職場客製化體重管理介入方案之評價研究-以某企業體重過重員工為例

「職場健康促進」的概念自1970年代開始發展，1979年世界衛生組織已將工作場所定義為一個有價值的健康促進介入場域，許多研究證實企業推行職場健康促進具有多項經濟及非經濟的效益。肥胖為全球最普遍的慢性病，研究顯示過重或肥胖者得到慢性疾病之機率，較其他體位者高出45個百分點。2016年衛生福利部國民健康署指出，我國成人過重及肥胖盛行率達43%，已居亞洲肥胖之冠。因肥胖而產生之健康風險將影響個人健康、工作效能及整體企業產能；因此，改善員工肥胖問題為職場健康促進首要努力之目標。目前國內外職場推動的健康促進方案，多為團體制式化的策略，對於對生活型態介入依從性差及克服行為改變障礙意志力低的高健康風險族群，往往達不到預期的健康效益。根據過去文獻指出，職場健康促進計畫之內容應依據目標對象之性質分群，提供客製化及符合個人所需要之資訊內容及介入方案，才能有助於個人行為的改變。本研究採準實驗設計，邀請某職場企業身體質量指數大於24以上的員工加入本計畫，實驗組27位，對照組24位，實驗組接受為期8週的客製化體重管理方案介入。本計畫運用跨理論模式瞭解研究對象的行為改變階段及介入時適宜採用的對應改變方法，運用客製化、動機式晤談、健康自主管理，以及目標設定等方法設計介入方案，以提高研究對象體重管理信念、行為、自我效能，以及行為改變階段，達到改善體位，降低健康風險之目的。根據本研究結果顯示，客製化體重管理方案介入對實驗組在提升體重管理信念、改善飲食行為、提高飲食運動自我效能、提升體重管理行為改變階段，以及降低身體質量指數、改善體脂肪率與減少腰圍等方面皆達到統計顯著改善，唯整體介入方案之評價分析結果顯示，介入後，在控制飲食運動自我效能、體脂肪率，以及腰圍於介入前之狀況後，實驗組上述三項指標於介入後並未顯著優於對照組，但體脂肪率及腰圍在後續追蹤與介入前比較，實驗組顯著優於對照組。在身體活動量方面，研究結果顯示，不管是實驗組於介入前後或與對照組比較，都未達統計顯著提升，表示計畫實驗期間內，客製化的介入方案對提高身體活動量成效並不顯著。整體而言，客製化體重管理方案介入對於改善職場員工體重管理信念、飲食行為、飲食運動自我效能、體重管理行為改變階段、身體質量指數、體脂肪率以及腰圍是有效的方法。建議未來研究者於職場規劃方案介入，應配合企業業務特性，降低環境造成之阻礙因素(如業務旺季)，以提高員工執行健康行為的可能性，並可將對象擴及各工作區域的員工，讓本研究的研究成果，回饋於企業，應用於員工健康促進與照護上，以增進員工健康、降低病假率，進而提高團隊士氣、增加工作產能，進而讓企業主更認同職場健康促進是最有效益的投資。

關鍵字

客製化；體重管理；成效評價

並列摘要

The concept of a "workplace health promotion" has evolved since the 1970s. In 1979, the WHO proposed the workplace as being a worthwhile setting for health promotion. Many studies have confirmed that workplace health promotion has both economic and non-economic benefits for enterprises. Obesity has been regarded as the most prevalent chronic disease worldwide. Studies have shown that people who are overweighed or obese are 45% more likely to have chronic diseases than others. In 2016, the Health Promotion Administration, Ministry of Health and Welfare, pointed out that the prevalence rate of overweight and obesity in Taiwan reached 43%, which was the highest amount in Asia. The health risks posed by overweight and obesity will affect personal health, work efficiency, and the overall corporate productivity. Therefore, reducing overweight and obesity is a priority in the workplace health promotion. At present, weight and obesity management programs in Taiwan and in other countries are mostly group-oriented have failed to achieve the expected outcomes for those who had poor adherence and those who had a low intention to overcome barriers. Research suggested that a tailored and individualized health promotion program may be effective for behavioral changes. This research employs a quasi-experimental design. Subjects in the experimental group participated in a weight management program with dynamic tailoring for a period of eight weeks. Based on the trans-theoretical model, strategies such as motivational interviews, self-management, goal setting, and social support, were adopted to help the participants establish a positive belief and adopt a healthful lifestyle, in order to achieve their goal of weight management, which may reduce their health risk and enhance their work productivity. Results of the study showed that the tailored weight management program had positive effects on the experimental group's weight control belief, dietary behavior, exercise self-efficacy, stages of behavioral changes on weight management behavior, body mass index, body fat percentage, and waistline. However, results showed that there was no statistically significant change in dietary and exercise self-efficacy, and wastline before and after the intervention between control and experiment groups after controlling for dietary and exercise self-efficacy, body fat percentage, and waistline measured before the intervention. However, the body fat percentage and waistline have showen improvement between before and follow-up periods. In terms of physical activity, results indicated no statistically significant difference between the two groups, suggesting that the tailored intervention program was not effective in improving physical activity. Overall, the tailored weight management program was effective in improving employees’ belief towards weight management, dietary behavior, exercise self-efficacy, stages of change, body mass index, body fat percentage, and waistline. We recommend that the design of workplace intervention programs need to consider implementation barriers in the specific environment of the enterprise (e.g., seasonal workload) in order to increase employee participation. Expansion of the intervention program examined in this study to other employees throughout the workplace would be beneficial in terms of employee health improvement, reduction of absenteeism, elevation of employee morale, work productivity, and increased awareness among employers of the effectiveness of workplace interventions.