醫療院所健康促進成效-以健康減重後體重維持為例

The effectiveness of health promotion program in hospitals: body weight maintenance as an example

張晋瑋(Chin-Wei Chang)

指導教授 ： 高月慈

義守大學/醫學院/醫務管理學系/碩士(2017年)

摘要

藉由健康促進減重後個案的自我效能、社會支持、遵醫囑行為與是否維持體重的關係，瞭解個案減重後，如何達成維持體重之成效。藉此給予未來求減重者或治療照顧者在減重計劃上的評估和參考。
本研究為橫斷式研究，以專家之結構式問卷採發放式和郵寄收集資料。研究對象採立意抽樣，選取 2013 年 1 月至 2015 年 12 月為某醫院健康促進減重計畫進行，符合下列條件者為研究對象：確定為肥胖個案(BMI>25)、年齡介於 20 至 65 歲間、參與某醫院健康減重期間大於等於 6 個月、減少原有體重達 5 %以上。
本研究共發出問卷 130 份，除描述性統計分析外，本研究另以卡方、T 檢定、ANOVA 分析健康促進減重者體重維持在背景資料上的差異，並進一步以邏輯斯迴歸、相關因素分析減重後個案維持體重的預測能力。
本研究有效樣本共收 122 位，問卷回收率 94%，性別比率，男佔 29 位(23.8%)和女佔 93 位(76.2%)，平均年齡 37.29 歲。教育程度以大學為多佔 64位(52.5%)。職業以醫療相關者為多佔 50 位(41%)。收入以 2~4 萬為多佔 72 位(59%)。能有效維持體重者共 69 位(57%)，平均減重時間 6~12 個月，減重前BMI 值平均:28.73，減重後 BMI 值平均:27.57，平均 BMI 下降 1.18。此研究中顯示 BMI≧25 健康減重族群中，有慢性疾病:最多為脂肪肝佔 31 位(29%)，次之為高血脂佔 18 位(16.8%)，減重介入措施中，有 81 位(66%)採介入方式， 其中以規律運動佔 48 位(39%)，行為改變佔 41 位(34%)，藥物改變佔 12 位(.98%)。
本研究將所有健康減重的 BMI 族群分成 5組(BMI≦25 一組；2530 一組；全部的 BMI 族群 All BMI)，其中以BMI>30 之族群( p=<.001**, p <.01；成效:7.2%)其減重後 BMI 平均數更達顯著性差異，All BMI 之族群(p =<.001**, p <.01；成效:5.3%)達顯著性差異。故研究顯示，BMI 大於 25 以上減重成效越明顯外，此研究不分 BMI 之 All BMI 健康減種之族群，減重成效均達顯著性差異。2530 之族群，介入分數總合(p =-.353*, p <.05) 呈現負相關性。故研究結果顯示，健康減重者之 BMI 大於 30 以上之介入分數總合負相關性越大，減重成效越顯著。依據本研究發現，研究減重後個案平均經過 6~12 個月後，能有效維持體重者有 57%。本研究減重後個案恢復原有體重者共 53 位，佔 41.8%，減重者於 6~12 個月，復胖率高達 43%。BMI≧30 之族群，其健康減重成效越明顯，BMI≦25 之族群不收案建議可繼續維持，家庭支持程度、朋友支持程度、遵醫囑行為程度越顯著，可減少減重人力資源，BMI≧25~30 建議可以自我管理，以 BMI≧30 以上為主要收案族群，減重成效越高，告知個案短期減重或可達成目標，但健康減重後體重需長期維持才算是真正的成功。
本研究結果，女性的朋友支持程度越高(r=-.185*, p <.05)，維持體重復胖的程度越長；社會支持程度與體重維持之相關因素分析出，家庭的支持程度越高(r=.022*, p <.05)對於體重的維持有正相關性；教育程度與體重維持相關因素分析出，教育程度越高，專科/大學(r=-.185*, p <.05)， 復胖時間越長；收入與體重維持相關因素分析出，收入越高 4~6 萬/月(r=.315*, p <.05)其遵醫囑行為越高，復胖時間越長。

