臺灣博碩士論文加值系統

背景：因民俗習慣及文化因素，使得台灣原住民中有46.1%具有嚼食檳榔的習慣，嚼食檳榔會引起牙結石沈積及牙周炎，所以具有嚼食檳榔經驗或嚼食檳榔較多者，都會有不良的口腔衛生。研究證實不良的口腔衛生習慣會造成口腔癌的發生。另外，交通、社會經濟及對口腔保健知識不足，都會影響其牙醫就診率，100年台灣原住民門診就診率為89.1%，其中牙醫門診率僅占31.7%。社區健康指導員（Lay Health Advisor, LHA）主要應用於語言及文化背景不同的族群，且已被證實能有效傳遞基本的健康資訊，對社區民眾的健康照護是有功效的。
研究方法：使用單組前後測設計。本研究共招募59位南台灣屏東縣及台東縣山地鄉原住民，比較LHA培訓課程後學員在口腔保健知識、態度、與行為之成效。共六梯次培訓時間，每梯次上課4次，合計12小時。培訓內容包括口腔基本知識、潔牙原理與技巧、教學原理與方法及情境模擬，最終共有51人完成培訓課程及測驗，參加者的研究資料是使用自填式問卷獲得。檢測培訓課程前後差異使用的統計方法包括麥氏檢定（McNemar test）、邊緣同質性檢定（marginal homogeneity test）、配對t檢定（paired t- test）、簡單迴歸（Simple Linear Regression）、複迴歸（Multiple Linear Regression）、邏輯斯迴歸（Logistic Regression）。
結果：學員課程前後口腔保健知識、自我效能、態度分數、每天刷牙次數、每次潔牙時間、刷牙方法、含氟牙膏使用都具有統計上顯著性差異 (p<0.05)。培訓前後口腔保健知識分數相差3.51分（p<0.001）；口腔保健態度分數相差1.39分（p=0.028）；調整族別、年齡、性別、教育程度，口腔保健自我效能分數相差1.49分（p=0.001）。
利用邏輯斯迴歸（Logistic Regression）分析，學員在調整年齡、性別、教育程度後，接受培訓後有2.78倍的機會每天刷牙3次以上(95%CI為1.07-7.21)；接受培訓後，學員有3.43倍的機會每次刷牙三分鐘以上(95%CI為1.23-9.56)；平常刷牙時，使用改良式貝氏刷牙法為未使用的49.16倍(95%CI為13.34-181.18)；有使用含氟牙膏刷牙為未使用的5.06倍(95%CI為1.93-13.24)。
結論：原住民社區健康培訓課程可有效提升其口腔保健知識、態度及自我效能，並採取正確的口腔保健行為
關鍵字：口腔健康、衛生教育、原住民、社區健康工作者

Background：About 50%of aboriginals have betel nut chewing habit. Betel nut chewing lead to poor oral health, including oral mucosa ulcer and periodontal disease. Poor oral hygiene was proved related to oral cancer. Community health advisor (CHA) was effectively intervention strategy in language and culture difference population and remote areas to deliver health information and health care skill.
Methods：The study design was the pre and post-test. There were 59 aboriginals recruited from aboriginal communities in Pingtung County and Taitung County in Southern Taiwan. Six training classes were held. Each training cycle went for 4 consecutive weeks including 12 hours lecture. The training includes basic oral morphology, oral health knowledge and skill, principles and methods of teaching and situational simulations. Overall, 51 participants finished the training course and passed post-training knowledge test. The pre-and post-data were collected by a self-administered questionnaire. McNemar test, marginal homogeneity test, paired t test, Simple Linear Regression,Multiple Linear Regression, and logistic regression were used to analyze the difference at pre- and post-training
Results：The result showed that significantly increase level of oral hygiene related knowledge, self-efficacy, attitude, brush time, brush times,brush method, fluoride toothpaste use (P<0.05). LHA trainers were more likely to have higher 3.51 points of oral health knowledge (95%CI:2.70-4.32), 1.39 points of attitude (95%CI: 0.16-2.63] ,andAdjusting race,age,gender,education level,1.49 points of self-efficacy (95%CI: 0.63-2.35) than pre-test. In addition, Adjusting age,gender,education level,LHA trainers were more likely to brush their teeth over three times every day [AOR = 2.78, 95%CI:1.07-7.21], brush their teeth over three minutes every time [AOR =3.43, 95%CI: 1.23-9.56],use modified Bass brush method[AOR =49.16, 95%CI: 13.34-181.18], use fluoride toothpaste [AOR = 5.06, 95%CI: 1.93-13.24].
Conclusions：The LHA training for aboriginals is an effective way to promote oral health knowledge, attitudes, self-efficacy, and oral health behavior.
Key word：oral hygiene,health education, aborigine,lay health advisor

