本研究的目的在探討產前哺乳教育方案對父親與嬰兒親子依附行為、父母親的壓力與對嬰兒餵食態度與哺乳意圖、母親產後哺乳時感受被支持的程度及哺乳率之成效。本研究以自我效能理論為架構。研究採實驗性研究法設計，研究對象為北部某區域懷孕滿36週初孕夫妻為收案對象，137對準父母採隨機分派至實驗組與對照組，實驗組71對準父母接受產前哺乳教育方案的課程，對照組66對準父母則給予「準父親哺乳指導單張」，於產前收集基本資料、壓力知覺量表、嬰兒餵食態度及哺乳意圖量表，產後第二天及第一個月評估父親方面以親子依附行為量表、壓力知覺量表、嬰兒餵食態度及哺乳意圖量表；同樣的，母親方面則填寫母乳哺餵社會支持量表、壓力知覺量表、嬰兒餵食態度、哺乳意圖量表，也同時收集哺乳的方式，另外電訪收集產後二個月哺乳方式。整個資料收集期間為2012年4月至2012年12月。
本研究結果顯示實驗組比對照組有顯著高的父親與嬰兒親子依附行為分數，在產後第二天（52.73 vs. 34.52, p < .001），在產後一個月（53.56 vs. 34.94,p < .001）。實驗組比對照組父親有顯著低的壓力知覺分數，在產後第二天（13.41 vs. 15.47, p < .05），在產後一個月（11.93 vs. 17.02, p < .001）。實驗組比對照組母親在產前及產後第二天壓力知覺分數上無顯著差異，在產後一個月實驗組比對照組母親有顯著低的壓力知覺分數（15.30 vs. 18.11, p < .01）。實驗組比對照組父親有顯著高的嬰兒餵食態度分數，在產後第二天（67.79 vs. 60.06, p < .001），在產後一個月（70.56 vs. 59.06, p < .001）。實驗組比對照組母親有顯著高的嬰兒餵食態度分數，在產後第二天（67.38 vs. 62.95, p = .001），在產後一個月（70.35 vs. 63.12, p < .001）。實驗組比對照組父親有顯著高的嬰兒餵食意圖分數，在產後第二天（13.58 vs. 9.70, p < .001），在產後一個月（13.58 vs. 8.15, p < .001）。實驗組比對照組母親有顯著高的嬰兒餵食意圖分數，在產前（13.14 vs. 10.67, p < .001），在產後第二天（13.14 vs. 9.77, p < .001），在產後一個月（13.94 vs. 9.17, p < .001）。實驗組比對照組母親有顯著高的哺乳社會支持的分數，在產後第二天（102.66 vs. 76.02, p < .01），在產後一個月（103.13 vs. 72.15, p < .001）。實驗組與對照組母親在第一次哺乳的時間上無顯著差異，實驗組比對照組母親有較高的純母乳哺餵率，在住院期間（81.69 vs. 16.67, p < .001），在產後一個月（88.73 vs. 24.24, p < .001），在產後二個月（61.97 vs. 4.55, p < .001）。
整體而言，本研究結果可以提供臨床醫護人員對準父親產前教育的重視，讓父親於母親哺乳時能發揮支持與協助的功能，也有助於提升哺乳率。

關鍵字：自我效能、產前哺乳教育方案、親子依附、哺乳率

The objectives of this study were to investigate the efficacy of prenatal breastfeeding education programs for fathers on father-infant attachment, stress, attitudes to infant feeding, breastfeeding intentions, intensity of supports perceived by breastfeeding mothers and breastfeeding rates. The study was constructed under the framework of self-efficacy theory and adopted an experimental study design. The study population was new couples with expectant mothers who were pregnant at least 36 weeks or more in a regional hospital in northern Taiwan. One hundred and thirty seven couples were randomly assigned to an experimental group or a control group. The experimental group included 71 couples of expectant parents who participated in prenatal breastfeeding education programs designed for expectant fathers, and the control group included 66 couples of expectant parents who were given guidance leaflets of breastfeeding for expectant fathers only. In the prenatal period, basic data were collected and expectant fathers and mothers were evaluated with the Perceived Stress Scale, Infant Feeding Attitude Scale and Infant Feeding Intentions Scale. On the second day and at one month after birth, fathers were evaluated with Paternal Attachment Inventory, Perceived Stress Scale, Infant Feeding Attitude Scale and Infant Feeding Intentions Scale, while mothers were evaluated with Breastfeeding Social Support Scale, Perceived Stress Scale, Infant Feeding Attitude Scale and Infant Feeding Intentions Scale, and the methods of infant feeding were collected. The methods of infant feeding at two months after birth was collected by telephone interviews. The duration of data collection in this study was from April 2012 to December 2012.
The results of this study showed that fathers in the experimental group had significantly higher father-infant attachment scores than the control group on second day (52.73 vs. 34.52, p < .001) and at one month (53.56 vs. 34.94, p < .001); significantly lower stress scores on second day (13.41 vs. 15.47, p < .05) and at one month (11.93 vs. 17.02, p < .001); and significantly higher infant feeding attitude scores on second day (67.79 vs. 60.06, p < .001) and at one month (70.56 vs. 59.06, p < .001); and significant higher infant feeding intentions scores on second day (13.58 vs. 9.70, p < .001) and at one month(13.58 vs. 8.15, p < .001). Mothers in the experimental group had significantly lower stress scores than control group at one month after birth (15.30 vs. 18.11, p <.01), but not in the prenatal period or on second days postpartum; significant higher infant feeding attitudes scores on second days (67.38 vs. 62.95, p = .001) and at one month (70.35 vs. 63.12, p < .001); significant higher infant feeding intentions scores prenatally (13.14 vs. 10.67, p < .001), on second days (13.14 vs. 9.77, p < .001) and at one month(13.94 vs. 9.17, p < .001); significant higher social support scores on second days (102.66 vs. 76.02, p < .01) and at one month (103.13 vs. 72.15, p < .001); significant higher rates of exclusive breastfeeding during hospitalization (81.69 vs. 16.67, p < .001), at one month (88.73 vs. 24.24, p < .001) and at two months (61.97 vs. 4.55, p < .001); but no significant difference on time of initiation of breastfeeding .
Overall, the results of this study may provide evidence for health professionals to pay more emphasis on father prenatal education, which can help to enhance the role of father support and assistance during breastfeeding and improve breastfeeding rates.

