臺灣博碩士論文加值系統

背景:本研究為第一個在台灣使用社區健康工作者(Lay Health Advisor，簡稱LHA)來促進口腔健康的5年計畫旨在促進新移民孩童的口腔健康。此計畫之前，國內外並未有任何LHA模式應用於口腔保健。根據之前的調查顯示，新移民孩童相較於本籍孩童有較差的口腔健康狀況，齲齒經驗指數分別為6.05 和3.88顆。過去文獻結果顯示社區健康工作者的介入模式在國外應用於各種不同健康促進議題都有不錯的成效。
目的:本研究目的為評值都市新移民女性參與社區口腔健康促進計畫保健指導員培訓之成效。
研究方法: 本研究共招募50名高雄市越南或印尼籍的新移民女性，主要是從教會、國小中文班以及新移民家庭服務中心進行招募，共開辦四個梯次。課程的設計為15堂課(每堂課為2小時)，包含3次的實地衛教實習，而每次課程都是由口腔健康專業人員執行。上課所用的手冊內容包含齲齒等疾病的相關知識、口腔保健方法的說明與操作示範、教學與溝通技巧以及實際練習等。最後共有37名新移民女性完成整個培訓課程並通過測驗，參加者的前後測資料是使用自填式問卷收集。而本研究所用來檢測前後測差異的統計方法包含配對t檢定、精確麥氏檢定以及邊緣總和一致性檢定
結果: 研究結果顯示在口腔保健知識、自我效能以及態度都有顯著的提升。而在口腔保健行為也顯示每日潔牙次數、牙線使用習慣、含氟牙膏的使用及帶小孩去看牙齒的行為等都有顯著提升與改變(P<0.05)
結論:口腔保健指導員培訓課程可有效促使新移民女性採取正確的口腔健康行為以及提升她們的口腔保健知識、自我效能和態度

Background: The 5-year Lay Health Advisors Approach to Promote Oral Health Program, aimed at promoting the oral health of new immigrants’ children, was first implemented in Taiwan in 2011. Prior to this study, no oral health promotion programs for mixed-marriage preschool children and their mothers were conducted. The baseline data showed significant higher caries index in immigrant children aged 4 to 6 than in native children (6.05 vs. 3.88). The use of Lay Health Advisors (LHAs) to address health issues is well documented and considered an appropriate model of community health promotion.
Objective: The aim was to evaluate the effectiveness of Lay Health Advisor (LHA) training for urban immigrant women in an oral health promotion program.
Method: There were 50 Vietnamese and Indonesia women recruited from the churches, Chinese language program and immigrant service centers in Kaohsiung city. Four training classes were held. Each training cycle went for 15 consecutive weeks (one 2-hour training session per week) including 3 weeks practicum and each session is conducted by oral health professionals. The training manual includes caries-related knowledge, oral hygiene instructions and demonstrations, teaching/communication skill and hands-on practice etc. Overall, 37 participants finished the training course and passed post-training knowledge test. The pre- and post-data were collected by the self-administered questionnaire. Paired-t test, McNemar exact test and marginal homogeneity test were used to analyze the pre/post differences.
Result: The results showed significantly increased level of oral hygiene knowledge, self-efficacy, and attitude toward oral hygiene. It also showed a higher frequency of brushing teeth a day, using dental floss a day, using fluoride toothpaste, and children’s dental visits (P<0.05).
Conclusion: The LHA training for immigrant women is an effective way to facilitate adoption of oral healthy behaviors and increase their level of oral hygiene knowledge, self-efficacy, and attitude.

