評價社區健康工作者模式應用於提升南台灣原住民社區口腔癌篩檢計畫之成效

Evaluate the Effects of an Oral Cancer Screening Intervention Program using Lay Health Advisor Approach in Aboriginal Communities in Southern Taiwan

李恆(Heng Lee)

指導教授 ： 黃曉靈

高雄醫學大學/口腔醫學院/牙醫學系博士班/博士(2020年)

摘要

目標：
嚼食檳榔會導致口腔癌，並且有著很差的預後，而不良的口腔保健習慣會導致許多口腔疾病，而台灣偏遠的原住民社區有著傳統性嚼食檳榔的習慣，並且有較高比例的檳榔嚼食者，同時也是罹患口腔癌的高危險群，同時此地點也具有口腔健康不均等的現象。利用Lay health advisor (LHA)這項介入策略，可以協助少數族群提升健康照顧的能力，而本研究評估融合健康信念模式（Health belief model, HBM），使用LHA策略在偏遠原住民社區進行口腔癌篩檢、口腔黏膜自我檢查與口腔健康行為之介入成效。
方法：
本研究參加者被隨機分派為介入組與對照組，介入組參加者會接受四次LHA一對一的教學，對照組參加者會拿到四張衛教單張。介入的內容包含口腔癌篩檢的資訊、口腔黏膜自我檢查的技巧與口腔保健行為。本研究使用結構式問卷進行LHA介入與單張閱讀之效果的測定
結果：
透過訓練良好的LHA進行介入，介入組的參加者有2.04倍（95% confidence interval, 95%CI: 1.31–3.17）的機會比對照組的參加者在介入後表示會進行口腔黏膜自我檢查，並且介入組的參加者有較高的接受口腔癌篩檢與進行口腔黏膜自我檢查的自我效能（β = 0.53 與 0.44, effect size, ES = 0.33 與 0.25），且介入組參加者有較低的接受口腔癌篩檢障礙（β = −1.81,ES = −0.24），且介入組參加者有1.89倍（95%CI: 1.20-2.97）的機會比對照組的參加者在介入後表示會改用含氟牙膏潔牙，有1.67倍（95%CI: 1.05-2.67）的機會在介入後表示每天刷牙兩次或以上。
結論：
LHA介入策略對於推廣口腔黏膜自我檢查、提升相關自我效能與降低接受口腔癌篩檢的障礙有正向效果，且對口腔保健行為也有正向效果。

關鍵字：原住民、檳榔、吸菸、口腔癌、篩檢、社區健康工作者、健康信念模式

關鍵字

原住民 ； 檳榔 ； 口腔癌 ； 篩檢 ； 口腔保健 ； 健康促進 ； 介入 ； 社區健康工作者 ； 健康信念模式

並列摘要

Objective: Chewing betel nuts can cause oral cancer, and patients’ prognosis is rather poor. Besides, poor oral health habits will lead to a host of oral diseases. Aboriginal people living in remote areas in Taiwan have a tradition of chewing betel nuts and thus have a higher proportion of betel nuts chewers. They are viewed as a high-risk group for oral cancer as well. Also, inequality of oral health happened in remote aboriginal communities. Using a lay health advisor (LHA) can increase access to health care among minorities. This study evaluated a health belief model (HBM) incorporates LHAs intervention for oral cancer screening (OCS), mouth self-examination (MSE) and oral health behavior in remote aboriginal communities.
Methods: The participants were randomly assigned to intervention (IG) and control groups (CG). In the IG, participants received a four-chapter one-on-one teaching course from LHAs, whereas those in the CG received only four leaflets. The intervention included OSC information, MSE skill, and oral health behavior teaching. We used a structured questionnaire to measures effect of LHA intervention and leaflet reading.
Results: Through the intervention of a well-trained LHA, the IG participants were 2.04 times more likely to conduct a monthly MSE than those in the CG (95% confidence interval, 95%CI: 1.31–3.17). The participants of IG showed significantly higher self-efficacy toward OSC and MSE, (β = 0.53 and 0.44, effect size, ES = 0.33 and 0.25, respectively) and a lower barrier level for OSC (β = −1.81, ES = −0.24). The IG participants are 1.89 times more likely to use fluoride toothpaste than those in the CG (95%CI:1.20-2.97) and 1.67 times more likely to brush their teeth twice or more per day than those in the CG (95%CI:1.05-2.67) after the intervention.
Conclusion: The LHA intervention had a significantly positive effect on MSE, enhancing self-efficacy, and reducing barriers to OCS among aboriginal populations. Also, LHA intervention had significantly positive impact on oral health behavior.
Keyword: Aboriginal, Betel nuts, Oral cancer, Screening, Oral health, Health promotion, Intervention, Lay health advisor, Community health worker, Health belief mode

並列關鍵字

Aboriginal ； Betel nuts ； Oral cancer ； Screening ； Oral health ； Health promotion ； Intervention ； Lay health advisor ； Community health worker ； Health belief mode

參考文獻

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