家長感受兒童復健服務過程之「以家庭為中心」的程度及其影響因子：以臺北地區為例

The Extent of Family-Centered Service Implemented in Pediatric Rehabilitation Programs in Metropolitan Taipei: Parents’ Perceptions and Its Influencing Factors

廖研蒲(Yen-Pu Liao)

指導教授 ： 鄭守夏

共同指導教授 ： 曾美惠(Mei-Hui Tseng)

國立臺灣大學/公共衛生學院/健康政策與管理研究所/碩士(2013年)

https://doi.org/10.6342/NTU.2013.00288

摘要

背景：「以家庭為中心的服務(Family-Centered Service, FCS)」是目前國內外兒童復健界的目標。身心障礙兒童的家長比起一般兒童之家長有較多的親職壓力、情緒困擾，若服務提供者能提供「以家庭為中心的服務」可促進家長心理層面的健康與安適，然而臺灣目前僅有少數文獻探討家長對兒童復健之滿意度，因此「以家庭為中心的服務」之情形仍然未知，也需要進一步探究其影響因素。「照護過程評量表(Measure of Processes of Care, MPOC-20)」是目前國際上最常用於評量身心障礙兒童的家長感受兒童復健服務過程之「以家庭為中心」的程度的工具之一，但尚需評估其繁體中文版在臺灣使用的適用性及心理計量特性。
目的：第一部分：將「MPOC-20繁體中文版」本土化為「MPOC-20臺灣版」並驗證其心理計量特性(請見「工具」)。第二部份：(1)調查臺北地區家長感受兒童復健服務過程之「以家庭為中心」的程度，及(2)探討其影響因子。
工具：MPOC-20為家長自填式問卷，共20題，原始架構為5個向度：賦能及合作(3題)、提供一般資訊(5題)、提供具體資訊(3題)、全面及一致(4題)、尊重及支持(5題)，採用李克氏7點量尺作答，範圍自1分(完全沒有)到7分(極大的程度)，另有0分(不適用)。「MPOC-20臺灣版」經過兩回專家問卷針對其適用性及語意清析度進行修改，具良好內容效度，且透過田野測試進一步對問卷之文字敘述進行修正，確保家長能理解問卷內容。驗證性因素分析顯示「MPOC-20臺灣版」原始5個向度與本土樣本並不適配，而探索性因素分析顯示「MPOC-20臺灣版」之20題共可萃取出3個因素(合作與完整及支持、提供一般資訊、提供具體資訊)。本研究驗證「MPOC-20臺灣版」具有良好之心理計量特性，包含建構效度、同時效度(與家長滿意度評量呈現中度正相關)、內部一致性(Cronbach’s α介於0.83至0.95)、及再測信度(組內相關係數值介於0.80至0.87)。
樣本：本研究於2011年11月16日至2012年1月12日由研究者於臺北市及新北市親自進行問卷收集，共12個兒童復健單位、68位治療師及476位有接受兒童復健服務之家長參與此研究。家長完成MPOC-20臺灣版及基本資料問卷，兒童復健單位主管及治療師完成自填基本資料問卷。
資料分析：樣本基本資料、「以家庭為中心的服務」概況以描述性統計方式呈現。本研究以多元線性迴歸分析「服務相關因素」對MPOC-20臺灣版3個向度各自之平均分數的影響，並同時控制「服務提供者」及「服務接受者」特性。
結果：(1)第1向度「合作與完整及支持」之平均分數最高(平均數=5.39、標準差=1.04)，第3向度「提供具體資訊」(平均數=4.80、標準差=1.38)次之，第2向度「提供一般資訊」之平均分數最低(平均數=4.41、標準差=1.32)。(2)控制了單位、治療師、家長及兒童的特性之後，治療模式為個別治療、每次治療時間為40~60分鐘、治療期間為1年以上未滿2年及2年以上，對於家長感受兒童復健服務過程之「以家庭為中心」的程度各有其正面的影響，治療頻率則無顯著影響。
結論與建議：目前臺北地區兒童復健服務能夠給予家長尊重及支持，並提供全面及一致的照護，然而，兒童之治療相關書面資訊及療育相關訊息的提供則相當不足。早期療育政策、健保給付制度、臨床服務制度與評鑑均應支持FCS，並考量服務相關因素對於提供FCS的影響，且進行適當調整，以期提升發展遲緩或身心障礙兒童及其家庭的健康與安適。

