- 學位論文
得舒(DASH)營養教育介入對高血壓者的營養知識、飲食行為、自我效能和血壓的影響
Effects of a DASH Nutrition Education Intervention on Nutritional Knowledge, Dietary Practices, Self-Efficacy and Blood Pressure in Hypertensive Individuals
摘要
背景 高血壓是台灣當前相當重要之公共健康議題。推廣高血壓防治教育刻不容緩。得舒（DASH）源自美國，是防治高血壓的一個飲食計畫。國內少見相關研究。 目的 針對北醫附近的高血壓者設計一個得舒營養教育計畫。評估其對於高血壓者的營養知識、飲食行為、自我效能和血壓的影響。 研究方法與設計 以臺北醫學大學為中心，透過鄰里社區、北醫附醫和周邊住戶發送招募傳單，完成招募64位高血壓前期及第1期高血壓者。研究設計為「準實驗法」-非隨機化實驗對照組前後測。立意取樣後分為得舒組（n=34）和對照組（n=30）。得舒組接受4週的每週1次營養教育介入，由研究者(蔡)執行團體教育課程和個人電訪諮詢。教學策略運用健康信念模式和社會認知理論；對照組不作介入。利用問卷收集營養知識、飲食行為、自我效能資料，並測量血壓及體位如身高、體重、體脂率、腰圍並計算BMI。這些資料分別於前測（第1週）、後測（第5週）及追蹤期（第9週）蒐集。 結果 得舒組在介入後，增加營養知識，並改善飲食行為，且維持至追蹤期（第9週），但自我效能無顯著的改變。飲食行為方面：得舒組在全穀類(7-8份/日)、低脂/脫脂奶類（2-3份/日）、蔬菜類(4-5份/日)、堅果種子類（1份/日）的飲食建議，介入後的每週攝取頻率皆 顯著增加(p<0.05)；紅肉及內臟類（<1份/日）、含糖飲料及甜食類(<5份/週)、動物性油脂類以上的飲食建議，介入後的每週攝取頻率皆顯著減少。對照組的營養知識、飲食行為、自我效能在第5與9週皆無顯著改變。得舒組的收縮壓及舒張壓於第5週皆顯著降低(-7.73/-4.91 mmHg, SBP/DBP, p<0.05)﹔並維持至第9週；但其體重、體脂率、腰圍及BMI在第5與9週皆未改變。對照組在第5與9週的舒張壓降低3.46 mmHg，體重輕微上升；收縮壓、BMI、體脂率、腰圍則未改變。本研究未調整受試者的生活形態如規律運動、控制體重、飲食減鹽、限制飲酒及戒煙，故得舒組改善飲食行為，是降低血壓的主要因素。得舒組和對照組的飲食行為與營養知識、自我效能呈顯著正相關(r=0.45, 0.57, p<0.01)﹔且與體重、BMI呈顯著負相關(r=-0.28, -0.25, p<0.05)。 結論 得舒營養教育計畫對北醫附近的高血壓者，增加營養知識，並改善飲食行為，改善血壓，且維持至第9週。
並列摘要
Background Hypertension is one of the most important publicissues in health in Taiwan. To promote education on its prevention and treatment is urgent. DASH (Dietary Approaches to Stop Hypertension) is originated from United States. The research and the literature on DASH have been rare in Taiwan. Purpose The study was to evaluate the effects of a DASH nutrition education intervention on nutrition knowledge, dietary practices, self-efficacy and blood pressure of individuals with pre-hypertension or stage I hypertension. Methods Participants were recruited by poster, flyers on bulletin board in near-by community or TMU hospital and flyers to mailbox of households near the TMU. The study was nonrandomized pretest-posttest quasi-experiment design. A total of 64 individuals with prehypertension or stage 1 hypertension completed the study: 34 in DASH group and 30 in control group. DASH group received 4-week of nutrition education program conducted by author Tasi together with counseling by telephone. DASH nutrition education program was developed on the basis of Health Belief Model and Social Cognitive Theory. Control group did not received intervention. Data on nutrition knowledge, dietary practices, self-efficacy were collected by questionnaire. Blood pressures and anthropometric measurements including height, weight, body fat percentage, waist circumference were taken at pretest (week 1th), posttest (week 5th) and follow-up (week 9th). Body mass index was calculated at 3 different time points. Results After DASH nutrition education intervention, nutrition knowledge, dietary practices, and blood pressures of DASH group improved significantly and the effectiveness lasted for 4 more weeks (at week 9th), but self-efficacy did not change significantly. Food intake frequency (per week) significantly increased for whole-grain, low-fat dairy products, vegetables, and nuts & seeds; food frquency significantly decreased in red meats & giblets, sweets & beverages, animal fats and refined grains. SBP and DBP significantly decreased in DASH group (-7.73/-4.91 mmHg). There were no changes in control group. Weight, body fat percentage, waist circumference and BMI of DASH group did not change significantly throughout the study period. In control group DBP significant decreased (-3.46 mmHg) and weight increased slightly; SBP, body fat percentage, waist circumference and BMI index did not change significantly. The study did not involve in “lifestyle modification” to decrease blood pressures. Thus, it’s suggested the main reason for lowering blood pressures in DASH group is the change of dietary practices due to nutrition education intervention. Correlation of nutrition knowledge to dietary practices or self-efficacy was significantly positive (r=0.5, 0.55, p<0.01). Dietary practices correlated negatively with DBP, weight and BMI (r=-0.21, -0.26, -0.22, p<0.05). Conclusion DASH nutrition education intervention can improve nutrition knowledge and dietary practices, and lower blood pressures of individuals with prehypertension or stage I hypertension up to 9th week, but not for self-efficacy.