關鍵字

健康促進 ； 體重維持 ； 自我效能 ； 社會支持 ； 遵醫囑行為

並列摘要

Health promotion of self - efficacy in post weight loss cases, social support, Obeys the doctor's advice behavior with whether maintains the body weight the relations. After understood the populace reduce weight, how achieves effect of the maintenance body weight.Will take advantage of this gives the future to seek the reduction or treats watcher's in reduction plan appraisal and the reference.
This study is a cross-sectional study, the structure of the experts to collect and collect questionnaires by mail collection of information. Subjects sampled from January 2013 to December 2015 were enrolled in a hospital health promotion weight loss program, and those who met the following criteria were identified as obese (BMI> 25), aged between 20 and 65 years old, participate in a hospital healthy weight loss period greater than or equal to 6 months, reducing the original weight of more than 5%.
In this study, 130 questionnaires were sent out. In addition to the descriptive statistical analysis, the difference of body weight of health-promoting weight loss was analyzed by chi-square, T-test and ANOVA, and the logistic regression and related factors The predictive ability of weight maintenance was analyzed.
This research effective sample altogether receives 122, Questionnaire recovery rate was 94%，Sex ratio,with the ratio of male to female, male 29 (23.8%) and female 93 (76.2%), with an average age of 37.29 years. The education level is university-wide (52.5%). Occupationalhealth-related is about 50 (41%). Income to 2 to 4 million accounted for 72(59%). A total of 69 (57%) of 69 subjects (57%) were effective in weight maintenance, and the average weight loss time was 6 to 12 months. The average BMI value was 28.73, the mean BMI value after weight loss was 27.57 andthe average BMI decreased by 1.18. The average weight loss of BMI was 1.18 . This study showed that BMI≧25 healthy weight loss group,there are chronic diseases: up to 31 fatty liver (29%), followed by hyperlipidemia accounted for 18 people (16.8%), weight loss intervention measures, 81 (39%),behavioral changes (41%), and drug changes (12%) (98%). In this study, all healthy weight loss BMI groups were divided into 5 groups (BMI≤25; 25≤BMI≤27; 27≤BMI≤30; BMI≥30; all BMI),(P: <.001; effect: 7.2%). The mean BMI of the group with BMI> 30 was significantly higher than that of the control group (P < Sexual differences. Therefore, the study shows that BMI greater than 25 or more significant reduction in weight. This study regardless of the BMI of the All BMI healthy reduction of ethnic groups, weight loss achieved significant differences. 27 30 of the ethnic groups, BMI ≤ 30 of the ethnic groups, the score of the total score of intervention (-164) showed a negative correlation; (-.353 *) showed a negative correlation. Therefore, studies have shown that healthy weight loss of BMI ≧30 greater than the total score of the negative correlation between thegreater involvement of weight loss effect is more significant.
Wherever according to the study found the cases that weight loss after an average of 6 to 12 months abd can effectively maintain body weight are 57%. In this study, domestic weight loss cases to achieve the success rate of maintaining weight higher than abroad, but it still need to continue to track. In this study, weight loss cases after the restoration of the original weight is a total of 53.
Accounting for 41.8% weight loss in 6 to 12 months will be back fat, obesity rate as high as 43%, BMI ≧ 30 of the ethnic groups, the effect of their health weight loss more obvious, BMI ≦ 25 of the ethnic groups do not accept the proposal can continue to maintain family support degree; friend support; degree of compliance with the more significant, can reduce weight loss, BMI ≧ 25 ~ 30 Suggested to self-management, BMI ≧ 30 or more as the main income groups, the higher the effectiveness of weight loss, short-term weight loss to inform the case or achieve the goal, but healthy weight loss after long-term maintenance is considered a real success .
The results of this study showed that the higher the level of support of female friends (r = -. 185 *, p <.05), the longer the degree of maintaining weight gain; the degree of social support and weight-related factors, family support (R = - .052 *, p <.05) had positive correlation with the maintenance of body weight. The higher education level was correlated with education level and weight maintenance. (R = .315 *, p <.05), the higher the follow-up behavior, the more fat, the longer the time to re-fat; income and weight maintenance factors related to the analysis, the higher the income of 4 to 6 million / The longer the time.

並列關鍵字

health promotion ； weight maintenance ； self-efficacy ； social support ； compliance behavior

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