- 學位論文
原住民族糖尿病個案健康識能與運用文化合適性足部自我照顧教育介入之研究-以台中某泰雅族地區為例
The Study of Health Literacy and Cultural Congruence on Foot Self-Care Educational Intervention for Indigenous Diabetes Cases─Taking Atayal Groups in Taichung City as an Example
摘要
糖尿病的盛行率不斷持續上升，而且糖尿病病情控制不佳所引起的足部病變等併發症，常會造成民眾生理和心理上的不適，甚至造成殘障或是死亡。然而，原住民族的生活型態及文化差異，都與其健康議題相關，同時也影響個人自我照顧的健康知識與技能。國內外文獻也證實，健康識能不足可能會造成其健康相關知識不足、疾病自我管理不佳及健康服務利用不充分，而進一步影響到民眾的健康及生存。教育應根據個人需求、文化背景及生活的脈絡量身制定，應以通過文化和語言上適當的方法呈現，例如使用當地的語言及代表性的圖案等呈現。糖尿病足部自我照顧中重要的初始步驟為早期識別，醫護人員提供正確及具文化合適性的足部自我照顧方法，可以減少高危險人群受傷、感染和截肢的風險。所以本研究旨在探討具有文化合適性足部自我照顧教育方案介入與以常規門診衛教糖尿病足部照顧方法成效之比較。 本研究採類實驗雙組前、後測的研究設計，研究對象採立意取樣，來自台中原鄉某衛生所診斷第二型糖尿病的泰雅族人 (N=60)，分為實驗組 (n=30)、對照組(n=30)，共計60人；兩組研究介入前以「中文多面向健康識能量表」、「糖尿病足部自我照護行為量表」及「密西根神經病變之理學檢查」進行前測，實驗組以文化合適性足部自我照顧教育方案介入，對照組以常規門診衛教糖尿病足部照顧方法，兩組皆在衛教完成4週後進行後測。以SPSS 26.0版進行資料建檔與分析，並以廣計估計方程式 (Generalized Estimating Equation, 簡稱GEE) 檢定重複測量得分。研究結果顯示：(一) 實驗組在接受文化合適性足部自我照顧教育方案介入後，實驗組的健康識能後測分數優於前測，具有統計顯著之成效。(二) 對照組在接受常規衛教後，對照組的健康識能後測分數優於前測，具有統計顯著之成效。(三) 實驗組在接受文化合適性足部自我照顧教育方案介入後，實驗組的足部自我照顧行為後測分數優於前測，具有統計顯著之成效。(四) 對照組在接受常規衛教後，對照組的足部自我照顧行為後測分數優於前測，具有統計顯著之成效。(五) 文化合適性足部自我照顧教育方案，對實驗組於健康識能與足部自我照顧行為成效優於對照組，具有統計顯著之成效，密西根神經病變理學檢查，無明顯之差異。 文化合適性足部自我照顧教育方案可顯著提升原住民族罹患第二型糖尿病病人對於健康識能與足部自我照顧行為執行之成效，建議未來可利用文化合適性足部自我照顧教育方案作為原鄉糖尿病衛教人員之策略，以增進病患的自我照顧行為能力，使原住民族罹患第二型糖尿病長者的足部潰瘍風險降低，來預防神經足部病變發生。
並列摘要
The prevalence of diabetes continues to rise, and complications such as foot lesions caused by poorly controlled diabetes often cause physical and psychological discomfort, disability or even death to the patients. However, the lifestyle and cultural differences of indigenous peoples are related to their health issues, and it also affects their health knowledge and skills in self-care. Domestic and foreign literatures also confirmed that the insufficiency of health literacy may lead to insufficient health-related knowledge, poor self-management of diseases, and inadequate utilization of health services, which further affects the health and survival of the public. Education should be tailored to them according to individual needs, cultural background and the context of their lives, and it should be presented through culturally and linguistically appropriate methods, such as using local languages and representative patterns. An important initial step in diabetic foot self-care is early recognition, and providing correct and culturally appropriate foot self-care methods by health care personnel can reduce the risk of injury, infection, and amputation in high-risk populations. Therefore, the purpose of this study is to compare the effectiveness of the intervention of a revised culturally appropriate foot self-care education program with routine outpatient education on diabetic foot care. This study adopts a quasiexperimental double-group Pretest-posttest control group design. The research objects are purposive sampling. Atayal people (N=60) diagnosed with type 2 diabetes in a health center in an aboriginal region of Taichung city were divided into the experimental group (n=30), the control group (n=30). Before the study intervention, the " Mandarin Multidimensional Health Literacy Questionnaire ", " diabetes foot self-care behavior scale " and " Michigan Neuropathy Screening Instrument " were used to conduct pre-test. Then, the intervention of culturally appropriate foot self-care education program was applied, and the post-test was conducted one month after the intervention was completed. The SPSS version 26.0 was used for data archiving and analysis, and the repeated measurement scores were tested with the generalized estimating equation (GEE). The results of the study showed that: (1) After the intervention, the post-test score of health literacy in the experimental group was better than that of the pretest with statistically significant results. (2) After the routine health education, the post-test score of the control group was better than that of the pre-test, which was statistically significant.(3) After the intervention of culturally appropriate foot self-care education, after the intervention of the culturally appropriate foot self-care education program in the experimental group, the scores of the posttest and foot self-care of the experimental group were better than those of the pretest, which was statistically significant the effect.(4) After routine health education, the post-test score of the control group's foot self-care behavior was better than that of the pre-test, which had a statistically significant effect. (5) The culturally appropriate foot self-care education program has a statistically significant effect on the health awareness and foot self-care behavior of the experimental group than the control group, and there is no significant difference between groups in the pathological examination of Michigan neuropathy. The culturally appropriate foot self-care education program can significantly improve the effectiveness of the indigenous people with type 2 diabetes on health literacy and foot self-care behavior. It is suggested that the culturally appropriate foot self-care education program can be used as the strategy of rural diabetes health educators is to improve the self-care behavior ability of patients, reduce the risk of foot ulcers in the elderly with type 2 diabetes of indigenous peoples, and prevent the occurrence of diabetic foot.