長照機構照顧服務員對老人性的認知與實現老人性健康之量表的發展及其應用

研究目的：探究長照機構照顧服務員對老人性的認知程度，可作為未來設計性教育介入方案的參考，藉以提升照顧服務員對老人性的認知；性認知臻備能有助於照顧服務員進而實現老人性健康，終為避免老年住民衍生性問題風波與提升照護生活品質。測量工具的有無與良窳為評估之關鍵，學術領域缺乏長照機構照顧服務員對『「老人性的認知量表」(The Aging Sexual Knowledge Scale, ASKS)及「實現老人性健康量表」(Fulfilling the Aging Sexual Health Scale, FASHS)』的瞭解，希冀能發展深具信效度的結構式臺灣本土化量表；並進一步探討實現老人性健康之ASKS的最佳認知切截分數；最後進行照顧服務員對「老人性的認知」與「實現老人性健康」的推論統計分析。研究方法：立意取樣中臺灣長照機構照顧服務員進行面訪問卷，完成結構式問卷484份，分二組為238份與246份，分別進行探索性因素分析(EFA)與驗證性因素分析(CFA)；接續，以ROC曲線分析及約登指數(Youden’s index)進行最佳切截分數的判別；再以獨立樣本t檢定與單因子變異數分析，瞭解照顧服務員對「老人性的認知」是否具人口學統計上的顯著差異性，與逐步多元迴歸分析探討重要的預測變項；最後以皮爾遜積矩相關及簡單迴歸分析，瞭解照顧服務員對「老人性的認知」與「實現老人性健康」的相關與預測。研究結果：1.量表信度方面：ASKS之Cronbach's α值為0.93，CR值為0.92, 0.89, 0.92，AVE值為0.67, 0.53, 0.70；FASHS之Cronbach's α值為0.87，CR值為0.89, 0.89, 0.85，AVE值為0.72, 0.74, 0.66，雙量表皆有良好的信度。2.量表效度方面：ASKS原始問卷43題；內容效度檢定刪除6題；項目分析之決斷值及t檢定考驗後刪除3題。接著進行EFA，共同性檢定行逐題刪除，共刪除13題；再進行三次主成份分析，共刪除3題，結果分析出三個因素為「性表達」6題、「性功能」7題、及「親密感」5題。FASHS原始問卷12題；內容效度、項目分析皆未刪題；接著進行EFA，共同性檢定行逐題刪除，共刪除3題；再進行主成份分析，結果分析出三個因素為「性活動」、「性權利」及「性表達」各3題。最後雙量表分別進行CFA，樣本為常態分配、無違反估計、適配指標值(「ASKS /FASHS：卡方值/自由度=2.66/2.62；RMSEA=0.08/ 0.08、GFI=0.87/0.95、AGFI= 0.83/0.91、NFI=0.90/ 0.96、CFI=0.94/0.97、PNFI=0.78/ 0.64」，為相當程度的適配)、另也具收斂效度與區別效度。3.照顧服務員對老人性的認知之「ROC曲線下面積(AUC)」在區辨實現老人性健康的準確度為良好(AUC=0.8)；又根據約登指數顯示照顧服務員對老人性的認知分數以「67.5分」作為評估實現老人性健康為最佳的切截點。4.照顧服務員對老人性的認知之描述性及推論性統計結果為女性(86 %)、已婚(73.3%)、40-49歲(35.9%)、高中(職)(42.3%)、工作年資5年以內(74.5%)居多。照顧服務員對老人性的認知程度比較上，女性>男性，40-49歲>20-29歲、40-49歲>30-39歲、50-59歲>20-29歲、50-59歲>30-39歲，高中組>國中組，工作年資『「<1年」<「1-2年」、「3-5年」、「6-10年」』及『1-2年< 6-10年』；工作年資在「照顧服務員對老人性的認知」具最大的預測力。照顧服務員對老人性的認知與實現老人性健康呈顯著正相關(r= 0.68)；照顧服務員對老人性的認知可以解釋實現老人性健康46.7%的變異量。結論：本研究發展ASKS與FASHS為具信效度的量表，且照顧服務員對「老人性的認知量表(ASKS)」可作為區辨「實現老人性健康」與否的有效篩檢工具；另，本國照顧服務員對老人性的認知仍舊不足，因而建議衛生福利部社會及家庭署之「照顧服務員訓練實施計畫」的核心課程應將老人性的相關議題納入其學習範疇，以提升照顧服務員對老人性的認知，方能促使實現老人的性健康。

