臺灣博碩士論文加值系統

背景：在目前為止，尚未有相關運用在對新移民孩童口腔健康促進。而本研究主要目的為比較社區健康顧問介入前後實驗組與對照組孩童乳牙齲齒經驗之差異。
研究方法：本研究使用隨機分派實驗設計。研究對象為越南籍新移民母親且有2-6歲孩童。實驗組為Lay health advisor (LHA)介入組別，而對照組僅僅只有給予衛教單張。最後，實驗組有32位新移民母親，對照組有26位。在前測及後測追蹤，每位研究對象其孩童須接受口腔檢查，以記錄乳牙齲齒經驗(dmft) (Frazao & Marques, 2009; Paskett et al., 2011)；研究對象則需接受問卷收集，以記錄其齲齒預防認知、自我效能、態度與行為。利用廣義估計方程式Generalized Estimating Equations (GEE)之線性迴歸比較組間孩童齲齒經驗、母親對孩童齲齒預防認知、自我效能與態度之差異；另利用GEE模式之邏輯斯迴歸比較組間母親對孩童齲齒預防行為之差異。
結果：介入後，實驗組孩童的因齲齒而填補的顆數有顯著增加(p<0.001)。齲齒顆數的改變與母親對孩童齲齒預防態度呈現負相關(p=0.033)，而因齲齒而填補顆數的改變則成為正相關(p=0.040)。實驗組母親有較正向的行為改變在於協助孩童刷牙三分鐘(p=0.012)。實驗組的母親有較高的機會去協助孩童一天刷牙兩次[Odds Ratio (OR)=2.68, 95%CI=1.13-6.36]。母親對孩童齲齒預防認知，實驗組不論在後測(p<0.001)或是追蹤時(p<0.001)都有顯著提升。
結論：社區健康顧問介入策略應用在於提升孩童齲齒填補顆數與母親對孩童齲齒預防認知及對孩童齲齒預防行為是有效的。

Background: Prior to this study, no oral health promotion program for immigrant children was conducted using Lay Health Advisor (LHA) intervention approach. The aim is to evaluate effects of LHA outreach program on immigrant children’s caries experience.
Methods: A community-randomized experimental design was used. Vietnamese women who have 2-6 years old children were recruited and randomized into the LHA intervention or brochure only group. Overall, 32 and 26 mothers were assigned into experimental and control group. Each LHA taught assigned mother about oral hygiene knowledge and techniques four times at 4-week period. Each immigrant’s child had an oral examination by well-trained oral hygienist from pre-test to follow-up. We used the caries index: dmft decayed (d), missing (m), or filled (f) tooth (t) to present the child teeth health status. Questionnaire was used to collect the data in oral health care behaviors from baseline to follow-up. Linear regression in Generalized Estimating Equations (GEE) to analyze the difference of children’s caries experience, maternal caries prevention cognitive, self-efficacy and attitude between groups. Logistic regression in Generalized Estimating Equations (GEE) to analyze the difference of maternal toward children caries prevention behavior between groups.
Results: After intervention, children caries experience (dmft) had no significant change between two group, but ft had more significant increase in LHA group in follow-up (p<0.001). The change of dt and ft had correlation with the change maternal caries prevention attitude (p<0.05). In follow-up, the mothers in LHA intervention group were more likely to assist in child brushing two times daily [Odds Ratio (OR)=2.68, 95%CI=1.13-6.36]. Between two group, the LHA group had more positive change in assisted child brushing teeth minutes (p=0.012) in post-test. The mothers in LHA group had more significant improved in maternal caries prevention cognitive in post-test (p<0.001) and follow-up (p<0.001). Conclusion: The LHA intervention was effective on improving immigrant children’s caries prevention behavior and caries experience in LHA group.

致謝 i
中文摘要 ii
英文摘要 iv
第一章 緒論 1
第一節 研究背景 1
第二節 研究目的 4
第二章 文獻探討 5
第一節 新移民學齡前兒童口腔健康不均等 5
第二節 新移民學齡前兒童口腔健康影響因素 7
第三節 社區健康顧問策略及其應用 13
第三章 研究方法 15
第一節 研究設計 15
第二節 研究對象 16
第三節 研究流程 18
第四節 研究架構 20
第五節 介入過程 22
第六節 介入工具 25
第七節 測量工具 27
第八節 測量變項 32
第九節 資料收集方法 39
第十節 研究倫理 41
第十一節 統計分析 42
第四章 研究結果 45
第一節 退出分析(dropout analysis) 45
第二節 基本人口學分布 45
第三節 介入前後母親對孩童齲齒預防認知之差異 47
第四節 介入前後母親對孩童齲齒預防自我效能之差異 47
第五節 介入前後母親對孩童齲齒預防態度之差異 48
第六節 介入前後母親對孩童齲齒預防行為之差異 49
第八節 介入前後孩童齲齒經驗之差異 52
第九節 孩童齲齒經驗與母親對孩童認知、自我效能及態度改變量之相關性分析 53
第五章 討論 54
第一節 孩童齲齒經驗介入成效 55
第二節 母親對孩童齲齒預防行為介入成效 56
第三節 母親對孩童齲齒預防認知介入成效 57
第四節 母親對孩童齲齒預防自我效能、態度介入成效 58
第五節 過程評值 60
第六節 研究限制 64
第六章 結論與建議 66
第一節 結論 66
第二節 建議 66
參考文獻 68
分析表格 74
附錄 86
附錄一 學齡前兒童口腔健康檢查表 87
附錄二 高雄市學齡前兒童新移民媽媽口腔保健問卷(中文版) 88
附錄三 高雄市學齡前兒童新移民媽媽口腔保健問卷(越文版) 98
附錄四 口腔衛生保健衛教手冊(中文版) 109
附錄五 口腔衛生保健衛教手冊(越文版) 119
附錄六 社區口腔健康顧問培訓手冊(封面&目錄) 129
附錄七 社區口腔健康顧問工作日誌 131
附件八 觀察員培訓手冊 135
附件九 觀察員紀錄單 137
附件十 訪員培訓手冊 138

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