中高齡糖尿病患者圖像衛教課程成效之研究

The Effectiveness of Images Health Education Curriculum for Middle-aged and Elderly diabetes patients

曾雲鳳(Yun-Feng Tseng)

指導教授 ： 陳毓璟

國立中正大學/教育學院/成人及繼續教育學系/碩士(2014年)

摘要

本研究運用混合研究法，以類實驗研究法（Quasi-experimentation）為主，質性訪談資料分析為輔助於加強量化資料的結果；研究旨在探討台灣的共同照護網衛教模式的中高齡糖尿病患者，介入圖像衛教課程對健康識能、自覺糖尿病自我管理效能和血糖管理控制的影響，和在圖像衛教課程之學習歷程。以台灣嘉義某區域教學醫院之新陳代謝科有加入共同照護網衛教模式一年以上和40歲以上者為對象，以叢聚取樣立意分配方式分組。對照組25人為原本的共同照護網衛教模式，實驗組26人是介入圖像衛教課程方案（兩單元主題）連續兩週，課程後一個月有20位同意接受半結構式訪談。研究工具包括，一、圖像衛教課程之工具：看圖對話工具地圖（Conversation map）主題為足部護理和健康飲食與運動。二、評量結構式問卷有（一）中文健康識能評估量表之簡易量表（Health Literacy Scale; HLS）（二）自覺糖尿病自我管理量表（Perceived Diabetes Self-Management Scale; PDSMS）（三）自編的圖像衛教課程評量表（四）自擬半結構式訪談問題。三、臨床血糖控制指標：空腹血糖、糖化血色素、血脂、身體質量指數和腰圍等數值。
研究結果：
一、在健康識能和自覺自我管理之量表部分，以ANCOVA分析兩組之間未達顯著差異，在前後差之平均數實驗組是多於對照組，顯示實驗組進步幅度分數較多；在實驗組內的健康識能和自覺自我管理量表分數前後測差異，有達顯著進步。
二、以ANCOVA分析檢定糖化血色素和獨立樣本t檢定空腹血糖之控制成效，有達顯著性差異，其次在實驗組之三酸甘油脂前後測差異有顯著進步。
三、在自我執行管理行為有效率的提升百分比率，實驗組優於對照組。其中的血糖紀錄和自我監測血糖，實驗組顯著多於對照組。
四、圖像衛教課程學習歷程之質性研究結果，包含有三個主題：
（一）圖像衛教課程之學習優點
（二）圖像學習課程增加自我管理行為能力
（三）自我調控與衛生教育之困境和建議
研究結論：
根據中高齡學習特性設計圖像衛教課程方案，運用圖像工具的引導對話，融入學員（病人）生活經驗和情境的實作練習之學習歷程，在中高齡糖尿病者自我管理的動機、能力與信心、與血糖控制成效有正向幫助和提升，也在質性訪談的學習歷程之內容分析發現，有意義的圖像課程學習之優點，可增進執行自我管理的行為，學員（病人）也反思比較此兩種不同的學習經驗的差異，說出對現況共同照護網衛生教育模式限制和缺口之現象。因此，本篇結論為圖像衛教課程可提供糖尿病健康促進機構的衛生教育者，在中高齡糖尿病患者共同照護網之糖尿病自我管理的課程方案設計參考。

關鍵字

中高齡糖尿病患者 ； 中高齡學習特性與需求 ； 圖像衛教課程 ； 看圖對話工具

並列摘要

This study was carried out in the mixed method,primary the type of quasi-experimentation research method and the qualitative interview data analysis forstrengthening the results of quantitative data. The goal of this study is to discuss the influence ofImages Health Education Curriculum (IHEC) onmiddle-aged and elderly diabetic patients in the Taiwan network of shared care health education pattern through conscious of the image effects of health literacy, self-managementefficacy and glycemic control, as well as IHEC process learning.Diabetic patients, who joined the Diabetes Shared Care Network for at least one year and over 40 years old, were purposively divided into the interventiongroup (26 patients) and control group (25 patients). The control group, maintaining in original DM-caring education, compares to the intervention group with two topics of the Conversation map courses, Foot Care and Healthy eating and Keeping Active,which were applied 3 hours per week for 2 weeks.A month after the course there were 20 subjects who agreed to accept semi-structuredinterview.The following data were collected at baseline and 3-month follow-up: Health Literacy Scale (HLS), Perceived Diabetes Self-Management Scale (PDSMS), self-designed assessment questionnaire, Glycated Hemoglobin (HbA1c) and fasting plasma sugar level.
Results:
1. The mean scores of the HLS and PDSMS are more in the interventiongroup than in the control group, though,without a statistical significance (ANCOVA analysis). While the mean scores of PDSMS and self-designed assessment questionnaire are better in the interventiongroup than in the control group with statistical significant differences.
2. In the ANCOVA analysis, the program resulted in significant reduction in both HbA1c and fasting plasma glucose in the intervention group.
3.Self-managementan administrative act with efficiency gainshigher percentage rate in the experimental group than in the control group. In the Records and self-monitoring of blood glucose in blood glucose, the intervention group was higher than the control group.
4. The IHEC results of the qualitative research process consist of three themes:
(1) The IHEC process learning advantages
(2) The IHECincrease capacity of self-management
(3) Self-regulated and the dilemma of health education and suggestions
Conclusions:
Being designed according to characteristics and needsof the senior learners, this IHEC program is designed to guide participants (patients) to learn and to practice in their life experiences by the tool, the Conversation Map. Whilemiddle-aged and elderly diabetic patients improve their self-management, motivation, capacity and confidence, and the blood glucose control. Course content analysis of qualitative interview study found that advantages of meaningful-image courses can enhance implementation of self-management behaviors. Participants (patients) proposed restrictions of the shared care model of health education and gap under present DM education statusafter comparing two different kinds of reflective learning experience. Therefore,the IHEC should be introduced to educators in the Diabetes Shared Care Network for proper application.

並列關鍵字

middle-aged and elderly diabetic patients ； middle-aged and elderly of leaning characteristics and learning needs ； Images Health Education Curriculum (IHEC) ； Conversation Map

參考文獻

范秀櫻（2011）。以生活技能為導向的糖尿病衛教成效探討（未出版碩士論文）。

蔡清田（2008）。課程學。台北：五南圖書。

給付改善方案分析與建議。中華民國糖尿病衛教學會會訊，30-34。

尿病老人自我效能之因素探討~以屏東某區域教學醫院為例。中華民國糖

王振宇（2010）。糖尿病共同照護網患者憂鬱狀態之探討。（未出版碩士論文）。