關鍵字

發展遲緩兒童 ； 身心障礙兒童 ； 早期療育 ； 兒童復健服務品質 ； 以家庭為中心的服務 ； 心理計量

並列摘要

Background: Family-Centered Service (FCS) has been acknowledged as the ‘best-practice’ model in pediatric rehabilitation. Parents of children with disabilities have greater parental stress than parents of typically developing children. There is evidence that FCS results in better parental psychosocial well-being and better psychological adjustment of children. However, the extent of FCS implemented in pediatric rehabilitation programs as perceived by parents in Taiwan has not been investigated before, and a limited number of studies have addressed the service-related variables that contribute to parents’ perceptions of FCS in pediatric rehabilitation service. Measure of Processes of Care (MPOC-20) is widely used to evaluate the extent to which the service was family-centered from the parents’ perspectives. The questionnaire had been translated to traditional Chinese. Yet, it has not yet been cross-culturally adapted, neither the cross-cultural validation has been conducted when used in Chinese-speaking society.
Objectives: The first part of this study was to cross-culturally adapt the traditional Chinese translation of MPOC-20 and to examine its validity and reliability for use in Taiwanese context (see ‘instrument’ as follows). There were 2 aims in the second part of this study: (1) to describe parents’ perceptions of the extent to which FCS behaviors occurred in outpatient pediatric rehabilitation facilities in metropolitan Taipei, and (2) to examine factors influencing parents’ perceptions of the family centeredness of care.
Instrument: MPOC-20, a 20-item self-report measure, originally comprises of five scales:(1)Enabling and partnership; (2)Providing general information; (3)Providing specific information about the child; (4)Coordinated and comprehensive care and (5)Respectful and supportive care. The answers are given on a seven-point scale from ‘to a great extent (7)’ to ‘never (1)’, with an additional alternative of ‘not applicable (0)’. We conducted the cross-cultural adaptation by consulting 11 experts in the field of pediatric rehabilitation twice to confirm the content validity, in terms of the applicability and clarity of each item in the traditional Chinese translation of MPOC-20. After we accomplished a revision based on experts’ comments, we carried out a field test to make sure that the wording of the traditional Chinese (Taiwanese context) version of MPOC-20 is understandable by parents. The Confirmatory Factor Analysis (CFA) showed that the original model which contained 5 factors extracted from 20 items is not fit with Taiwanese sample, so we further performed the Exploratory Factor Analysis (EFA) which indicated there are 3 factors among the 20 items including ‘cooperative, integrated and supportive care’, ‘Providing general information’, and ‘Providing specific information about the child’. The concurrent validity was confirmed by positive correlations between MPOC-20 scale scores and a Parent Satisfaction Questionnaire(r 0.54~0.78). The internal consistency analyses (Cronbach’s α 0.83~0.95) and the test-retest analyses (intraclass correlation coefficients (ICCs) 0.80~0.87) showed that the traditional Chinese (Taiwanese context) version of MPOC-20 is a reliable tool.
Subjects：476 parents and 68 therapists from 12 outpatient pediatric rehabilitation facilities in metropolitan Taipei participated in this study from November 16th, 2011, to January 12th, 2012. Parents answered the traditional Chinese (Taiwanese context) version of MPOC-20 and an attached demographic questions sheet, while therapists were asked to provide demographic information.
Statistics: Descriptive analyses were used for showing demographic characteristics of the participants and the results of the traditional Chinese (Taiwanese context) version of MPOC-20. Multiple linear regressions with both service providers/receivers variables entered were performed to determine whether service-related variables affecting parents’ perceptions of FCS.
Results: (1) Parents rated higher in ‘cooperative, integrated and supportive care’ (M=5.39, SD=1.04), while the lower 2 ratings were given to ‘Providing general information’ (M=4.41, SD=1.32) and ‘Providing specific information’ (M=4.80, SD=1.38). (2) Controlling the variables of service providers/receivers, we found that individual therapy, length of each therapy session between 40 to 60 minutes, and duration of therapy beyond 1 year are the positive factors associated with some or all aspects of FCS, while frequency of therapy is not significantly associated with FCS in the view of parents.
Conclusions and policy implications：The parents in metropolitan Taipei felt the services respectful, supportive, coordinated, and comprehensive; however, parents perceived they received insufficient information from therapists. In order to promote the health and well-being of children with developmental problems and their families, FCS provision should be considered as a priority in policy of early intervention, payment system in Taiwan national health insurance, clinical service delivery and service evaluation; furthermore, service-related variables should be taken into account in the planning and delivery of FCS.

並列關鍵字

children with developmental delay ； children with disabilities ； early intervention ； quality of pediatric rehabilitation service ； family-centered service ； psychometric properties

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