南臺灣原住民口腔癌篩檢計畫社區口腔健康顧問培訓課程之成效

背景：惡性腫瘤為台灣原住民主要死因第一名，其中口腔癌為原住民十大癌症死因排名第三位，口腔癌更是帄均死亡年齡最年輕的癌症別，有一半以上患者未滿57 歲就死亡。由於語言及文化上的差異、對於健康資訊方陎的缺乏，及照護服務的可近性及可獲得性較低等因素，原住民在健康照護利用率偏低。而過去研究顯示社區健康顧問(LayHealth Advisor，LHA)的培訓課程適用於有文化考量且結果多顯示能有效提升專業知識、自我效能及行為的能力。目的：本研究目的為評值原住民LHA 的培訓課程成效包括促進口腔癌篩檢知識、自我效能及行為的能力。研究方法：本研究使用單組前後測設計。共有51名屏東縣及台東縣的原住民學員完成LHA口腔健康培訓課程，八個梯次課程。每一梯次4堂課總共12小時，課程由口腔專業背景的人員擔任講師。培訓手冊包含口腔癌篩檢及口腔保健相關的知識、口腔癌篩檢、口腔黏膜自我檢查與操作示範、教學方法與溝通技巧以及實際練習等。參加者的前後測是採用自填式問卷收集。使用配對t檢定(Paired-t test)以及邏輯斯迴歸分析(Logistic regression)檢測培訓課程前後測知識、態度、自我效能及行為差異。結果：研究結果顯示在口腔癌篩檢、口腔癌自我檢查及口腔保健的相關知識、自我效能都有顯著提升(P<0.05)；而在口腔癌篩檢行為前後測並沒有顯著的差異。結論：原住民社區健康工作者培訓為有效的方法來促進口腔黏膜自我檢查行為及提升口腔癌知識、自我效能及態度。關鍵字：原住民，社區健康工作者，口腔癌篩檢

關鍵字

原住民；社區健康工作者；口腔癌篩檢

並列摘要

Background: Oral cancer is the third leading cause of cancer death in aboriginal population, and the youngest average age of death caused by cancer are oral cancer and half of patients died under 57years old . Due to the language and cultural differences, lack of access to health message, and availability and accessibility of medical care services. The health care utilization rate among mountainous aboriginals is still low. Through training aboriginal lay health advisors can be effective way to increase professional knowledge, self-efficacy and behavior. Objectives: To evaluate the effectiveness of Lay Health Advisors (LHA) training for aboriginals in oral cancer screening promotion program. Methods: The study design is the pre and post-test. There are 51 aboriginals lived in Ping-tung and Taitung county finished the LHA oral health training course. Eight training class were held. Each training cycle went for 4 consecutive weeks including 12 hour lecture and each session is conducted by oral health professionals. The training manual included oral cancer knowledge, oral mucosa self-examination skill and demonstrations, teaching/communication skill etc. The pre-and post-data were collected by self-administered questionnaire. Paired-t test and Logistic regression were used to analyze the differences between the pre-and the post-data. Results: The result showed that significantly increase level of oral cancer related knowledge, self-efficacy toward oral cancer screening, and self-efficacy toward oral cancer self-examination There are significance increase in oral mucosa self-examination behavior (p<0.05); however the oral cancer screening behavior have no significance difference between pre and post-test. Conclusions: The LHA training for aboriginals is an effective way to promote oral cancer self-examination behavior and the level of oral cancer knowledge, self-efficacy and attitude.