臺灣博碩士論文加值系統

本研究目的是引用認知缺損危害需求驅動之行為模式來驗證一項中文翻譯之非牙醫專業人員所使用的口腔健康評估量表(Oral Heal -th Assessment Tool, OHAT)信、效度，並經由口腔健康評估量表來瞭解失智症住民口腔健康狀況。研究設計為橫斷式調查法，以立意取樣方式收集台灣南部護理之家的116位失智症患者資料，研究工具為結構式問卷，包括:個人基本屬性問卷、口腔健康評估量表、整體認知功能量表、巴氏量表、簡易的口腔健康調查表、簡短版老人憂鬱量表及神經學病徵量表。研究結果：OHAT信度部分:一、Cronbach's α為.598(N=116)，顯示該量表具有相當的內在一致性；二、測試者間的一致性的ICC値為.868，達顯著相關。效度部分: 一、同時效度，Kappa值在3.162-4.337之間，顯示BOHSE與OHAT各項間都具有高度相關(p＜0.05)；二、OHAT建構效度的假設驗證部分: 失智住民的牙痛與問題行為總分(r=-.184, p＜.05)具有顯著負相關；影響失智症住民神經調節方面的問題行為，為慢性病種類、體重改變及牙痛等三個變項，能夠有效解釋失智住民的問題行為的變異數(R2)為14.9%-
39.6 %。故此問卷具可接受之信效度。以OHAT評估護理之家失智住民口腔健康狀況總分，得平均値(標準差)為8.85±.609分(OHAT總分為16分)，顯示護理之家失智住民口腔健康開始改變甚至不健康。結論：本研究驗證: 一、中文版OHAT為一信效度俱佳的口腔健康評估工具；二、認知缺損危害需求驅動之行為模式可用於護理之家的失智長者，來探討失智老人背景因素與立即因素(牙痛)和問題行為之間的關係；三、失智老人口腔健康狀況不佳，未來需進一步探討如何提升失智老人的口腔健康照護品質。

Abstract
Purpose: The purpose of this research study was to use the” Need-Driven Dementia-Compromised Behavior Model” (NDB Model) to test reliability and validity of a translated “Oral Health Assessment Tool” (OHAT) for non-dental professionals. Using this instrument, we surveyed the oral health statuses of demened residents in nursing homes in southern
Taiwan. Method: It was a cross-sectional survey design with a purposive sampling to recruit 116 demened residents. The test battery included demographic variables, OHAT, Brief Oral Health Status Examination (BOHSE), Mini Mental State Examination, Geriatric Depression Scale-
Short (GDS-S) and Chinese Neuropsychiartic Inventory (CNPI).
Results: There were three important results of this research. 1. Reliability. The reliability of OHAT was acceptable (Cronbach’s α=.598). The inter-rater reliability were examined by Item Characteristic Curve (ICC) and was significant (ICC = .868). 2. Validity. The concurrent validity was analyzed by Kappa, showing that BOHSE and OHAT were highly correlated (Kappa value = 3.162- 4.337, p < .05). The construct validity then was examined by testing the hypotheses generated from the NDB model. We found that toothache was significantly and negatively correlated with the NPI total scores (r= -.184, p＜.05). In addition, the number of chronic diseases, current weight, and toothache directly predicted demented residents’ neural regulation behaviors (R2 = 14.9% ~39.6%).3. The demened residents in the nursing homes exhibited poor oral health (M = 8.85 ± .609).Conclusions. The Chinese OHAT was a validated instrument to be used in demented residents in nursing homes. Moreover, the NDB Model could be used in nursing home in southern Taiwan to explain the relationships among background factors, immediate factors (toothache) and behavioral outcomes in demented residents of nursing home. Finally, this study found that demented residents showed poor oral health. Therefore, future research is needed to improve the oral health of this population.

