臺灣博碩士論文加值系統

本研究目的在探討更年期女性的營養認知與行為現況及以跨理論模式設計的教學課程介入後對更年期女性的營養認知及行為的改變成效。採準實驗研究法，研究對象為新竹市更年期女性，以結構性問卷為研究工具，分為實驗組及對照組，實驗組57人進行六節課的教學介入，對照組64人則否。六節課的課程內容是依據跨理論模式設計營養識能介入措施，教學策略包括影片欣賞、分組討論、意識覺醒、同儕夥伴的協助關係、健康模範的經驗分享及填寫學習單等活動。以前、後測的方式進行量化比較，探討兩組之間的飲食認知及行為改變差異。資料分析以SPSS20.0.0中文版套裝軟體進行資料建檔與統計，以描述性統計、共變數分析等統計方式進行分析比較，研究結果如下：
一、在更年期女性的營養認知與行為改變現況方面，研究之前，兩組的營養認知答對率都在80%左右，飲食行為改變也都介於準備期與行動期之間，對照組與實驗組無統計上的差異。
二、營養識能課程介入後，實驗組的營養識能認知方面以共變數分析結果顯著優於對照組(p＜0.5)，顯示教學介入對飲食認知的提升有成效。
三、營養識能課程介入後，實驗組在共享決策、衡量決定、行為改變階段及飲食自我效能等四個面向以共變數分析結果均顯著優於對照組(p＜0.5)，教學介入對飲食的行為改變提升有成效。
本研究以跨理論模式的教學課程介入後，研究對象的營養認知及飲食行為皆有顯著進步，建議可擴大範圍辦理相關營養教育課程。

關鍵詞：營養識能、更年期營養、跨理論模式、共享決策、行為改變

The purpose of this study was to investigate the effects of changes in nutritional cognition and behavior change of menopausal women after intervening in Trantheoretical model. The experimental study method was adopted. The research subjects were women in menopause in Hsinchu City which divided the subjects into experimental group and control group. There were 57 in the experimental group, and were intervened with nutrition literacy program, while those in the control group were 64. A structured questionnaire was used as a research tool. A trantheoretical-model-based nutrition literacy program was developed. The teaching strategies included film appreciation, group discussion, awareness awakening, assistance relationship with peers, experience sharing of health models, and filling out working sheet. Quantitative comparisons were made between pre- and post-data to explore differences in dietary cognition and behavioral application abilities between the two groups. The data was analyzed and compared by statistical methods such as descriptive statistics, Analysis of Covariance with SPSS v20. The research results were as follows:
1. In terms of the status of nutritional cognition and behavioral change in menopausal women,before the study,the nutritional recognition answer rate of the two groups were all around 80%,and dietary behavior change were between the preparation stage and the action stage.There was no significant difference between experiment group and control group.
2. After intervention of the Nutritional Literacy Education, the nutritional cognition of the experimental group was significantly better than that of the control group (p<0.5).
3. After the intervention of Nutritional Literacy Education, the experimental group was significantly better than the control group (p<0.5) in the four factors: shared decision making, decisional balance, behavioral change stage and dietary self-efficacy (p<0.5).
To improve the dietary cognition and behavior change of menopausal women, trantheoretical-model-based nutrition literacy program was recommended.


Keywords: Nutritional literacy, Menopause nutrition, Trantheoretical model, Shared decision making(SDM), Behavior change

目錄
論文口試委員審定書 I
誌謝 II
摘 要 III
ABSTRACT IV
圖 目 錄 IX
表 目 錄 X
第一章 緒論 1
1.1 研究背景與動機 1
1.2 研究問題 3
1.3 研究目的 4
1.4 研究假設 4
1.5研究限制 4
1.6名詞解釋 4
第二章 文獻探討 6
2.1 更年期現象 6
2.2 更年期婦女營養需求 7
2.3 營養識能 9
2.4 跨理論模式 14
2.5 共享決策(SHARED DECISION MAKING,SDM) 18
第三章 研究方法 19
3.1研究設計 19
3.2研究架構 20
3.3研究工具 20
3.3.1 問卷 20
3.3.2 營養衛教課程 29
3.4研究對象 36
3.5研究倫理 36
3.6研究流程 38
3.7資料分析 39
第四章 研究結果與討論 40
4.1研究對象的社會人口學變項： 40
4.2更年期女性之飲食認知及行為之現況 43
4.2.1更年期女性之飲食認知現況 44
4.2.2更年期女性之共享決策現況 45
4.2.3更年期女性之衡量決定現況 46
4.2.4更年期女性之飲食行為改變階段現況 47
4.2.5更年期女性之飲食自我效能現況 49
4.3以跨理論模式為教案設計的營養識能課程介入後，更年期女性的飲食認知與行為改變之改變成效。 50
4.4營養課程教案介入後研究對象飲食認知與行為改變之改變結果分析與討論 64
4.5教學課程介入後的學習單結果分析與討論： 66
第五章 結論與建議 71
5-1結論 71
5-2建議 72
參考文獻 73
一、英文部分 73
二、中文部分 78
附錄 81
附錄一 更年期營養識能量表 81
附錄二 更年期營養識能教案單元一 86
附錄三 更年期營養識能教案單元二 91
附錄四 更年期營養識能教案單元三 95
附錄五 更年期營養識能教案單元四 99
附錄六 更年期營養識能教案單元五 104
附錄七 更年期營養識能教案單元六 109