致謝…………………………..……………………………………. Ⅱ
中文摘要……………………..……………………………………. Ⅲ
Abstract ........................................................................................... Ⅳ
目錄…………………...……………………………………………. 1
第一章 緒論……………………………………………………… 6-8
第一節 研究背景……………………………………………… 6-7
第二節 研究目的……………………………………………... 8
第二章 文獻探討………………………………………………… 9-20
第一節 原住民口腔流行病學………………………..……… 9-10
第二節 原住民口腔健康因素探討………….………………… 11-15
第三節 過去相關衛教介入成效………………………..………16-17
第四節LHA介入模式及其應用成效…….…………………. 18-20
第三章 研究方法......…...…………..……………………………... 21-53
第一節 研究對象………..…………………...……………….. 21
第二節 研究設計……...…………………………………….. 22
第三節 倫理考量………………...………………………….. 23
第四節 研究流程…………………………………………… 24-25
第五節 培訓過程…………………….…………………………26-34
第六節 研究工具…………………………………………… 35-47
第七節 資料收集過程..………….………………………… 48
第八節 資料處理與統計分析……….………………………. 49-53
第四章 研究結果………..………….……………………………. 54-65
第一節 口腔保健培訓學員基本人口學分佈……….……….. 54
第二節 口腔保健培訓學員口腔保健知識培訓課程前後測比較...55
第三節 口腔保健培訓學員口腔保健自我效能培訓課程前後測
比較 ………...……………………………………….… .56
第四節 口腔保健培訓學員口腔保健態度培訓課程前後測比較.57
第五節 口腔保健培訓學員口腔保健行為培訓課程前後測
比較………………………………………………… 58-59
第六節 口腔保健培訓學員培訓前後知識、自我效能、態度與
社會人口學變項相關性………….………………..…….…60
第七節 口腔保健知識、自我效能、態度培訓課程前後測分數比較
…………..……………………………………………… 61
第八節 口腔保健行為前後測改變比較…….…..……………… 62
第九節 口腔保健知識、自我效能、態度培訓課程前後測改變…63
第十節 潔牙行為培訓課程前後測改變……..……….………… 64
第十一節 培訓後自評知識、表達能力及教學技巧分佈情形……65
第五章 討論………………………………………………………...66-77
第一節 口腔保健知識成效探討…………..………………......66-67
第二節 口腔保健自我效能成效探討………..……………….. 68
第三節 口腔保健態度成效探討………………..…………….. 69
第四節 口腔保健行為成效探討………………..……………..70-73
第五節 過程評價……………………………...……………….74-75
第六節 研究限制………………………………………………76-77
第六章 結論與建議…………..…………………………………… 78
參考文獻………………...………………………………………….79-83
圖表分析
表1 口腔保健培訓學員之基本人口學分佈…………………. 85
表2 完成培訓與退出口腔保健培訓學員人口學變項比較…….86
表3 完成培訓與退出口腔保健培訓學員前測口腔保健知識、自
我效能、態度分數比較………………………………… 87
表4 口腔保健培訓學員口腔保健知識培訓課程前後測比較……
…………………………………………………………..88-89
表5 口腔保健培訓學員口腔保健自我效能培訓課程前後測比較
………………………………………………………… 90
表6口腔保健培訓學員口腔保健態度培訓課程前後測比較……
………………………………………………………… .91-92
表7 口腔保健培訓學員潔牙行為培訓課程前後測比較….... 93
表8 口腔保健培訓學員看診行為培訓課程前後測比較…… 94
表9 口腔保健培訓學員輔助工具使用行為培訓課程前後測比較
………………………………………………………….. 95
表10口腔保健培訓學員社會人口學變項與培訓前後知識比較.
………………………………………………………… 96
表11口腔保健培訓學員社會人口學變項與培訓前後自我效能
比較…………………..……………………………… 97
表12口腔保健培訓學員社會人口學變項與培訓前後態度比較
………………………………….…………………… 98
表13口腔保健培訓學員口腔保健知識、自我效能、態度分數
培訓課程前後測比較…………………..…………… 99
表14口腔保健行為前後測改變比較…………...……….. 100
表15口腔保健培訓學員口腔保健知識、自我效能、態度培訓
課程前後測分數改變……………………..……..… 101
表16口腔保健培訓學員潔牙行為培訓課程前後測改變…..102
表17口腔保健培訓學員培訓後自評知識、表達能力及教學技
巧分佈情形………………....……………………… 103
表十 課程結果滿意度…………………….……………………… 75
圖1 口腔保健培訓學員培訓課程滿意度調查…………….……. 75
附錄
屏東縣/台東縣社區口腔保健指導員口腔保健問卷調查….105-127

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