識讀素養不足照顧者適用的書面小兒氣喘照護指導教材之研究

A Study of Printed Pediatric Asthma Education Material for Caregivers with Limited Literacy Skills

張美娟(Mei-Chuan Chang)

指導教授 ： 陳月枝

國立臺灣大學/醫學院/護理學研究所/博士(2012年)

https://doi.org/10.6342/NTU.2012.00569

摘要

研究背景：
照護指導是小兒氣喘照護的重要策略之一，書面照護指導教材是醫護人員進行照護指導的重要工具。然書面教材的訊息必須對氣喘病童照顧者是可讀的、可接受的以及易理解，才能發揮效果，尤其針對識讀素養不足的照顧者。提供易讀、適用的照護指導教材是護理人員重要的職責。
研究目的：
本研究主要的目的在探討原有書面小兒氣喘照護指導教材的適用性以及發展並驗證識讀素養不足照顧者適用的書面小兒氣喘照護指導教材的成效。
研究方法：
研究方法分為兩個階段。第一階段應用資料來源三角交叉的研究設計，從原有書面氣喘照護指導教材的評值以及教材使用者，包括：氣喘病童照顧者以及氣喘衛教師的使用經驗，呈現原有氣喘教材的適用性，作為發展識讀素養不足照顧者適用的書面教材的依據。原氣喘教材以中文版的教材適用性評估( Suitability Assessment of Materials, SAM)工具進行分析。教材使用者的經驗則合併質性訪談以及問卷調查的方式收集資料。第二階段的研究為準實驗法不等的前測-後測控制組設計，含實驗組與對照組，實驗組閱讀本研究發展的新氣喘教材，對照組閱讀原氣喘教材。每組再分成適當識讀與識讀不足照顧者。研究對象的識讀素養以中文年級認字量表測量。成效指標為照顧者對教材的理解度與滿意度，以自擬的書面教材內容理解度問卷以及滿意度問卷測量。研究之質性資料進行內容分析；量性資料以描述性統計呈現各變項的分布，包括：次數、百分比、平均數、標準差、最大值及最小值。研究處置的成效分析主要以二因子共變數分析以及獨立樣本t檢定進行。

研究結果：
第一階段研究分析20篇書面氣喘照護指導教材，訪談5位氣喘病童照護者以及5位氣喘衛教師。以SAM中文版的分析，呈現教材內容普遍缺乏總結，封面圖缺乏目的、圖表缺標題與說明、缺乏互動式學習等缺點。而SAM的分析結果與照顧者及衛教師的訪談共同呈現原氣喘教材無法引起動機且缺乏通俗字彙、識讀困難等問題。除此之外，照顧者與衛教師的訪談認為書面教材的內容太多且缺乏統整、氣喘專門照顧訊息不足、版面編排與設計不適當等現象。第二階段研究共76位照顧者參與，結果發現不管是適當識讀或識讀不足的照顧者閱讀實驗組教材後對氣喘照護知識的理解度與滿意度皆高於閱讀對照組教材者。同樣是使用對照組教材的照顧者，識讀不足者對氣喘照護知識的理解(15.25±4.52)低於適當識讀者(24.55±4.25)。同樣使用實驗組教材的照顧者，識讀不足者對氣喘照護知識的理解(30.06±5.07)雖然亦低於適當識讀者(34.52±2.39)，但由識讀程度與教材兩個自變項對照顧者氣喘照護知識理解程度的交互作用分析發現，實驗組教材同時提高了識讀不足者與適當識讀者對氣喘照護知識的理解，也縮短了識讀不足與適當識讀間的理解差距。不論是適當識讀或識讀不足的照顧者對實驗組教材的滿意度皆比對照組教材高。
結論：
本研究發展的實驗組教材具備SAM的教材適用性原則以及內容統整等特色。研究結果證實此教材比原有的氣喘教材更易理解，照顧者滿意度亦高。尤其針對識讀素養不足的照顧者其理解度的提高比適當識讀的照顧者大。本研究提出醫護專業人員依此適用性標準以及整合訊息為原則製作的氣喘照護指導教材，能增進照顧者的理解，提升滿意度。研究結果提供醫護專業人員製作合適書面教材的專門知識以及技能，特別是針對識讀不足照顧者的需求。

關鍵字

識讀素養 ； 小兒照顧者 ； 氣喘 ； 書面照護指導教材 ； 適用性

並列摘要

Background
Patient education is an important aspect of asthma care. Printed health education materials are vital teaching tools for health professionals to educate asthmatic children and their caregivers. However, these materials are effective only if their intended audiences can read, understand, and accept the information. Nurses have an important responsibility to provide easy-to-read and appropriate printed asthma education materials to caregivers, particularly those with limited literacy.

