- 學位論文
台灣原住民學童的文化回應式結核病公共衛生教育課程開發與評估
Culturally inclusive public health curriculum of tuberculosis for indigenous children in Taiwan
摘要
雖然台灣的結核病（TB）預防是有效的，但2007年政府統計數據指出原住民與全國平均標準死亡率差為4.5倍。特別是，結核病的死亡率在1-14歲台灣原住民為第六大死因，但同一族群的非原住民沒有因結核病而死亡。從文獻探討得知，對於敏感的族群如原住民，結核病的控制政策經常較不容易得到成效。從美國CLAS指導準則指出，衛生單位應該提供他們符合文化的健康信念、習慣和母語的服務。本研究探討之目的為 一）開發適合台灣排灣族與阿美族原住民學童的文化敏感度結核病公共衛生教材。二）為結核病公衛教育課程，培訓八位阿美族與排灣族種子教師。三）評估此教育介入對台灣排灣族與阿美族原住民5-9年級學童在結核病知識之立即成效。方法：課程是在花蓮（壽豐鄉，光復鄉）與屏東（獅子鄉及牡丹鄉）四個鄉中的5所小學和3所國中進行。結果顯示結核病公衛教育介入後，所有學生在結核病知識的有顯著增加，前、後測的分數達顯著差異，可以得知文化可近性的教材對原住民5-9年級學童，有很好的教育效果，並且課程滿意度平均分數為4.22分(滿分五分)，代表5-9年級原住民學童滿意這份教材。課程滿意度也可以看出，5-9年級的原住民學童對上課的老師是滿意的。本研究的結核病衛生教育介入結果顯示，相較於傳統在原住民鄉的結核病衛生教材，這樣的教材是較為合適且充足。希冀未來有更多針對原住民的衛生教育教材被開發出來，相信改善原住民族與一般人健康不均等的狀況是指日可待。
並列摘要
Although the prevention of Tuberculosis (TB) is effective in Taiwan, the standard mortality rate amongst indigenous Taiwanese is 4.5 times that of the National average from statistic data of the government, in 2007. Especially, the mortality rate of TB ranks the 6th cause of death in indigenous Taiwanese children between 1-14 years old, but nobody is dead in TB in the same cohorts of non-indigenous Taiwanese. From literature review, the limited success of TB control program often resulted from a sensitive populations, such as indigenous populations. Government gives cultural tolerance for specific indigenous groups that not only understands the culture differences, and it is the important references for drawing up relative public health policy. Moreover, from the CLAS standards in USA, the provider should offer in a manner compatible with their cultural health beliefs and practices and preferred language. This study investigated a)evaluation the degree of acceptance for cultural responsive indigenous public health electronic teaching materials of tuberculosis and for indigenous Taiwanese of Amis and Paiwan, b)making the teacher evaluation scale for 8 training pilot teachers of Amis and Paiwan for this curriculum, c) evaluate the aware difference of TB for indigenous Taiwanese children of Amis and Paiwan of grade 5-9 students(10-15 years old) from 5 primary schools and 3 junior high schools of four villages in Hualien (Shoufeng Township and Guangfu Township) and in Ping-Tung(Shrtz Township and Mudan Township) by pre-post evaluation. The results showed that all students have a significant increase in knowledge of tuberculosis after tuberculosis in public health educational intervention. The pre-test and post-test scores were significantly different and you can see that the cultural responsive teaching materials have a good educational result in indigenous students of grade 5-9 students. Furthermore, the average score of course satisfaction degree is 4.22 which mean that the students are satisfied with the teaching materials. The score of course satisfaction degree also shows that indigenous students of grade 5-9 students are satisfied with the teachers. The study of indigenous TB health education intervention showed that, compared to the traditional materials in indigenous village, such materials are more appropriate and adequate. In the future, more and more health education materials for indigenous people should be developed. Therefore, the improvement of "Health Inequality" for the indigenous people can be expected soon.