綜合高中學生口腔衛生教育介入之成效

背景：過去針對國內青少年口腔衛生習慣的調查顯示，青少年的口腔保健知識偏低，保健態度和行為亦不積極，事實上，青少年齲齒盛行率伴隨著年齡的增加而日益嚴重。國內口腔保健教材，大多偏重學齡前及學齡兒童，針對高中職以上青少年的口腔衛生教材則明顯不足。目的：本研究中製訂了一套適合高中生的口腔衛生教材，主要目的為： 1.）探討教育介入課程對口腔保健知識、態度、行為的影響； 2.）評估影響衛生教育介入課程前後測改變量的因素； 3.）以跨理論模式之行為改變階段探討教育介入對潔牙意圖之影響； 4.）探討青少年對口腔衛生教育介入之評價。研究方法：針對高雄縣某綜合高中一年級學生共239人，分為實驗組（85人）與對照組（154人），兩組同時執行口檢及問卷前測，實驗組採每隔週進行五十分鐘教育介入共八次，教育介入後二週進行問卷後測，四週後再進行口檢後測及問卷後後測，共十個月完成。資料統計以JMP512版軟體進行描述性統計、t-test、ANOVA、卡方檢定及迴歸分析。結果：本研究主旨藉由教育介入對青少年口腔衛生知識態度行為的影響來評價本教案之適用性，研究結果顯示實驗組經教育介入後在知識增加7.24±0.49分，態度增加0.76±0.17分與對照組達顯著差異，而知識改變量(1.99±0.47分)於後後測仍與對照組達顯著差異；但兩組的潔牙行為改變量與牙菌斑指數並未達顯著差異，利用廻歸分析發現，潔牙環境的隱密性是影響青少年潔牙意願的重要因素且男女生並無差異。針對青少年潔牙行為意圖的改變情形，顯示實驗組前測原處於「意圖期」的學生於後測進步到「行動期及維持期」的比例(60%)顯著高於對照組(32%)，而原處於「行動期」的學生保持在「行動期與維持期」的比例(46%)亦顯著高於對照組(15%)。而實驗組對整體教育介入成效持正向評價，其中對老師教學態度評價最高，顯示對青少年進行教育介入首重建立良好互動關係。結論：利用本教案對青少年進行口腔衛生教學後，對保健知識及態度的提升具有正面效果，沒有獨立的潔牙環境使青少年執行潔牙的意願低落，女生在保健知識的學習成效優於男生；可見口腔衛生教學活動能修正偏頗不正確的牙齒保健觀念，建議將之納入正式課堂並增加授課時數及加強潔牙技巧之練習，另外，在學校硬體空間規劃上則期望能設置專屬的潔牙空間，避免相互干擾以增強青少年潔牙意願。

關鍵字

青少年；口腔衛生教育；行為改變階段

並列摘要

Background: Previous oral health studies of adolescents indicated that they might not have enough oral health knowledge, proper attitudes and adequate behaviors. In fact, the prevalence rates of dental caries in senior high school students were rather high. Majority of the current oral health teaching materials were for preschool- or elementary school-aged children. Oral health teaching materials for adolescents, especially, senior high school students are not sufficient apparently. Study objective: A course of oral health education material for teaching senior high school students was designed for this study. The main purposes of this study were as follows. 1. To discuss the impact of the education intervention on the oral health knowledge, attitudes, and behaviors. 2. To evaluate related factors that influence the variation between the pre-test and post-test of the hygiene education intervention. 3. To explore the impact of education intervention on tooth-cleaning intention by using the stages of change behavior that was designed in the trans-theoretical model. 4. To evaluate adolescent appraisal of the intervention program. Methods: There were 239 first grade students of a general high school in Kaohsiung County recruited for this study. Students were divided into the experimental group (85 students) and the control group (154 students). They received an oral checkup and the pre-test of the questionnaire simultaneously. Eight 50-minute classes were conducted every two weeks for the experimental group. One post-test of the questionnaire was given two weeks after the education intervention. In addition, the post-test of the checkup and the post-test of the questionnaire were provided four weeks later after the education intervention. The study lasted for ten months. The statistical analysis was conducted by JMP512 for descriptive statistics, t-test, ANOVA, chi-square test, and regression analysis. Results: The main theme of this study was to evaluate the applicability of this education program by investigating the impact of the intervention on adolescent oral hygiene knowledge, attitudes and behaviors. The study results revealed that the experimental group had an increase of 7.24±0.49 points on knowledge and 0.76±0.17 points on attitudes after the education intervention was provided. This indicated that there was significant statistical difference between the two groups. Moreover, the variation of knowledge (1.99±0.47) in the experimental group was still different from that in the control group during the post-test significantly. However, the variation of the tooth-cleaning behaviors and the plaque index of the two groups did not differ significantly. Regression analysis discovered that the privacy of tooth cleaning environment was an important factor affecting both boys’ and girls’ willingness to clean teeth. For the variation of adolescents’ tooth-cleaning behavior contemplation, 60% of students in the experimental group improved from stage “contemplation” during the pre-test to stages “action” and “maintenance” during the post-test. This proportion was also significantly higher than that (32%) of the control group. In addition, 46% of students of the experimental group improved from stage “action” to stages “action” and “maintenance”. This proportion was significantly higher than that (15%) of the control group. Students of the experimental group confirmed the positive effect of the education intervention. They gave the highest appraisal for teachers’ teaching attitudes; this indicated that establishing good interaction relationships is most essential in providing education intervention to adolescents. Conclusions: Applying this oral health education program in adolescents can improve the health knowledge and attitudes of adolescents. Lacking an independent environment for tooth cleaning reduce adolescent willingness to clean teeth. The effect on girls in learning health knowledge was higher than that of boys. It is apparent that the activities of oral health teaching are able to rectify incorrect dental health concepts. It is recommended that the activities of oral hygiene teaching should be included in the curriculum with more course hours and more practice for tooth-cleaning skills added. Besides this, an independent space for tooth cleaning is expected in planning the space inside the school buildings in order to avoid interference between students during tooth cleaning as well as strengthening adolescent willingness to clean teeth. Keywords: adolescent, oral hygiene education, stages of change of behavio