圖 目 錄
圖3-1研究設計圖 19
圖3-2研究架構圖 20
圖3-3研究流程圖 37

表 目 錄
表2-1營養識能國內外文獻相關探討 11
表2-2跨理論模式的核心概念與內容 14
表3-1內容效度考驗之專家名單 21
表3-2更年期營養識能(認知、衡量決定、行為改變、自我效能)CVI值 22
表3-3更年期營養識能量表認知題難易度及鑑別度分析 22
表3-4更年期營養識能量表Cronbach’s α值 22
表3-5更年期營養識能量表營養認知題信度分析 23
表3-6更年期營養識能量表共享決策構面之信效度分析 24
表3-7更年期營養識能量表衡量決定構面之信效度分析 26
表3-8更年期營養識能量表行為改變階段構面之信效度分析 27
表3-9更年期營養識能量表自我效能構面之信效度分析 28
表3-10更年期營養識能衛教課程 28
表3-11教案內容效度考驗之專家名單 29
表3-12更年期營養識能教案CVI值 30
表3-13單元二之營養識能課程教案 33
表3-14單元二營養識能課程之活動流程 34
表4-1試教對象與實驗組、對照組之實際填答人數 39
表4-2更年期女性受試者婚姻狀態分析 39
表4-3更年期女性受試者教育程度分析 40
表4-4更年期女性受試者平日飲食習慣分析 40
表4-5更年期女性受試者一週平均外食天數分析 41
表4-6更年期女性受試者最近一個月的運動習慣分析 42
表4-7更年期女性受試者有無更年期症狀之分析 42
表4-8對照組與實驗組前測營養認知題答對率平均值 43
表4-9對照組與實驗組前測共享決策平均值 44
表4-10對照組與實驗組前測衡量決定平均值 45
表4-11對照組與實驗組前測行為改變階段人數及百分比 46
表4-12 對照組與實驗組前測行為改變階段平均值 46
表4-13對照組與實驗組前測自我效能平均值 48
表4-14更年期女性的營養認知前測、後測答對得分平均數分析 49
表4-15更年期女性在「營養認知量表」後測成績答對得分之描述性統計 49
表4-16「營養認知」組內迴歸係數同質性考驗摘要表 50
表4-17不同組別在「營養認知量表」後測成績答對得分之共變數分析 50
表4-18營養識能衛教課程介入後之營養認知題答對率得分分析 51
表4-19更年期女性的「共享決策」前測、後測平均數分析 52
表4-20更年期女性「共享決策量表」後測成績平均數之描述性統計 52
表4-21「共享決策」組內迴歸係數同質性考驗摘要表 53
表4-22不同組別在「共享決策量表」後測成績之共變數分析 53
表4-23營養識能衛教課程介入後之共享決策題平均數分析 54
表4-24更年期女性的衡量決定之前測、後測平均數分析 55
表4-25更年期女性「衡量決定量表」後測成績平均數之描述性統計 55
表4-26「衡量決定」組內迴歸係數同質性考驗摘要表 56
表4-27不同組別在「衡量決定量表」後測成績之共變數分析 56
表4-28營養識能衛教課程介入後之衡量決定題平均數分析 57
表4-29更年期女性的「行為改變階段」前測、後測平均數分析 58
表4-30更年期女性「行為改變階段量表」後測成績平均數之描述性統計 58
表4-31「行為改變階段」組內迴歸係數同質性考驗摘要表 59
表4-32不同組別在「行為改變階段量表」後測成績之共變數分析 59
表4-33營養識能衛教課程介入後之行為改變階段平均數分析 60
表4-34更年期女性的「飲食自我效能」前測、後測平均數分析 60
表4-35更年期女性「飲食自我效能量表」後測成績平均數之描述性統計 61
表4-36「飲食自我效能」組內迴歸係數同質性考驗摘要表 61
表4-37不同組別在「飲食自我效能量表」後測成績之共變數分析 61
表4-38營養識能衛教課程介入後之自我效能平均數分析 62
表4-39表我的每日均衡攝取六大類食物平均數 66
表4-40表我的外食紀錄卡 67
表4-41我的補鈣日記平均數及標準差 68
表4-42減重NG飲食行為調查平均數及標準差 69

