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研究生:李佩珊
研究生(外文):Lee, Pei-Shan
論文名稱:E化更年期健康篩檢系統與健康諮詢介入對婦科求診婦女充能成效探討
論文名稱(外文):The effectiveness of the electronic menopausal health screen system and counseling intervention on the empowerment of women in gynecologic clinics
指導教授:曹麗英曹麗英引用關係
指導教授(外文):Tsao, Lee-Ing
口試委員:曹麗英李奇龍陳文進劉介宇尤嫣嫣
口試委員(外文):Tsao, Lee-IngLee, Chyi-LongChen, Wen-ChinLiu, Chieh-YuYu,Yen-Yen
口試日期:2013-05-29
學位類別:博士
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:2013
畢業學年度:101
語文別:中文
論文頁數:170
中文關鍵詞:更年期婦女電子化照護健康促進生活型態健康風險因子
外文關鍵詞:menopausal womenelectronic carehealth promotionlife stylehealth risk factor
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更年期婦女是處於健康多變化的時期,而門診求醫之更年期婦女對更年期身心症狀及其自我健康照護,更需有個別性之健康諮詢。然而在繁忙與時間緊縮的門診服務中,若能透過電子化系統在婦女候診時即做快速且完整的健康評估與專屬個人的量身訂作之衛教建議,有助於提供護理人員衛教諮詢的依據與醫師診療的輔助參考。有鑑於此本研究乃結合護理、醫學與資訊工程等跨領域專業合作模式,共同研發並建構E化更年期健康篩檢平台與建置衛教資料庫,期能透過此系統的建置協助婦科求診婦女檢視自己的更年期症狀與罹患心血管疾病、糖尿病、骨質疏鬆症的風險因子,以促使婦女能增加自我照護其健康問題之能力;此外,透過此系統及個別性的諮詢介入方案,提供婦女量身訂做的更年期訊息與健康相關知識,使之採取有益健康的行動力與決策力,落實健康促進行為。本研究分為三個階段進行,研究結果分述如下:
本研究初期為研究工具的研發,在跨領域專業合作下完成E化更年期健康篩檢系統相關介面與軟體的開發。此E化更年期健康篩檢系統之主要架構包括:更年期症狀困擾評量、健康指標評量(身體活動、飲食、抽菸)、風險因子評量(心血管疾病風險因子、糖尿病風險因子、骨質疏鬆風險因子)、生理指標評量(身體質量指數、體重、腰圍、血壓,飯前血糖、膽固醇、及高密度脂蛋白)、自我設定目標與改善策略、整體評估總表精簡報告以及E化更年期健康篩檢系統成效評估。
本研究第二階段進行前趨測試E化更年期健康篩檢系統,E化更年期健康篩檢系統通過良好信效度的檢測之後(專家效度:content validity index during 0.97~09.8, 內容效度:content validity index =0.96,以及重測信度:Pearson’s correlation during 0.797~0.959 and Intra-Class Correlation during 0.793~0.958)進入研究第三階段。

