臺灣博碩士論文加值系統

背景
山地鄉原住民由於文化及風俗習慣，有較高的菸、酒及檳榔使用率，因而造成較高的口腔疾病發生率(尤其為口腔癌)。若忽略山地醫療資源缺乏地區原住民之需求，導致健康不均等情形。應用社區健康顧問-Lay Health Advisor (簡稱LHA)模式於各種可預防疾病之介入研究已被證實能提供醫療資源缺乏地區有效的健康服務資源，提高醫療服務可近性，降低其健康不均等。
研究方法
本研究採隨機分派之實驗設計，將具資格的LHAs隨機分派到原住民社區教導原住民族口腔癌及口腔保健的認知、強化早期診斷早期治療態度，進而提升口腔癌篩檢及口腔黏膜自我檢查之意願。LHA衛教介入對象為台東縣山地鄉原住民，使用隨機分派將社區原住民參加者分為實驗組與對照組。實驗組有160位完成介入，對照組有162位。實驗組給予LHA衛生教育課程介入模式，對照組則僅給予衛教單張。實驗組LHA介入4次課程，各課程間隔不超過一周，衛教課程包含口腔基本知識、檳榔菸酒對身體的傷害、口腔癌知識、自我檢查與口腔癌篩檢、口腔保健技巧。使用自填式問卷收集口腔癌篩檢與口腔保健行為前後測。最後使用T檢定、卡方檢定、邊緣一致性檢定與邏輯斯迴歸分析介入前後測差異。
結果
實驗組相較於對照組，口腔黏膜自我檢查之自我效能與進行口腔癌篩檢之阻礙，有顯著差異(p<0.05)。介入後，兩年內口腔癌篩檢率分別為實驗組56.3%及對照組48.2%。實驗組有更高的比例去進行口腔癌篩檢[aOR=1.31, 95%CI 1.13-1.53]及口腔黏膜自我檢查[aOR=4.07, 95%CI=2.62-6.32]。
結論及建議事項
本計畫使用社區口腔健康顧問介入策略，能有效提高山地鄉原住民口腔癌篩檢行為，建議可將此社區層次介入模式應用推廣至其他原住民鄉施行，並可做為衛生單位於原住民鄉推動社區口腔癌篩檢利用率相關計畫之參考依據。

Background:
The use of tobacco, alcohol and betel nut among aboriginals living in mountainous community are higher than the general population, lead to higher incidence rate of oral cancer. We evaluated the effects of Lay Health Advisor (LHA) intervention approach to promote oral cancer screening utilization in aboriginal villages in Taitung County, Taiwan.
Material and methods:
A randomized experimental design was used. Eligibility criteria for participants were 18 years of age or older, a resident of aboriginal villages who is a betel nut chewer or smoker. Participants were randomly assigned to the LHA intervention or to a brochure-only control group. A total of 160 in experimental group and 162 in control group were conducted. Primary roles of LHAs included serving as oral health advisors and health care systems consulting, distributing materials and being role models on oral health care. We collected information by a structural self-administered questionnaire. A series of regression models analyzed variables between intervention and control group.
Results:
LHA group had significantly higher level of self-efficacy and lower level of perceived barriers toward oral cancer screening compared to control group (all P<0.05). After intervention, the proportion of oral cancer screening utilization in experimental group was 56.3% compared to 48.2% in control group. Participants in experimental group were more likely to have oral cancer screening [Adjust Odds Ratio (aOR)=1.31, 95%CI 1.13-1.53] and weekly oral mucosal self-examination [aOR=4.07, 95%CI=2.62-6.32] in comparison to control group.
Conclusion:
The Lay Health Advisor strategy was effective in increases of aboriginals’ oral cancer screening.

中文摘要 .......................................iii
Abstract ........................................v
目錄 ...........................................vii
第一章 緒論........................................1
第一節 研究背景 ....................................1
第二節 研究目的 ....................................3
第二章 文獻探討 ....................................4
第一節 原住民口腔健康流行病學........................4
第二節 原住民口腔健康需求與健康不均等.................6
第三節 影響原住民口腔健康因素........................8
第四節 預防口腔癌之介入研究.........................11
第五節 LHA策略介入實證.............................13
第六節 健康信念模式................................17
第三章 研究方法 ..................................22
第一節 研究對象 ..................................22
第二節 研究倫理審查 ...............................23
第三節 研究設計 ...................................24
第四節 研究對象招募 ...............................25
第五節 研究流程 ...................................26
第六節 介入執行 ...................................28
第七節 研究工具 ...................................31
第八節 研究人員培訓 ...............................36
第九節 資料統計分析 ...............................37
第四章 研究結果 ..................................39
第一節 社會人口學與環境背景資料分佈.................39
第二節 知識、自我效能與健康信念模式變項前後測分佈.....42
第三節 口腔癌篩檢及口腔黏膜自我檢查行為分佈..........48
第五章 討論......................................49
第一節 口腔癌篩檢與口腔黏膜自我檢查之成效...........49
第二節 健康信念模式變項介入成效....................51
第三節 口腔癌知識與篩檢自我效能相關變項之成效........54
第四節 研究限制...................................56
第六章 結論與建議.................................58
參考文獻.........................................60
表格分析.........................................65
附錄.............................................87

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