探討健康介入方案對心血管高危險群個案之成效
：以台東縣東河鄉與長濱鄉為例

本研究探討是以台東縣東河鄉及長濱鄉社區民眾心血管疾病高危險群為目標族群，採衛生教育進行介入模式，對心血管高危險群之健康行為影響與身體檢查值的改變。並實際考量兩社區族群間的健康狀態與文化背景差異，進而探討衛教介入後在衛教組組內原住民與漢族族群，在認知、態度；生理檢查值的改變情形。並且同時探討影響健康主要的因子，以延續日後相關研究之參考。研究方法本研究利用描述性統計與推論性統計，進行衛教介入後相關健康行為與認知、態度之差異分析。將選定的社區進行衛教組與對照組的分組，並且經由94年台東縣社區整合式篩檢資料，利用隨機取樣方式選定心血管高危險群民眾進行抽樣，並且以電話聯絡確認參加意願，排除已經確診心血管相關疾病與拒絕之個案，區分原住民及漢族族群，每組各為40人，共計160人。再經由訪員填寫前後測之問卷，由衛生所醫護人員進行前後測之生理檢查值試驗，執行期間為95年5月至96年1月止(共計九個月)。研究結果經由衛教介入之後對於衛教組的健康行為與體重的改變是無顯著改差異；在認知、態度與腰圍改變則有顯著差異。在血壓、血液生化值的結果，收縮壓值、舒張壓值、肌酸酐與空腹血糖指數有顯著改變。對於原住民的影響結果，除了高血壓認知、態度，腰圍值、舒張壓值、肌酸酐指數、高密度脂蛋白膽固醇指數無顯著差異之外，其他皆有顯著差異。透過複迴歸模式分析，統計結果發現在衛教組對於收縮壓值、高密度脂蛋白膽固醇、三酸甘油酯指數，為最顯著的影響因子。結論與建議在結論方面，本研究採用衛教介入評估心血管高危險群民眾成效，衛教組的確對照組在各項生理檢查值與知識、態度的改變較為顯著，無論是原住民或是漢族族群也皆為相同結果。因此建議未來衛生政策規劃與執行時，應就族群的文化背景與健康情形的差異，進而採行因地制宜的衛教介入方式，以達到增加個案對其可近性與適用性。

關鍵字

衛教成效；原住民；心血管疾病；健康檢查

並列摘要

Object：This study was mainly focused on the residents with high-risk of cardiovascular diseases in Taitung County Dunghe Township and Changbin Township as target subjects. This research took health education as intervention model to find out how it would affect the health behaviors and changes in the result of body check of the group with high-risk of cardiovascular diseases. It also considered the health status and cultural differences between these two communities. Thence it discussed about how, after health education was intervened in, health, cognition and attitude of the aboriginals and Hans in health education group changed. Meanwhile, it also probed into the major factors influencing health for relevant study in the future. Method：This research took descriptive statistics and inferential statistics to analyze the differences of health, cognition and attitude after the intervention. These two communities were divided into Health Education Group and Control Group. According to the information of Taitung county community-based integrated screening in 2005, residents with high-risk of cardiovascular diseases were randomly chosen. Through telephone contact their agreement of participation in the research was confirmed, and residents who refused to join this research or who already had cardiovascular diseases would be excluded from the study. They were grouped into aboriginals and Hans, and there are 40 in each group, 160 persons in sum. Interviewers filled in pre-test and post-test questionnaires, and medical staffs in the health office examined subjects' physiological changes. It started from May in 2006 to January 2007 (9 months totally). Results：The intervention of health education didn't make significant influences to health behaviors and body weigh changes in Health Education Group. However, the change of cognition, attitude and waistline was remarkable. Blood pressure , blood biochemical value examinations revealed significant changes in systolic pressure value, diastolic pressure value, creatinine and fasting blood sugar. For the aboriginals, there were lots significant changes in aspects other than cognition of high blood pressure, attitude, waistline, diastolic pressure value and creatinine. By multiple-regression analysis, the result showed systolic pressure value, high density lipoprotein cholesterol and triglyceride value were the major factors in Health Education Group. Conclusion and suggestion：In the conclusion, this study evaluated the intervention of health education to residents with high-risk of cardiovascular diseases. For both aboriginals and Hans, the physiological examination values, cognition and attitude of Health Education Group changed more than control group. Therefore, it is suggested hygiene policy plans and execution in the future with consideration of intervention of health education suitable to local conditions according to the cultural background and health situation of each community. Hence the policy would be carried out effectively to each specific individual.