本研究第三階段採縱貫性、重覆測試之實驗設計(experimental design),探討E化更年期健康篩檢系統與健康諮詢介入措施對婦科求診婦女的充能成效,以建立更年期婦女健康照護機制。依個案參與順序,以隨機分配方式,分為實驗組及對照組,收案日期於民國101年9月至次年3月。兩組各為37人,兩組在介入前進行前測,實驗組接受E化更年期健康篩檢與諮詢,且在介入後立即檢測更年期不確定感成效,並於第4週檢視與討論自我照護的目標與計畫達成情況,而控制組則作例行之門診常規照護。兩組均於第4週及第8週做延宕成效追蹤。充能成效的評值內容分別為更年期症狀困擾、更年期自覺不確定感、更年期健康行為、身體活動量、身體質量指數、體重、腰圍、血壓,並且檢測飯前血糖、膽固醇、及高密度脂蛋白。延宕成效之統計方式採用廣義估計模式(Generalized Estimating Equations, GEE)進行三次重複測量分析。研究結果發現:更年期自覺不確定感之即時成效,呈現顯著性的降低(P<.001)。在延宕成效方面,實驗組相較於對照組,在第4週有效改善更年期症狀困擾(β=-10.7,P<.001)、降低更年期的不確定感(β=-17.7,P<.001)、增加更年期的健康行為(β=16.8,P<.001)與減少腰圍 (β=-2.4,P<.001),且這些成效皆延宕至第8週並達統計上顯著差異。其餘的充能成效變項,在第8週才呈現顯著差異為增加身體活動量(β=840.6,P=.005)、減輕體重(β=-0.8,P=.046)與降低身體質量指數(β=-0.4,P<.001)。然而兩組的血壓及生化檢驗值不論是飯前血糖,膽固醇與高密度脂蛋白未呈現顯著差異。
綜合以上結果得知, E化更年期健康篩檢與諮詢介入可有效改善更年期症狀困擾、降低更年期自覺不確定感、增加健康行為,並且有助於增加身體活動量、減少體重、減少身體質量指數及減少腰圍。本研究的初步成效重新建構更年期照護模式,此模式是以婦女充能為主軸,加入健康促進元素,結合電子系統提供量身訂做訊息,有別於過去,本研究所重視的是事先檢視自己的健康行為及潛在的健康危害因子,讓婦女覺醒自身的健康問題,而能有效提升健康行為的執行力。於未來可以依循此模式,推廣至網際網路,利用網路系統的便利性與可近性,讓忙碌的職業婦女不受時間與地點的限制,透過使用者付費模式,給予具個別性的回饋與建議。另一方面,也因網路E化的健康服務讓更年期照護不再侷限於醫療院所,如此,不但規避更年期醫療化的詬病,更能因推展至廣大的社群婦女,而能實現健康促進的理念。

Women with menopause face numerous health changes. Menopausal women seeking outpatient care for psychosomatic symptoms and self-health care require individualized health counseling. However, in light of the busy and time-strapped nature of gynecology clinics, if a rapid and complete health assessment as well as individualized tailored health education and recommendations could be provided using an electronic system while a women is waiting in line at a clinic, such an assessment might help to provide auxiliary references for nursing staff when providing health consultations and for physicians delivering diagnoses and treatment. Accordingly this study utilized an interdisciplinary professional cooperative model combining the fields of nursing, medicine, and information engineering to develop and construct an electronic menopausal health screening platform and a health education database. It assist those women who come to gynecology clinics to check their menopausal symptoms and potential risk factors of causing cardiac vascular disease, diabetes and osteoporosis, to enhance their self-health management capabilities for reduce health issues. Through this electronic system and individual counseling provided tailored information and knowledge related to climacteric health to help them the following decision-making and act for health, and perform health promotion behavior. Our study separate 3 stage and summarize it as below:
The first stage, our research is developing and constructs the research material, which interdisciplinary professional cooperative model build an electronic menopausal health screening platform and a health education database. This electronic menopausal health screen system (EMHSS) main framework included Menopausal disturbance, Health index (physical activity, diet, smoke status), Risk factors (cardiovascular, diabetic mellitus, osteoporosis), Biology index (body mass index, waist circumference, blood pressing, glucose, cholesterol, high-density lipoprotein), Goal setting and action plans.
The second stage, our research undergo pilot test for EMHSS. After analyzing the system and confirming it to have a high degree of reliability and validity ( Expert validity: content validity index during 0.97~09.8, Content validity: content validity index =0.96 and Test-retest reliability: Pearson’s correlation during 0.797~0.959 and intra-class correlation during 0.793~0.958 ), this study entered the third stage.
The third stage, longitudinal experimental design was applied for this study, the effectiveness of the electronic menopausal health screen system and counseling intervention on the empowerment of women in gynecologic clinics was investigated for building up a menopausal care system. Those participants were randomly divided into an experimental group and a control group based on their order of enrollment. The participant enrollment period was from September, 2012 to March, 2013. Each group comprised 37 participants, and the two groups underwent pretests prior to the intervention. Those in the experimental group received an electronic menopause health screening and consultation, and the effectiveness of the assessment in treating menopausal uncertainty was determined immediately after the intervention. During the fourth week, the same group was given an opportunity to review and discuss the progress of their self-care goals and overall project accomplishments. The control group received routine outpatient care. Both groups received delayed effectiveness follow-up tracking between the fourth and the eighth week of the study. The content of the empowerment effectiveness appraisal consisted of menopausal disturbances, perceived menopausal uncertainty, menopausal health behavior, physical activity, body mass index, weight, waist circumference, and blood pressure, and also included blood glucose, cholesterol, and high-density lipoprotein tests before meals. In this study, we employed the generalized estimating equations (GEE) method to perform delayed effectiveness measurement analyses three times. The results of the study revealed a significant reduction in the immediate results of perceived menopausal uncertainty (p < .001). Regarding delayed effectiveness, the comparison between the experimental group and the control group after the fourth week showed that the system effectively relieved menopausal disturbance (β = -10.7, p <.001), reduced menopausal uncertainty (β = -17.7, p <.001), increased healthy menopausal behaviors (β = 16.8, p <.001), and decreased waist circumference (β = -2.4, p <.001). These effects also extended to the eighth week, and the difference was statistically significant. The other empowerment effect variables that showed significant differences after the eighth week included increased physical activity (β = 840.6, p = .005), weight loss (β = -0.8, p = .046), and reduced body mass index (β= -0.4, p < .001). However, no significant difference was found between the two groups in terms of blood pressure and biochemical tests such as blood sugar, cholesterol, and high-density lipoprotein before meals.
Based on the results of this study, electronic menopausal health screening and consultation intervention can effectively relieve menopausal disturbances, reduce perceived menopausal uncertainty, increase healthy behavior, and help to increase physical activity, thereby reducing weight, body mass index, and waist circumference. The preliminary results of this study were used to construct a new menopause care model focused on empowering women which includes health-promoting goals and an electronic system for providing individualized tailored information, which stands in contrast to past efforts. By emphasizing the preventive nature of self-examinations that focused on cultivating healthy lifestyle habits and avoiding potential health hazards, this study helped enable women become more aware of their health, as a result, effectively empowered women to take actions needed to improve their health. This model can be used in the future as the foundation for a more extensive web-based system. The convenience and accessibility of the Internet would allow busy career women to be free from time and location restraints, and enable women to receive individualized feedback and suggestions via a pay-to-use model. In addition, because an Internet-based electronic health care service would no longer relegate menopausal care to the confines of hospitals, stigma surrounding the medicalization of menopause could be avoided and the system could be extended to cover an even larger community of women, thereby helping to accomplish the concept of health promotion.

