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研究生:林淑晶
研究生(外文):Lin, Shuchin
論文名稱:產前「嬰兒行為訊息教育課程」對初產婦產後母育信心及母嬰依附之影響
論文名稱(外文):The effect of prenatal education with infant behavioral cues on postnatal maternal confidence and maternal-infant attachment in primipara
指導教授:邱慧洳邱慧洳引用關係
指導教授(外文):Chiu, Huiju
口試委員:林寬佳郭碧照
口試委員(外文):Lin, KuanchiaKuo, Pichao
口試日期:2012-07-31
學位類別:碩士
校院名稱:國立臺北護理健康大學
系所名稱:護理研究所
學門:醫藥衛生學門
學類:護理學類
論文種類:學術論文
論文出版年:2012
畢業學年度:100
語文別:中文
論文頁數:100
中文關鍵詞:嬰兒行為訊息教育課程初產婦社會認知理論母育信心母嬰依附
外文關鍵詞:Education with infant behavioral cuesPrimiparaSocial cognitive theoryMaternal confidenceMaternal-infant attachment
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醫療支付制度的改變減少了產後住院天數,護理人員提供相關衛教的時間與機會也相對的減少與受限,導致初產婦在未完整學習如何照顧新生兒之前就已出院,因此初產婦在出院後常感無助、焦慮、不確定感及低自信度,甚至產生產後憂鬱,抑制了母親與嬰兒間之互動,進而對母嬰依附產生負面之影響。
本研究採用類實驗性研究(quasi-experimental)中之「非等數對照組設計」(nonequivalent control group design),藉以瞭解初產婦產後母育信心及母嬰依附情形,並進一步探討以Bandura社會認知理論(Social Cognitive Theory)為設計基礎的產前「嬰兒行為訊息(infant behavioral cues)教育課程」,對初產婦產後母育信心程度與母嬰依附之成效。本研究於台灣北部某區域教學醫院之婦產科門診行收案,收案時間為民國101年1月至民國101年5月,採方便取樣及非隨機分派方式,先收對照組個案15位,研究對象同意參與時即進行前測,於產後接受醫院出院前一般常規衛教;然後再收實驗組17位,研究對象同意參與時即進行前測,於生產前2~3週接受本研究為期2週之介入措施,且於產後第1~3天接受研究人員一次產後訪視、介入措施複習與醫院出院前一般常規衛教,二組皆於產後第3天接受後測1及產後第14天接受後測2資料收集。測量工具包括「母親及新生兒基本資料表」、「母育信心量表」及「親子依附量表」。
以SPSS17.0版統計軟體進行描述性與推論性統計。以重複測量變異數(repeated measure ANOVA)來分析二組母育信心與母嬰依附之變化與差異,並以概化估計方程式(Generalized Estimating Equation, GEE)方法來推估介入措施之成效。研究結果顯示:在母育信心方面,二組研究對象整體的母育信心會隨著測量時間之延長而增加(p<.05),經過「組別與時間」之交互作用下,實驗組的母育信心平均分數比對照組低2.76分(p>.05),在共變數方面,生產滿意度皆會影響母育信心得分狀況(p<.05)。於母嬰依附方面,二組研究對象整體之母嬰依附會隨著測量時間之延長而增加,但無統計顯著差異(p>.05) ,經過「組別與時間」之交互作用下,二組在不同時間的母嬰依附平均分數,在後测1比前測時實驗組比對照組高0.15分(p>.05),反而在後测2比前測時實驗組比對照組低2.56分(p>.05),在共變數方面,生產滿意度量表會影響母嬰依附得分狀況(p<.05)。綜合研究結果,雖然本研究之介入措施對初產婦產後母育信心與母嬰依附的成效,對二組研究對象而言無顯著差異,但可提供新手父母與嬰兒間互動的示範教育課程,因此仍值得推廣與運用於臨床照護。

Purpose: The aims of this study was to examine the effect of the “education course of infant behavioral cues” on maternal confidence and maternal-infant attachments with the primipara during the post partum Day 3(post-test 1) and Day 14(post-test 2).
Methods: A quasi-experimental study which from nonequivalent control group research design(Random Sampling and convinces sampling ) was conducted with fifteen obstetrics and gynecology department y patients in the experimental group and seventeen in control group. Data were collected by the method of structured questionnaire survey in the clinic. From January to May, 2012, The numbers of the participants in the study group and the control group are 15 and 17 who participated in the study. The usual care(regular teaching education course) intervention was implemented the experimental group while patients in the control group received the “education with infant behavioral cues” for two weeks before delivery for 2 to 3 days ago. Maternal confidence data assessed by maternal confidence questionnaire (MCQ), and maternal-infant attachment data assessed by maternal attachment inventory(MAI). There were collected for 3time points, including pre-intervention (baseline) and post-intervention (after the completion of intervention, post partum Day 3(post-test 1) and Day 14(post-test 2).
Results: The Statistical Package of the Social Sciences Program (SPSS) for Windows 17.0 was used for descriptive and inferential statistical analyses. The following measurements were taken after delivered Day 3 and Day14. Repeated measure ANOVA was used for analyzing both group difference of maternal confidence, and maternal-infant attachment. Generalized Estimating Equation(GEE) model was used for analyzing the effectiveness of intervention. The result were showed: in maternal confidence, MCQ will increase with the extension of measurement time in both groups (p<.05). MCQ had time and group interaction, experimental group accepted the study intervention, decreased 2.76 point(p>.05) than control group at post-test 2. After added the covariance, postpartum social support, postpartum depression, and childbirth of satisfaction to analyze the MCQ and showed will influence maternal confidence score status (p <.05). In maternal-infant attachment, MAI will increase with the extension of measurement time in both groups, but no significance(p>.05). MAI had time and group interaction, the average the two groups at different times of MAI, post-test 1 than pretest experimental group was 0.15 points higher than the control group (p> .05). Instead, in the post-test 2 than the pretest experimental group was 2.56 points lower than the control group (p> .05). After added the covariance, the childbirth of the satisfaction scale will affect the MAI score(p <.05). Conclusion : These findings suggest that no significant proportion of between maternal confidence and maternal-infant attachments with the primipara. Increased awareness of the clinical presentations of these education courses may help new parents.
目  次
中文摘要 ………………………………………………………………………… i
英文摘要 ………………………………………………………………………… iii
目次 ……………………………………………………………………………… v
表次 ……………………………………………………………………………… viii
圖次 ……………………………………………………………………………… ix