Purpose
This study explores the suitability of existing printed pediatric asthma education materials, develops new pediatric asthma education materials, and verifies their effectiveness for caregivers with limited literacy skills.

Methods
The study comprised two phases. A method with data source triangulation was conducted during Phase 1 to explore the suitability of existing printed pediatric asthma education materials. The data included assessment scores for the suitability of the existing materials and caregivers’ and asthma educators’ experiences of using the materials. Various data were integrated to determine the suitability of existing materials and provide suggestions for developing new asthma education materials. The Suitability Assessment of Materials (SAM) Chinese Version was used to analyze the suitability of existing materials. The experiences of caregivers and asthma educators were recorded through interviews. The structure of Phase 2 was a quasi-experimental nonequivalent group design. This study included an experimental group and a control group. The participants were legal caregivers of asthmatic children. Through purposive sampling, the participants were assigned to the experimental group, who received new printed pediatric suitable education materials (NSPPAEM), and the control group, who received existing printed pediatric asthma education materials (EPPAEM). Each group contained 2 subgroups, that is, caregivers with adequate literacy and caregivers with limited literacy. A Chinese graded word recognition inventory was used to assess the participants’ literacy. The outcome indicators were the participants’ comprehension and satisfaction of the printed material, which were measured using self-designed questionnaires. Data analysis methods included content analysis of qualitative data and statistical analysis of quantitative data, such as calculating the frequency, percentage, mean, and standard deviation and conducting one-way analysis of covariance (ANCOVA), two-way ANCOVA, and independent sample t-tests.

Results
During Phase 1 of this study, 20 existing printed asthma education materials were examined and 5 caregivers of asthmatic children and 5 asthma educators were recruited. The suitability scores of SAM showed that the materials lacked summary and review of content, the cover graphics did not convey the topic, the graphics did not have titles, and the majority of the materials did not contain any section for audience interaction. The SAM scores and data from interviews with the caregivers and asthma educators all suggested that the existing materials did not motivate caregivers to read, lacked common vocabulary, and were difficult to read. Furthermore, the caregivers and asthma educators expressed that the information was not integrated, the advice on asthma care was insufficient, and the layout and typology of the materials was inappropriate.
During Phase 2, a total of 76 legal caregivers were enrolled in this study. For the caregivers’ comprehension of asthma information and satisfaction of the materials, regardless of their literacy level, the experimental group (NSPPAEM) scored higher than the control group (EPPAEM) did. For the control group, who received the EPPAEM, the comprehension scores of the caregivers with limited literacy (15.25 ± 4.52) were lower than those of the caregivers with adequate literacy (24.55 ± 4.25). For the experimental group, who received the NSPPAEM, the comprehension scores of the caregivers with limited literacy (30.06 ± 5.07) were lower than those of the caregivers with adequate literacy (34.52 ± 2.39). However, by analyzing the interaction between the two variables material and literacy we found that the caregivers who received the NSPPAEM were better able to comprehend the asthma information than those who received the EPPAEM. Additionally, the comprehension gap between the caregivers with limited literacy and those with adequate literacy decreased. For the caregivers’ satisfaction of the materials, regardless of their literacy level, the experimental group scored higher than the control group scored.

Conclusion
The NSPPAEM was designed based on the SAM criteria, integrating asthma care information. The results of this study verify the effectiveness of the NSPPAEM. The caregivers’ comprehension and satisfaction of the NSPPAEM was higher than that of the EPPAEM, particularly caregivers with limited literacy. This study indicates that health care professionals developing asthma education materials according to the criteria of suitability and integrating information will enhance caregivers’ comprehension and satisfaction of written information. The results of this study provides practical knowledge and skills for health care professionals on developing suitable education materials for the caregivers of asthmatic children, especially for caregivers with limited literacy.

並列關鍵字

literacy ； caregivers ； asthma ； printed education material ； suitability

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