目  次

中文摘要 …………………………………………………………………………… i
英文摘要 …………………………………………………………………………… vi
目次 ………………………………………………………………………………… viii
表次 ………………………………………………………………………………… x
圖次 ………………………………………………………………………………… xiii
第一章 緒論
第一節 研究背景與動機 ………………………………………………………… 1
第二節 研究目的 ………………………………………………………………… 5
第三節 研究問題 ………………………………………………………………… 6
第四節 研究假設 ………………………………………………………………… 7
第五節 名詞界定 ………………………………………………………………… 8
第二章 文獻探討
第一節 E化健康促進介入相關研究 …………………………………………… 11
第二節 健康行為對預防慢性疾病相關研究 …………………………………… 15
第三節 運用充能策略的相關研究 ……………………………………………… 19
第四節 更年期之健康照護介入相關研究 ……………………………………… 23
第五節 研究架構 ………………………………………………………………… 28
第三章 研究方法
第一節 研究設計 ………………………………………………………………… 29
第二節 研究對象、取樣方法與招募過程 ……………………………………… 32
第三節 研究工具 ………………………………………………………………… 35
第四節 研究步驟 ………………………………………………………………… 62
第五節 資料分析 ………………………………………………………………… 68
第四章 研究結果與討論
第一節 研究結果 ………………………………………………………………… 77
第二節 討論 ……………………………………………………………………… 122
第五章 結論與建議
第一節 結論 ……………………………………………………………………… 137
第二節 建議 ……………………………………………………………………… 141
第三節 研究限制 ………………………………………………………………… 146
參考文獻
中文部分 ………………………………………………………………………… 147
外文部分 ………………………………………………………………………… 150
附錄
附件一 國際身體活動量表-短版之同意使用公文 …………………………… 161
附件二 弗雷明漢風險評分表(Framingham risk assessment)之同意使用……… 162
附件三 弗雷明漢風險評分表(Framingham risk assessment) …………………… 163
附件四 E化更年期健康篩檢的操作手冊……………………………………… 165
附件五 E化更年期健康篩檢的操作平台之專家效度名單…………………… 169
附件六 E化更年期健康篩檢的衛教資料庫之專家效度名單………………… 170


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