第一章 緒論
第一節 研究動機及重要性 …………………………………………………… 1
第二節 研究目的 ……………………………………………………………… 3
第三節 名詞定義 ……………………………………………………………… 3
第二章 文獻查證
第一節 母育信心與母嬰附 …………………………………………………… 5
第二節 依附理論對嬰兒行為訊息教育課程的應用 ………………………… 7
第三節 嬰兒行為訊息教育課程 ……………………………………………… 10
第四節 國內外嬰兒行為訊息教育課程之研究現況 ………………………… 16
第五節 影響母育信心與母嬰依附之相關因素 ……………………………… 18
第六節 總結 …………………………………………………………………… 23
第七節 研究問題與研究假設 ………………………………………………… 24
第三章 研究方法
第一節 概念架構 ……………………………………………………………… 25
第二節 研究設計 ……………………………………………………………… 26
第三節 檢力分析 ……………………………………………………………… 31
第四節 研究對象與場所 ……………………………………………………… 31
第五節 研究工具 ……………………………………………………………… 32
第六節 資料收集過程 ………………………………………………………… 35
第七節 資料統計與分析 ……………………………………………………… 35
第八節 倫理考量 ……………………………………………………………… 36
第四章 研究結果與討論
第一節 研究對象之基本資料分析 …………………………………………… 37
第二節 影響母育信心及母嬰依附之因素探討 ……………………………… 43
第三節 產前「嬰兒行為訊息教育課程」對母育信心之影響 ……………… 48
第四節 產前「嬰兒行為訊息教育課程」對母嬰依附之影響 ……………… 53
第五節 小結 …………………………………………………………………… 58
第五章 討論
第一節 檢力說明 ……………………………………………………………… 61
第二節 產前「嬰兒行為訊息教育課程」對母育信心之成效 ……………… 62
第三節 產前「嬰兒行為訊息教育課程」對母嬰依附之成效 ……………… 65
第四節 研究限制 ……………………………………………………………… 67
第五節 研究建議 ……………………………………………………………… 69
第六節 結論 …………………………………………………………………… 70

參考文獻
中文部分 ……………………………………………………………………… 72
外文部分 ……………………………………………………………………… 74

附錄
附錄二 母親及新生兒基本資料 ……………………………………………… 84
附錄三 母育信心量表 ………………………………………………………… 86
附錄四 母育信心量表使用授權書 …………………………………………… 87
附錄五 親子依附量表 ………………………………………………………… 88
附錄六 親子依附量表使用授權書 …………………………………………… 89
附錄七 產後社會支持量表 …………………………………………………… 90
附錄八 產後社會支持量表使用授權書 ……………………………………… 91
附錄九 愛丁堡產後憂鬱量表中文版 ………………………………………… 92
附錄十 愛丁堡產後憂鬱量表中文版使用授權書 …………………………… 93
附錄十一 生產滿意度量表 …………………………………………………… 94
附錄十二 生產滿意度量表英文版使用授權書 ……………………………… 96
附錄十三 生產滿意度量表中文版使用授權書 ……………………………… 97
附錄十四 醫院倫理委員會審查結果通知書 ………………………………… 98
附錄十五 學校研究倫理審查通知書 ………………………………………… 99
附錄十六 實驗組受試者同意書 ……………………………………………… 100
附錄十七 對照組受試者同意書 ……………………………………………… 102

表  次
表3-1 母育信心程度與母嬰依附之研究設計時間表 ……………………… 26
表3-2 「嬰兒行為訊息(infant behavioral cues)教育課程」之介入策略 30
表4-1 研究對象基本人口學之比較 ………………………………………… 40
表4-2 控制干擾因素量表之分數分佈與差異情形 ………………………… 44
表4-3 人口學變項及控制干擾因素量表與母育信心量表前測總分之相關性比較 45
表 4-4 人口學變項及控制干擾因素量表與母嬰依附量表前測總分之相關性比較 47
表4-5 二組研究對象於各施測點之母育信心分數差異情形 ……………… 51
表4-6 產前「嬰兒行為訊息教育課程」對母育信心成效之GEE分析 …… 53
表4-7 二組研究對象於各施測點之母嬰依附分數差異情形 ……………… 56
表4-8 產前「嬰兒行為訊息教育課程」對母嬰依附成效之GEE分析 …… 58

圖  次
圖3-1 研究之概念架構 ……………………………………………………… 25
圖4-1 研究對象參與研究之CONSORT流程 ……………………………… 42
圖4- 2 二組研究對象於各施測點之母育信心分數變化 …………………… 50
圖4-3 二組研究對象於各施測點之母育信心平均分數變化趨勢 ………… 50
圖4-4 二組研究對象於各施測點之母嬰依附分數變化 …………………… 55
圖4-5 二組研究對象於各施測點之母嬰依附平均分數變化趨勢 ………… 55

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