兒童牙科焦慮之行為觀察系統及評分量表

An observational behavioral coding system and rating scale of children's dental anxiety

朱妙盈(Mio-Ieng Chu)

指導教授 ： 陳弘森

高雄醫學大學/口腔醫學院/牙醫學研究所/碩士(2014年)

https://doi.org/10.6832/KMU.2014.00127

摘要

目的: 針對牙科治療中兒童、家長及牙醫師之行為表現，進行「兒童-照顧者-牙醫師」互動過程之行為觀察，用以建立一套有關兒童牙科害怕/焦慮行為之觀察記錄系統和評分量表。
材料與方法: 研究對象為2~12歲至高雄醫學大學附設中和紀念醫院兒童牙科門診及一般診所就診的兒童共60位，收案時間為民國101年11月~102年10月。所收集的資料包括兩部份：1. 使用CFSS-DS問卷及VAS請兒童作自我牙科恐懼評估。2.透過錄影方式把牙科治療完整過程完整記錄下來，再由經過訓練之兒童行為觀察研究人員進行觀察紀錄，包括兒童各種行為反應、照顧者之反應，及牙醫師所採取之行為處理策略，作詳細敍事法記錄，整合後建立一個包括九個項目的評分系統。這九個項目分別為治療進行期間，兒童的頭部、身體、上肢和下肢的動作；兒童的聲音及情緒；兒童和照顧者的互動；兒童和牙醫師的互動;牙醫師和照顧者的互動。3.用建立的評分系統和Frankl評分量表為60個個案評分。
結果:我們建立的評分系統和Frankl評分量表所得出的結果呈高度正相關外、和CFSS-DS分數、年齡、牙醫師使用的行為處理種類數目有顯著相關。
結論:透過詳細的兒童-照顧者-牙醫師行為觀察記錄所建立出來的評分量表能夠更有效的幫助牙醫師評估個案的配合程度，使牙醫師能夠制定出更有效的行為處理策略。

關鍵字

牙科焦慮 ； 兒童行為觀察 ； 行為紀錄評分量表

並列摘要

Aims: To establish an objective observational coding system and rating scale for better evaluation of dental fear in children. To investigate the relationship between the total score of our observational rating scale and other factors.
Methods: This clinical observational study of 60 subjects used convenient sampling method to recruit children of 2-12 years old from Nov 2012 to Oct 2013. CFSS and VAS were completed by children with the help of caregiver. Parental consent was obtained. Each dental procedure was recorded and transcribed into observational record. A rating scale was then established.
Results: There were 36 boys and 24 girls (mean age 5.36±0.85). The most treated problem was caries (53.3%). In WBFPRS questionnaire, 60% experienced no pain, 16.9% had moderate pain and 10.2% had severe pain. Mean behavioral rating score was 15.23, and mean CFSS-DS score was 27.8. According to our rating scale, 22 of the children had dental fear and 38 of them did not, while Frankl Rating Scale showed 20 children with dental fear and 40 of them did not. Correlation analysis show no significant relationship between observational total score and WBFPRS, but there is high significant relationship between observational total score and CFSS total score, age, number of behavior treatment type and Frankl score.
Conclusion: We developed a behavior coding system and rating scale for interactive behaviors between child, caregiver and dentist. Compared to other rating scale, such as the Frankl, it has shown some strengths and limitations.
The rating scale is objective and suitable for dentist to be used as behavior assessment tool. Further modification is need and inter- and intra-coder reliability need to be tested in the future.

並列關鍵字

dental anxiety ； children behavioral observation ； observational rating scale

參考文獻

References

1. Steen W. M. Our relation to children. Dental Review 1981; 5:534-537.

2. Freeman R. Communicating with parents and children: recommendations for a child-parent-centred approach for paediatric dentistry. Eur J Paediat Dent 2008; 9:16-22.

3. Bensing J. Bridging the gap: the separate worlds of evidence-based medicine and patient-centred medicine. Patient Educ Couns 2000; 39:17-25.

4. Blanch-Hartigan D. Measuring provider’s verbal and non-verbal emotion recognition ability: reliability and validity of the patient emotion cue. Patient Educ Couns 2011; 82:370-376.