致謝 i
中文摘要 ii
Abstract iv
目錄 vi
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 新移民孩童口腔健康概況 4
第二節 孩童齲齒相關影響因素探討 6
第三節 本土LHA-POHP計畫第一年結果探討 11
第四節 LHAs介入模式及其應用 15
第三章 研究方法 21
第一節 研究對象 21
第二節 研究設計 22
第三節 研究架構 23
第四節 研究流程 25
第五節 培訓過程 27
第六節 研究工具 38
第八節 資料處理與統計分析 55
第四章 研究結果 59
第一節 口腔保健指導員基本人口學分佈 59
第二節 口腔保健指導員口腔健康知識前後測比較 60
第三節 口腔保健指導員口腔保健自我效能前後測比較 61
第四節 口腔保健指導員口腔保健態度前後測比較 62
第五節 口腔保健指導員口腔健康生活品質前後測比較 64
第六節 口腔健康生活品質、知識、自我效能及態度前後測分數比較67
第七節 口腔保健指導員口腔保健行為前後測比較 68
第八節 課程滿意度結果 69
第五章 討論 70
第一節 基本人口學分佈探討 70
第二節 口腔健康知識探討 71
第三節 口腔保健自我效能探討 71
第四節 口腔保健態度探討 72
第五節 口腔保健行為探討 73
第六節 口腔健康生活品質探討 75
第七節 過程評值 76
第八節 研究限制 79
第六章 結論與建議 82
參考文獻 83
分析圖表 87
Table.1 Distribution of LHA trainees’ characteristics (N=37) 88
Table.2 Comparison of LHA trainees’ oral hygiene knowledge between pre- and post-test (N=37) 90
Table.3 Comparison of LHA trainees’ oral hygiene self-efficacy between pre- and post-test (N=37) 91
Table.4 Comparison of LHA trainees’ oral hygiene self-efficacy toward children between pre- and post-test (N=37) 92
Table.5 Comparison of LHA trainees’ oral hygiene attitude between pre- and post-test (N=37) 93
Table.6 Comparison of LHA trainees’ oral hygiene attitude toward children between pre- and post-test (N=37) 95
Table.7 Comparison of LHA trainees’ diet attitude toward children between pre- and post-test (N=37) 97
Table.8 Comparison of LHA trainees’ Oral Health Impact Profile-14 between pre- and post-test (N=37) 98
Table.9 Comparison of the level of oral hygiene-related knowledge, self-efficacy, attitudes and OHIP-14 of LHA trainees between pre- and post-test (N=37) 101
Table.10 Comparison of LHA trainees’ own oral hygiene behaviors between pre- and post-test (N=37) 102
Table.11 Comparison of LHA trainees’ oral hygiene behaviors toward children between pre- and post-test (N=26) 104
Table.12 Comparison of the level of oral hygiene knowledge, self-efficacy and attitudes of LHA trainees by education level in pre-test 105
Table.13 Comparison of the change of oral hygiene self-efficacy and attitudes toward children between LHA trainees having child and no child (N=37) 106
Table.14 Comparison of the level of oral hygiene-related knowledge, self-efficacy and attitudes of LHA trainees between pre- and post-test in 4 classes 107
Table.15 Satisfaction survey of curriculum in LHA trainees (N=37) 108
Figure.1 Comparison of the score of oral hygiene knowledge, self-efficacy and attitudes of LHA trainees between pre- and post-test (N=37) 109
Figure.2 Satisfaction survey of curriculum in LHA trainees (N=37) 110
附錄 111

Amin, T. T., & Al-Abad, B. M. (2008). Oral hygiene practices, dental knowledge, dietary habits and their relation to caries among male primary school children in Al Hassa, Saudi Arabia. Int J Dent Hyg;6:361-370.
Bryant-Stephens, T., Kurian, C., Guo, R., & Zhao, H. (2009). Impact of a household environmental intervention delivered by lay health workers on asthma symptom control in urban, disadvantaged children with asthma. Am J Public Health;99 Suppl 3:S657-665.
Chen, C. J., Ling, K. S., Esa, R., Chia, J. C., Eddy, A., & Yaw, S. L. (2010). A school-based fluoride mouth rinsing programme in Sarawak: a 3-year field study. Community Dent Oral Epidemiol;38:310-314.
Finlayson, T. L., Siefert, K., Ismail, A. I., Delva, J., & Sohn, W. (2005). Reliability and validity of brief measures of oral health-related knowledge, fatalism, and self-efficacy in mothers of African American children. Pediatr Dent;27:422-428.
Fisher-Owens, S. A., Gansky, S. A., Platt, L. J., Weintraub, J. A., Soobader, M. J., Bramlett, M. D., et al. (2007). Influences on children''s oral health: a conceptual model. Pediatrics;120:e510-520.
Frazao, P., & Marques, D. (2009). Effectiveness of a community health worker program on oral health promotion. Rev Saude Publica;43:463-471.