目 錄
指導教授推薦書……………………………………………………
口試委員會審定書…………………………………………………
致謝……………………………………………………………… iii
中文摘要……………………………………………………………. iv
英文摘要………………………………………………………… vi
目錄……………………………………………………………… viii
圖目錄..............................xi
表目錄………………………………………………………… xii
第一章 緒論 ........................................... 1
第一節 前言 ....................................... 1
第二節 研究動機 ................................... 4
第三節 研究目的 ................................... 6
第四節 研究的問題 ................................. 7
第五節 名詞界定 ................................... 7
第二章 文獻查證 ....................................... 9
第一節 認知缺損危害需求驅動之行動模式 ............. 9
第二節 一般口腔健康狀況的探討 ...................... 12
第三節 機構失智症住民口腔健康相關研究 .............. 13
第四節 口腔健康狀況測量指標的相關研究 .............. 19
第三章 研究方法 ........................................ 31
第一節 研究設計 .................................... 31
第二節 研究架構 .................................... 31
第三節 研究問題 .................................... 32
第四節 研究場所及對象 .............................. 33ix
第五節 研究工具及信效度 ............................ 34
第六節 工具信度與效度的測試 ........................ 41
第七節 研究步驟 .................................... 42
第八節 研究資料處理與統計方法 ...................... 46
第九節 倫理考量 .................................... 48
第四章 研究結果 ........................................ 49
第一節 問卷編製與問卷預試........................... 49
第二節 機構失智老人之基本人口學特性 ............... 50
第三節 問卷信度檢定................................. 60
第四節 問卷效度檢定 ................................ 61
第五章 討論 ............................................ 70
第一節 失智老人基本人口學特性變項 .................. 70
第二節 失智老人基本口腔健康狀況之比較分析........... 70
第三節 量表信度檢定 ................................ 72
第四節 量表效度檢定.......... ...................... 73
第五節 護理之家失智老人背景因素和 OHAT 之相關性分析 . 74
第六節 問題行為與背景因素和牙痛之相關性分析 ........ 76
第七節 失智症老人問題行為之預測因 .................. 77
第六章 討論、限制與建議 .................................79
第一節 結論 ........................................ 79
第二節 研究限制 .................................... 81
第三節 未來實務與研究建議 .......................... 82
參考資料 ............................................... 84
附錄一 Dr.John Warren 的同意 e-mail..................... 91
附錄二 Dr. Jeanie Kayser-Jones 的同意 e-mail ............ 92x
附錄三 內容效度專家一覽表 ............................. 93
附錄四 專家效度邀請函與專家效度前之研究問卷............ 94
附錄五 研究問卷(專家效度修改後正式施測之研究問卷)...... 100
圖目錄
圖 1 認知缺損危害需求驅動之行為模式………………………… 12
圖 2 研究架構概念圖……………………………………………… 33
表目錄
表 3-1 統整歸納口腔健康測量工具的優缺點……………………… 27
表 4-1 統計分析方法………………………………………………… 48
表 4-1-1 內容效度指標……………………………………………… 51
表 4-2-1 護理之家失智老人人口學特性…………………………… 52
表 4-2-2 護理之家失智老人口腔健康與慢性病之現況…………… 54
表 4-2-3 護理之家失智老人口腔健康現況………………………… 56
表 4-2-4 人口學特性與口腔健康各類別之差異性分析…………… 57
表 4-2-5 牙痛類別在問題行為之差異性分析……………………… 59
表 4-2-6 慢性疾種類與問題行為變異性分析摘要表……………… 60
表 4-3-1 研究量表之信度檢定……………………………………… 61
表 4-3-2OHAT 測量者間一致性……………………………………… 61
表 4-4-1OHAT 與 BOHSE 之量表之效度檢定………………………… 62
表 4-4-2OHAT 各類別與總分之相關性……………………………… 63
表 4-4-3 有無假牙與自然牙之差異性 …………………………… 63
表 4-4-4OHAT 總分與問題行為及牙痛之相關…………………… 64
表 4-4-5OHAT 中牙痛與問題行為之相關………………………… 64
表 4-4-6 背景因素與 OHAT 總分之相關性………………………… 65
表 4-4-7 背景因素與問題行為之相關性…………………………. 65
表 4-4-8 問題行為中神經運動調節之複迴歸分析………………….68
表 4-4-9 問題行為中神經運動調節之複迴歸分析………………….69XII
表 4-4-9 問題行為中神經運動調節之複迴歸分析………………….70
附件目錄
附件一 Dr.John Warren 的同意 e-mail..................... 92
附件二 Dr. Jeanie Kayser-Jones 的同意 e-mail ............93
附件三 內容效度專家一覽表 ............................. 94
附件四 專家效度邀請函與專家效度前之研究問卷............ 95
附件五 研究問卷(專家效度修改後正式施測之研究問卷)...... 101

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