Keywords: self-efficacy, education programs for expectant-fathers, father-infant attachment, breastfeeding rate

目 次
中文摘要…………………………………………………………………… Ⅰ
英文摘要…………………………………………………………………… Ⅲ
目次………………………………………………………………………… Ⅵ
表次………………………………………………………………………… Ⅸ
圖次………………………………………………………………………… XI
第一章 緒論 1
第一節 前 言……………………………………………………………. 1
第二節 問題陳述…………………………………………………………… 2
第三節 研究目的…………………………………………………………… 4
第四節 研究假設…………………………………………………………… 4
第五節 研究的重要性..................................... 4
第二章 文獻查證 6
第一節 影響母乳哺餵的因素……………………………………………… 6
第二節父親參與哺餵母乳的重要性與影響.......................9
第三節 父親參與協助哺乳對親子依附行為的影響…………………… 12
第四節 準父親對協助參與哺乳的壓力………………………………… 15
第五節 產前哺乳教育方案對父親的影響…………………………… 17
第六節 自我效能理論與產前哺乳教育方案………………………… 20
第三章 研究方法…………………………………………………………… 23
第一節 研究概念架構……………………………………………………… 23
第二節 研究設計………………………………………………………… 25
第三節 研究對象與場所………………………………………………… 26
第四節 研究變項與定義………………………………………………… 29
第五節 研究工具與信效度……………………………………………… 31
第六節 介入措施………………………………………………………… 38
第七集 資料收集………………………………………………………… 42
第八節 研究對象權益維護……………………………………………… 46
第九節 資料處理與分析………………………………………………… 46
第四章 研究結果…………………………………………………………… 50
第一節 研究對象的基本屬性……………………………………………… 50
第二節 產前哺乳教育方案對親子依附行為之差異分析…………… 58
第三節 產前哺乳教育方案對父母親壓力知覺之差異分析………… 60
第四節 產前哺乳教育方案對父母親嬰兒餵食態度之差異分析…… 65
第五節 產前哺乳教育方案對父母親嬰兒餵食意圖之差異分析…… 70
第六節 產前哺乳教育方案對母親哺乳時感受被支持程度之差異… 76
第七節 產前哺乳教育方案對母乳哺餵方式之差異分析…………… 79
第八節 父親參與哺乳及母親對父親參與哺乳之評值分析…………… 83
第五章 討論………………………………………………………………… 92
第一節 研究樣本之屬性…………………………………………………… 92
第二節 產前哺乳教育方案對父親親子依附行為之影響…………… 94
第三節 產前哺乳教育方案對父母親壓力知覺之影響……………… 95
第四節 產前哺乳教育方案對父母親嬰兒餵食態度之影響………… 98
第五節 產前哺乳教育方案對父母親嬰兒餵食意圖之影響………… 99
第六節 產前哺乳教育方案對母親哺乳時感受被支持程度之影響… 100
第七節 產前哺乳教育方案對母乳哺餵方式之影響………………… 102
第八節 父親哺乳支持及母親對父親哺乳支持之評值………………… 104
第六章 結論與建議………………………………………………………… 106
第一節 結論………………………………………………………………… 106
第二節 建議…………………………………………………………… 107
第三節 研究限制……………………………………………………… 109
參考文獻…………………………………………………………………… 111
中文部分………………………………………………………………… 111
英文部分………………………………………………………………… 115
附 錄……………………………………………………………………
附錄一 隨機分派表……………………………………………………… 124
附錄二 問卷……………………………………………………………… 126
附錄三 問卷使用同意書………………………………………………… 136
附錄四 專家效度名單…………………………………………………… 141
附錄五 專家評分結果及建議…………………………………………… 142
附錄六 產前哺乳教育指導方案............................ 146
附錄七 準父親哺乳教育指導單張……………………………………… 151
附錄八 同意臨床試驗證明書…………………………………………… 153

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