Friel, S., Hope, A., Kelleher, C., Comer, S., & Sadlier, D. (2002). Impact evaluation of an oral health intervention amongst primary school children in Ireland. Health Promot Int;17:119-126.
Han, H. R., Kim, K. B., & Kim, M. T. (2007). Evaluation of the training of Korean community health workers for chronic disease management. Health Educ Res;22:513-521.
Haq, Z., & Hafeez, A. (2009). Knowledge and communication needs assessment of community health workers in a developing country: a qualitative study. Hum Resour Health;7:59.
Harrison, R. L., & Wong, T. (2003). An oral health promotion program for an urban minority population of preschool children. Community Dent Oral Epidemiol;31:392-399.
Hashizume, L. N., Mathias, T. C., Cibils, D. M., & Maltz, M. (2013). Effect of the widespread use of fluorides on the occurrence of hidden caries in children. Int J Paediatr Dent;23:72-76.
Heunis, J. C., Wouters, E., Norton, W. E., Engelbrecht, M. C., Kigozi, N. G., Sharma, A., et al. (2011). Patient- and delivery-level factors related to acceptance of HIV counseling and testing services among tuberculosis patients in South Africa: a qualitative study with community health workers and program managers. Implement Sci;6:27.
Jerome, G., & Ivers, L. C. (2010). Community health workers in health systems strengthening: a qualitative evaluation from rural Haiti. AIDS;24 Suppl 1:S67-72.
Koloway, B., & Kailis, D. G. (1992). Caries, gingivitis and oral hygiene in urban and rural pre-school children in Indonesia. Community Dent Oral Epidemiol;20:157-158.
Krantz, M. J., Coronel, S. M., Whitley, E. M., Dale, R., Yost, J., & Estacio, R. O. (2013). Effectiveness of a community health worker cardiovascular risk reduction program in public health and health care settings. Am J Public Health;103:e19-27.
Lin, Y. C., Yen, Y. Y., Chang, C. S., Ting, C. C., Chen, P. H., Chen, C. C., et al. (2013). Oral Health Disparities of Children among Southeast Asian Immigrant Women in Arranged Transnational Marriages in Taiwan. Caries Res (Accepted).
Loc Giang, D., Spencer, A. J., Roberts-Thomson, K. F., Hai Dinh, T., & Thuy Thanh, N. (2011). Oral health status of Vietnamese children: findings from the National Oral Health Survey of Vietnam 1999. Asia Pac J Public Health;23:217-227.
Martin, M. A., Hernandez, O., Naureckas, E., & Lantos, J. (2006). Reducing home triggers for asthma: the Latino community health worker approach. J Asthma;43:369-374.
Mattila, M. L., Paunio, P., Rautava, P., Ojanlatva, A., & Sillanpaa, M. (1998). Changes in dental health and dental health habits from 3 to 5 years of age. J Public Health Dent;58:270-274.
Nguyen, T., Vo, P. H., McPhee, S. J., & Jenkins, C. N. (2001). Promoting early detection of breast cancer among Vietnamese-American women. Results of a controlled trial. Cancer;91:267-273.
Nguyen, T. T., Le, G., Nguyen, T., Le, K., Lai, K., Gildengorin, G., et al. (2009). Breast cancer screening among Vietnamese Americans: a randomized controlled trial of lay health worker outreach. Am J Prev Med;37:306-313.
Nguyen, T. T., Love, M. B., Liang, C., Fung, L. C., Nguyen, T., Wong, C., et al. (2010). A pilot study of lay health worker outreach and colorectal cancer screening among Chinese Americans. J Cancer Educ;25:405-412.
O''Brien, M. J., Halbert, C. H., Bixby, R., Pimentel, S., & Shea, J. A. (2010). Community health worker intervention to decrease cervical cancer disparities in Hispanic women. J Gen Intern Med;25:1186-1192.
Poutanen, R., Lahti, S., & Hausen, H. (2005). Oral health-related knowledge, attitudes, and beliefs among 11 to 12-year-old Finnish schoolchildren with different oral health behaviors. Acta Odontol Scand;63:10-16.
Poutanen, R., Lahti, S., Tolvanen, M., & Hausen, H. (2006). Parental influence on children''s oral health-related behavior. Acta Odontol Scand;64:286-292.
Retnakumari, N., & Cyriac, G. (2012). Childhood caries as influenced by maternal and child characteristics in pre-school children of Kerala-an epidemiological study. Contemp Clin Dent;3:2-8.
