, p=.002). Those elders also had significantly change on fall prevention knowledge (t=4.42, p=.000), perceived barriers (t=2.21, p=.03), perceived efficacy (t=2.24, p=.03), Falls Efficacy Scale (FES) (t=-3.67, p=.000), and fall prevention behavior (t=3.48, p=.001). Furthermore, the results also showed that the effects of fall prevention behavior were also affected by various factors, including gender, educational background, marital status, occupational status, disease and smoking habits. Participated at the program was a significant predictor of fall prevention knowledge, belief and behavior based on the analyses of multiple regression. The stronger the belief of community-dwelling elderly, the more frequent they adopt fall prevention behavior. Thus, this research demonstrates the behavioral pattern of fall prevention for elders which can be explained by the Health Belief Model.
In conclusion, the implementation of fall prevention and exercises programs can efficiently reduce risk factors of fall among community-dwelling elders and further strengthen their perception, belief and behavior of fall prevention. We anticipate the program can effectively lower the possibility of fall accidence and improve elderly health, therefore, can further reach the goal of health promotion for the elderly.

並列關鍵字

Fall prevention ； Community-dewelling elderly ； Quasi-Solomon research design

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