社區健康顧問介入策略應用在新移民母親對孩童齲齒預防認知、態度和行為之成效

The Effectiveness of Lay Health Advisors (LHAs) Intervention Approaches on Child’s Caries Prevention Cognitive, Attitude and Behaviors in Immigrant Mothers

魏芯樺(Sin Hua Moi)

指導教授 ： 黃曉靈

高雄醫學大學/口腔醫學院/口腔衛生科學研究所碩士班/碩士(2014年)

https://doi.org/10.6832/KMU.2014.00047

摘要

背景: 新移民配偶的增長所造成的健康不均等現象在近年來已成為公共衛生關心議題，尤其是婦幼衛生相關領域。前驅研究指出口腔健康差距存在於新移民與本土家庭的兒童，三歲的移民兒童的齲齒經驗指數(decayed, missing, or filled tooth)為6.05，相較於同齡本土兒童的3.88，有高達兩倍的齲齒經驗。低社經地位及母親口腔保健行為可解釋外籍孩童與本籍孩童口腔健康不均等現象。應用社區健康顧問(Lay Health Advisors，簡稱LHAs) 介入策略於社區健康照護上已有相當成效，尤其是針對新移民族群；然而在口腔健康領域上尚未被應用。
目的: 本研究目的為探討社區健康顧問介入策略應用在新移民母親對孩童齲齒預防認知、態度和行為之成效，及新移民母親口腔保健認知、自我效能及行為之成效。
研究方法: 本研究使用隨機分派實驗設計，研究對象為高雄市三民區育有2-6歲孩童之越南籍新移民母親。符合條件之研究對象會隨機分派至介入組或對照組。介入組母親在4週內接受4次一對一LHAs口腔衛生教育課程，而對照組母親僅給予衛教單張。研究工具使用結構式問卷進行介入前後測資料收集，執行期間為2012年8月至2014年3月，介入組共25人，對照組19人。精確麥氏檢定(McNemar’s exact tests)、邊緣同質性檢定(Marginal homogeneity test)和魏克森氏符號等級檢定(Wilcoxon signed-rank test)介入組前後測差異；檢測兩組間差異的統計方法則包含費氏精確檢定(Fisher’s exact test)和魏克森氏等級總和檢定(Wilcoxon rank sum test)。
結果: 介入組母親相較於對照組，幫孩子刷牙頻率3次或以上有正向階段改變者增加了24.00%(p=0.029)；幫忙孩子刷牙時間3分鐘或以上有正向階段改變者增加了60.00% (p=0.005)。介入組母親於介入後在齲齒預防認知得分有顯著提升，從前測5.80±2.31分增加至8.28±2.15分 (p=0.002)。另外，介入組母親自身口腔保健行為部分，刷牙頻率為每天3次或以上者，有正向階段改變的人增加36.00% (p=0.015)；刷牙時間3分鐘或以上有正向階段改變者增加40.00% (p=0.034)；使用貝氏刷牙法，改變階段為正向的人增加52.00% (p=0.001)；牙線使用有正向階段改變者增加40.00% (p=0.042)，皆顯著高於對照組母親。
結論: 社區健康顧問介入策略應用在提升新移民母親對孩童齲齒預防認知和潔牙行為、及自身口腔保健行為是有效的。

關鍵字

口腔衛生 ； 衛生教育 ； 新移民 ； 社區健康顧問 ； 孩童

並列摘要

Background: With the growing number of transnational marriages in Taiwan, health disparities have become a vital public health issue, especially in maternal and child health. Our current study showed the caries index was 6.05 in immigrant children and 3.88 in native children. Lower socioeconomic status and maternal oral health-related behaviors may explain the caries disparity among immigrant children aged 4 to 6 years and their native counterparts. The lay health advisors (LHAs) intervention strategy is feasible and effective for promoting health care, especially among disparate immigrant populations; however, no such community experience was applied in oral health field.
Objectives: To evaluate the outcome effectiveness of a community-based lay health advisor outreach program on child’s caries prevention behaviors among immigrant mothers in Kaohsiung, Taiwan.
Methods: A randomized experimental design was used. Vietnamese women who have one or more 2-6 years old children were recruited and randomized into the LHA intervention plus brochure group or brochure only group. Overall, 25 and 19 mothers were assigned into intervention and control group. Qualified LHAs used bilingual brochure, dental model and teeth cleaning kit in their outreach. Each LHA taught assigned mother about caries prevention cognitive and oral health care techniques four times at 4-week period. Participants in control group were asked to read the brochure by their own. Pre- and post-test questionnaire was used to collect the data in knowledge, attitude and behaviors. McNemar’s exact tests, Marginal homogeneity test and Wilcoxon signed-rank test were used to analyze the differences between the pre- and post-test data in same group. Wilcoxon rank sum test and Fisher’s exact test were used to examine the pairwise differences between the pre- and post-test data in both groups.
Results: Compared to the control group, the mothers in LHA intervention group had significant improvement in proportion of assisting in child brushing teeth 3+ minutes (24.00% , p=0.031) and child 3+ brushing minutes (60.00% , p=0.005). Intervention group had significant improvement in level of caries prevention cognition after outreach (5.80 at baseline vs. 8.28 at post-test (p=0.002). The LHA intervention group also had significant improvement in maternal brushing frequency (36.00%, p=0.015), brushing minutes (40.00%, p=0.034), modified bass method use (52.00%, p=0.001) and dental flossing (40.00%, p=0.042).
Conclusions: The LHA intervention strategy was efficacious in improving maternal caries prevention cognitive, behaviors and also maternal oral health care behavior among immigrant mother.

並列關鍵字

oral hygiene behavior ； health education ； immigrant ； lay health advisor ； children

參考文獻

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