Saad-Harfouche, F. G., Jandorf, L., Gage, E., Thelemaque, L. D., Colon, J., Castillo, A. G., et al. (2011). Esperanza y Vida: training lay health advisors and cancer survivors to promote breast and cervical cancer screening in Latinas. J Community Health;36:219-227.
Saied-Moallemi, Z., Virtanen, J. I., Ghofranipour, F., & Murtomaa, H. (2008). Influence of mothers'' oral health knowledge and attitudes on their children''s dental health. Eur Arch Paediatr Dent;9:79-83.
Sanchez, J., Silva-Suarez, G., Serna, C. A., & De La Rosa, M. (2012). The Latino Migrant Worker HIV Prevention Program: building a community partnership through a community health worker training program. Fam Community Health;35:139-146.
Selwitz, R. H., Ismail, A. I., & Pitts, N. B. (2007). Dental caries. Lancet;369:51-59.
Skeie, M. S., Riordan, P. J., Klock, K. S., & Espelid, I. (2006). Parental risk attitudes and caries-related behaviours among immigrant and western native children in Oslo. Community Dent Oral Epidemiol;34:103-113.
Slade, G. D. (1997). Derivation and validation of a short-form oral health impact profile. Community Dent Oral Epidemiol;25:284-290.
Spencer, M. S., Rosland, A. M., Kieffer, E. C., Sinco, B. R., Valerio, M., Palmisano, G., et al. (2011). Effectiveness of a community health worker intervention among African American and Latino adults with type 2 diabetes: a randomized controlled trial. Am J Public Health;101:2253-2260.
Taylor, V. M., Bastani, R., Burke, N., Talbot, J., Sos, C., Liu, Q., et al. (2013). Evaluation of a hepatitis B lay health worker intervention for cambodian americans. J Community Health;38:546-553.
Taylor, V. M., Jackson, J. C., Yasui, Y., Nguyen, T. T., Woodall, E., Acorda, E., et al. (2010). Evaluation of a cervical cancer control intervention using lay health workers for Vietnamese American women. Am J Public Health;100:1924-1929.
Thompson, H. S., Edwards, T., Erwin, D. O., Lee, S. H., Bovbjerg, D., Jandorf, L., et al. (2009). Training lay health workers to promote post-treatment breast cancer surveillance in African American breast cancer survivors: development and implementation of a curriculum. J Cancer Educ;24:267-274.
Vallejos-Sanchez, A. A., Medina-Solis, C. E., Maupome, G., Casanova-Rosado, J. F., Minaya-Sanchez, M., Villalobos-Rodelo, J. J., et al. (2008). Sociobehavioral factors influencing toothbrushing frequency among schoolchildren. J Am Dent Assoc;139:743-749.
Walton, J. W., Snead, C. A., Collinsworth, A. W., & Schmidt, K. L. (2012). Reducing diabetes disparities through the implementation of a community health worker-led diabetes self-management education program. Fam Community Health;35:161-171.
WHO. (2013). WHO Oral Health Country/Area Profile Programme.Significant Caries Index. Retrieved from http://www.mah.se/CAPP/Country-Oral-Health-Profiles/WPRO/.
內政部戶政司. (2012). 縣市外籍與大陸配偶人數. Retrieved from http://www.ris.gov.tw/zh_TW/346.
余慧容. (2007). 台灣東部6-12歲國小學生齲齒狀況與飲食習慣、口腔衛生習慣之探討.
周佩螢. (2007). 口腔醫療資源缺乏地區學童齲齒狀況與其影響因素之探討(碩士論文).
陳志章. (2012). 新移民與本土籍學齡前兒童口腔健康不均等與母親特質對口腔健康之影響-以高雄市為例(碩士論文).
詹敏賢. (2006). 台灣南部6-18歲兒童青少年齲齒狀況及相關因素之探討(碩士論文).
衛生署國民健康局. (2005-2006). 台灣地區兒童及青少年口腔狀況調查.
衛生署國民健康局. (2011). 台灣兒童及青少年口腔狀況調查.
鐘惠珊. (2010). 社區老人口腔健康相關生活品質（OHIP/OIDP）與整體性健康相關生活品質（WHOQoL-BREF）之關係(碩士論文).