關鍵字

長照機構；照顧服務員；性認知；實現性健康；因素分析； ROC曲線

並列摘要

Purpose: The purpose of this study was to investigate the knowledge of nurse aides caring for elderly people in long-term care facilities with regard to elder sexuality. Empirical findings of the study would be expected to develop more effective programs of sexuality education about the nurse aides in the future. And then enhanced sexual knowledge of the nurse aides for elderly, with fulfilling the sexual health in the elderly to escape persecution from sexual events. Ultimately improved the quality of life and care for older adults. The substance of the assessment tools were classified as essential, " The Aging Sexual Knowledge Scale(ASKS) and Fulfilling the Aging Sexual Health Scale (FASHS)" in long term care facilities weren’t present in the academic world, and we hoped to develop the indigenous and structured questionnaire in Taiwan, with the reliability and validity. In addition, this research aimed at exploring the relationship between the two scales. Methods: To purposive sampling the nurse aides in long term care facilities in Central Taiwan. They were interviewed with a structured questionnaire. The valid data from 484 nurse aides were analyzed, of which 238- person sample was targeted for exploratory factor analysis (EFA), the other subjects belonged to confirmatory factor analysis (CFA). Other analysis included receiver operating characteristic curve, descriptive statistics, and inferential statistics. Results:1. Scale reliability: ASKS had Cronbach's α value of 0.93, CR value of 0.92, 0.89, 0.92, AVE value of 0.67, 0.53, 0.70; FASHS had Cronbach's α value of 0.87, CR value of 0.89, 0.89, 0.85, and AVE value was 0.72, 0.74, and 0.66. 2. Scale validity : The original 43/12-item of ASKS/FASHS that had been reviewed by experts for validity and then 6/0 items of these questions were deleted according to the content validity index of less than 0.8. The result eliminated a further three/non questions by critical ration and t-test of the item analysis. EFA was then performed on data. The scale consisted of 13/3 items were deleted in the communality of less than 0.3. Principal component analysis was performed three/one times, and then 3/0 items were deleted. Based on EFA, 18/9 items were classified into three domain factors, namely "sexual expression/ sexual activity ", "sexual function/ sexual rights " and "intimacy/ sexual expression ", these structures contained 6/3, 7/3, and 5/3 items, respectively. Finalization of CFA, the result was a sample of normal distribution, non-offending estimated, goodness- of-fit indices were labeled as outstanding fit, with convergent validity and discriminant validity. The overall model fit of ASKS /FASHS: /df (2.66 /2.62), RMSEA (0.08/ 0.08), GFI(0.87/0.95), AGFI(0.83/0.91), NFI(0.90/ 0.96), CFI (0.94/0.97), PNFI(0.78/ 0.64). 3.In addition, the study offered cutoff points for evaluatingthe optimal cut-off level with 67.5 of ASKS and further analyzing its accuracy when assesseing fulfilling sexual health in the elderly. 4. Other important findings were that women, older, highly educated, and long-term working of the nurse aides had a higher level of cognition. The current job tenure of nurse aides had the greatest predictive power for the aging sexual knowledge. The aging sexual knowledge and fulfilling sexual health showed a significant positive correlation (r = 0.68) and the aging sexual knowledg explained 46.7% of the fulfilling sexual health. Conclusions: This study developed two scales with reliability and validity, and ASKS could been used as an effective screening tool for distinguishing FASHS. In addition, the nurse aides were still insufficient for aging sexual knowledge in Taiwan. Therefore, this report suggested that the government should strengthen nurse aides to aging sexual knowledge.

並列關鍵字

long term care facilities ； nurse aides ； sexual knowledge ； fulfilling sexual health ； factor analysis ； receiver operating characteristic curve

參考文獻

Anderson, J. C., & Gerbing, D. W. (1988). Structural equation modeling in practice: A review and recommended two-step approach. Psychological Bulletin, 103(3), 411-423.

中央社(2007)‧老人性需求，學者：安養機構應闢私室協助‧取自http://luvjeremy.pixnet.net/blog/post/9384498