南台灣原住民口腔健康指導員培訓課程對口腔保健知識、態度、與行為之成效

The effectiveness of a community lay health advisor training curriculum on oral health knowledge, attitudes, and self-care behavior of aborigine in Southern Taiwan.

劉佩汶(Liou Pei Wun)

指導教授 ： 黃曉靈

高雄醫學大學/口腔醫學院/口腔衛生學系碩士在職專班/碩士(2015年)

摘要

背景：因民俗習慣及文化因素，使得台灣原住民中有46.1%具有嚼食檳榔的習慣，嚼食檳榔會引起牙結石沈積及牙周炎，所以具有嚼食檳榔經驗或嚼食檳榔較多者，都會有不良的口腔衛生。研究證實不良的口腔衛生習慣會造成口腔癌的發生。另外，交通、社會經濟及對口腔保健知識不足，都會影響其牙醫就診率，100年台灣原住民門診就診率為89.1%，其中牙醫門診率僅占31.7%。社區健康指導員（Lay Health Advisor, LHA）主要應用於語言及文化背景不同的族群，且已被證實能有效傳遞基本的健康資訊，對社區民眾的健康照護是有功效的。
研究方法：使用單組前後測設計。本研究共招募59位南台灣屏東縣及台東縣山地鄉原住民，比較LHA培訓課程後學員在口腔保健知識、態度、與行為之成效。共六梯次培訓時間，每梯次上課4次，合計12小時。培訓內容包括口腔基本知識、潔牙原理與技巧、教學原理與方法及情境模擬，最終共有51人完成培訓課程及測驗，參加者的研究資料是使用自填式問卷獲得。檢測培訓課程前後差異使用的統計方法包括麥氏檢定（McNemar test）、邊緣同質性檢定（marginal homogeneity test）、配對t檢定（paired t- test）、簡單迴歸（Simple Linear Regression）、複迴歸（Multiple Linear Regression）、邏輯斯迴歸（Logistic Regression）。
結果：學員課程前後口腔保健知識、自我效能、態度分數、每天刷牙次數、每次潔牙時間、刷牙方法、含氟牙膏使用都具有統計上顯著性差異 (p<0.05)。培訓前後口腔保健知識分數相差3.51分（p<0.001）；口腔保健態度分數相差1.39分（p=0.028）；調整族別、年齡、性別、教育程度，口腔保健自我效能分數相差1.49分（p=0.001）。
利用邏輯斯迴歸（Logistic Regression）分析，學員在調整年齡、性別、教育程度後，接受培訓後有2.78倍的機會每天刷牙3次以上(95%CI為1.07-7.21)；接受培訓後，學員有3.43倍的機會每次刷牙三分鐘以上(95%CI為1.23-9.56)；平常刷牙時，使用改良式貝氏刷牙法為未使用的49.16倍(95%CI為13.34-181.18)；有使用含氟牙膏刷牙為未使用的5.06倍(95%CI為1.93-13.24)。
結論：原住民社區健康培訓課程可有效提升其口腔保健知識、態度及自我效能，並採取正確的口腔保健行為
關鍵字：口腔健康、衛生教育、原住民、社區健康工作者

關鍵字

口腔健康 ； 衛生教育 ； 原住民 ； 社區健康工作者

並列摘要

Background：About 50%of aboriginals have betel nut chewing habit. Betel nut chewing lead to poor oral health, including oral mucosa ulcer and periodontal disease. Poor oral hygiene was proved related to oral cancer. Community health advisor (CHA) was effectively intervention strategy in language and culture difference population and remote areas to deliver health information and health care skill.
Methods：The study design was the pre and post-test. There were 59 aboriginals recruited from aboriginal communities in Pingtung County and Taitung County in Southern Taiwan. Six training classes were held. Each training cycle went for 4 consecutive weeks including 12 hours lecture. The training includes basic oral morphology, oral health knowledge and skill, principles and methods of teaching and situational simulations. Overall, 51 participants finished the training course and passed post-training knowledge test. The pre-and post-data were collected by a self-administered questionnaire. McNemar test, marginal homogeneity test, paired t test, Simple Linear Regression,Multiple Linear Regression, and logistic regression were used to analyze the difference at pre- and post-training
Results：The result showed that significantly increase level of oral hygiene related knowledge, self-efficacy, attitude, brush time, brush times,brush method, fluoride toothpaste use (P<0.05). LHA trainers were more likely to have higher 3.51 points of oral health knowledge (95%CI:2.70-4.32), 1.39 points of attitude (95%CI: 0.16-2.63] ,andAdjusting race,age,gender,education level,1.49 points of self-efficacy (95%CI: 0.63-2.35) than pre-test. In addition, Adjusting age,gender,education level,LHA trainers were more likely to brush their teeth over three times every day [AOR = 2.78, 95%CI:1.07-7.21], brush their teeth over three minutes every time [AOR =3.43, 95%CI: 1.23-9.56],use modified Bass brush method[AOR =49.16, 95%CI: 13.34-181.18], use fluoride toothpaste [AOR = 5.06, 95%CI: 1.93-13.24].
Conclusions：The LHA training for aboriginals is an effective way to promote oral health knowledge, attitudes, self-efficacy, and oral health behavior.
Key word：oral hygiene,health education, aborigine,lay health advisor

並列關鍵字

oral hygiene ； health education ； aborigine ； lay health advisor

參考文獻

參考文獻

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