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3.王英偉. (2016). 醫病共享決策-決策輔助工具與臨床運用. 醫療品質雜誌, 10(4), 15-24.
4.王桂鳳, 溫瀚英, 孫納新. (2009).女性更年期保健需求調查研究,中國婦幼保健,24(1)119-120
5.台灣更年期醫學會. (2007). 荷爾蒙補充療法
6.台灣更年期醫學會. (2016). 關心妳的「心」事 6招打擊心血管疾病. Retrieved from http://www.menopause.org.tw/newsdetail.php?title_id=8&ca_id=15&news_id=394
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8.立法院. (2017). 國民營養及健康飲食促進法草案
9.江柏欣, 陳昱宏. （2014）. 肌少症的診斷、成因與臨床重要性, 台灣家醫誌, Vol.24 No.1.
10.吳姿蓉, 顏文娟, 李選. (2008). 更年期婦女症狀困擾、情緒狀態與健康需求之相關性研究
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11.李蘭, 晏涵文, 陳富莉, 陸玓玲, 吳文琪, 江宜珍. (2010). 健康行為與健康教育,82-97
12.李佩珊, 李絳桃, 黃久美, 李奇龍. (2006) 更年期婦女之更年期態度、更年期症狀與憂鬱情緒的相關性研究。 實證護理, 2(2) 156-165
13.林惠敏. (2017). 更年期營養照顧. http://www.tzuchi.com.tw/med/index.php/2014-12-08-07-33-12/2016-06-27-06-03-06/604-2017-03-24-02-40-27
14.林棟雍. (2014). 乳製品之攝取與人體健康指標間相關性之調查研究
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21.陳佩英. (2016). 大學生營養知識、飲食行為與健康狀態相關研究
22.劉宇衛,呂淑榮. (2018). 個人健康行為改變主要理論及其整合應用.中國健康教育,284-287
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24.衛生福利部國民健康署 .(2017) 王英偉 醫病共享決策與醫學教育
25.衛生福利部國民健康署. (2017a). 婦女更年期保健手冊. Retrieved from www.hpa.gov.tw/Pages/EBook.aspx?nodeid=1148
26.衛生福利部國民健康署. (2017d). 以網路媒體提升國人營養識能計畫. Retrieved from https://www.hpa.gov.tw/Pages/ashx/File.ashx?FilePath=~/...
27.衛生福利部國民健康署. (2017b). 美國最新發布的「2015-2020飲食指南」. Retrieved from https://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=543&pid=720
28.衛生福利部國民健康署. (2017c). 「國民營養及健康飲食促進法」草案Q&A. Retrieved from https://www.hpa.gov.tw/Pages/ashx/File.ashx?FilePath=~/.
29.衛生福利部國民健康署. (2017a). 婦女更年期保健手冊. Retrieved from www.hpa.gov.tw/Pages/EBook.aspx?nodeid=1148
30.衛生福利部國民健康署. (2018a). 代謝症候群. Retrieved from https://www.hpa.gov.tw/Pages/List.aspx?nodeid=221
31.衛生福利部國民健康署. (2018b). 外食也能吃得好健康. Retrieved from https://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=543&pid=717
32.衛生福利部國民健康署. (2018c). 更年期營養單張. Retrieved from https://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=868&pid=8317
33.衛生福利部國民健康署. (2019). 我的餐盤(聰明吃，營養跟著來). Retrieved from https://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=1622&pid=9514
34.衛生福利部國民健康署. (2018). 外食「四少、均衡、定量」上班族少煩惱. Retrieved from https://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=1425&pid=9807
35.衛生福利部國民健康署. (2019). 「2013－2016年國民營養健康狀況變遷調查」
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