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研究生:林冠妤
研究生(外文):Jessica Lin
論文名稱:醫療人員運動處方諮詢服務之調查及介入研究
論文名稱(外文):Pilot study: physicians’ and health educators’ feasibility of physical activity counselling and written prescription as a tool for clinical practice.
指導教授:張珏張珏引用關係
指導教授(外文):Chueh Chang
口試委員:林名男謝佳容
口試委員(外文):Ming Nan LinChia-Jung Hsieh
口試日期:2015-07-23
學位類別:碩士
校院名稱:國立臺灣大學
系所名稱:公共衛生碩士學位學程
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2015
畢業學年度:103
語文別:英文
論文頁數:81
中文關鍵詞:運動運動處方醫療人員諮詢介入計畫行為理論
外文關鍵詞:Physical ActivityExercise PrescriptionCliniciansCounsellingInterventionTheory of Planned Behavior
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背景:研究顯示規律運動與減少久坐的生活習慣對健康是保護因子。運動非常重要但並不被重視,醫療人員卻因沒有足夠的時間和缺乏訓練等為諮詢的障礙。有鑑於醫療人員在促進民眾運動可扮演重要角色,希望能夠降低運動諮詢的障礙並增加醫療人員進行運動諮詢的動機。

目的:本研究的目的為探討醫療人員個人進行有氧運動、伸展運動及肌力訓練,三項運動習慣與運動諮詢情形,包括執行率、進行諮詢的方式、內容及所遭遇之障礙,進一步比較楊宜青教授等人於2006年進行全國性的調查結果。另外,觀察介入過程參與者的滿意度與工具之實用性,並收集回饋與未來改善的建議。

方法:研究進行方式以自填式問卷與訪談方式收集資料,對象為大林慈濟醫院41位(家庭醫學科醫師、心臟科醫師與健康管理師)臨床醫療人員。「健康動一動」介入方案以計畫行為理論設計,題供運動諮詢教學課程、衛教單張和運動處方籤提供參與者在診間使用。

結果:研究顯示約有三分之一的醫療人員有久坐行為,家庭醫學科醫師比健康管理師在有氧運動(60%:47.6%)與肌力訓練(40%:10.5%)較多,而整體運動習慣比2006年的研究參與者略低。健康管理師在運動諮詢行為比醫師較高(有氧運動90.5%:80%;伸展運動76.2%:66.7%;肌力訓練66.7%:40%),兩組的執行率皆必2006年的研究參與者更高。參與者在介入前使用工具之意圖非常高,但在介入後卻減少。雖然量性資料未能顯著呈現介入的效果,但參與者認為「健康動一動」方案是是有效的入門,能協助提醒與引導執行運動諮詢。雖然在臨床使用上有其挑戰,但超過一半的參與者願意參與繼續教育訓練,希望能將內容針對銀髮族的需求調整運動動作。

結論:國內對醫療人員之運動行為及運動處方諮詢服務的介入和開發是相當前瞻的作法,除了可以檢視個人的運動與久坐行為,進而能有助於民眾及病患增加身體活動量。本研究建議針對不同需求病患和使用者作設計以達到促進健康的目的。


Introduction: Research has shown that promoting regular physical activity and decreasing sedentary behavior is a preventive measure for a healthier lifestyle. Although it is recognized that physical activity is important in a clinical setting, physicians do not always prescribe it on a daily basis due to barriers of time and knowledge (training). Clinicians play a key role in enabling and counseling patients to exercise. This raised the question on how to motivate exercise counselling and finding ways to overcome the barriers clinicians face.
Purpose: The aim of this pilot study was to observe the clinicians’ personal exercise and exercise counselling and to draw a trend comparison to the 2006 nationwide Taiwan survey. Secondly, this study was conducted to learn the effectiveness, satisfaction and practicality of the intervention. Finally, feedback from participants were documented and addressed for future improvements.
Methods: 41 clinician participants were enrolled from a convenience sampling strategy in Dalin Tzu Chi Hospital. The “Healthy Move” intervention is based on the theory of planned behavior and provides a course and physical activity counselling tools for clinicians to use. This pilot study used both quantitative methods to analyze the intervention effectiveness and qualitative in-depth interview methods to gain participants’ feedback.
Results: Exercise behavior and counselling were divided into 3 components, aerobic, stretch and strength exercise. A large amount of sedentary behavior is still seen in 29.3% of clinicians. Family physicians had a higher exercise habit than health educators in aerobic (60%; 47.6%) and strength (40%; 10.5%); overall exercise habits were slightly lower than the 2006 study participants. Health educators counselled more than physicians (aerobic 90.5%, 80%); stretching (76.2%, 66.7%); strengthening (66.7%, 40%); overall counselling habits were higher than the 2006 study participants. Quantitative data indicates the intention to use these materials was very high at the start, but the use of the material decreased after the intervention. Overall, most clinicians found the material useful and effective, although some identified its challenges in practice. More modifications need to be made to target elderly populations and practical exercise movements. Although quantitative data does now show significance in intervention effectiveness, qualitative data support that this intervention is a good starting program and served as a checklist and reminder when giving exercise counselling. More than half of the participants were willing to continue with these learning projects after the intervention ended.
Conclusion: This is one of the first few studies to pilot a specific program in behavior change and counselling skills for promoting physical activity in Taiwan. The importance of this study is to provide a tool for the hospital staff to promote physical activity to the community, as well as address the health of staff in their own personal physical activity and sedentary behavior. Thereby, this study proposes new innovative ideas for the hospital’s health promotion through continuous education and tools that can be applied and tailored to various patients and people in need.


ACKNOWLEDGMENTS iii
CHINESE ABSTRACT iv
ENGLISH ABSTRACT v
LIST OF FIGURES x
LIST OF TABLES xi
CHAPTER 1 INTRODUCTION 1
1.1 Practicum Unit Features and Brief Introduction 1
1.2 Research Purpose and Research Problem 3
CHAPTER 2 LITERATURE REVIEW 4
2.1 Physician’s personal exercise and counselling behavior 5
2.2 Effects of physical activity counselling and prescription 6
2.3 Feasibility of physical activity counselling and prescription 7
CHAPTER 3 METHODS 8
3.1 Sample 8
3.2 Survey 8
3.3 Validation 9
3.4 Questionnaire 9
3.5 Follow up surveys 10
3.6 In-depth Interview 10
3.7 Training of Physicians and Health Educators 13
3.8 Statistical Analysis 14
CHAPTER 4 RESULTS 15
4.1 Clinicians’ Demographic Profile 15
4.1.1 Family Medicine Physicians Demographic 16
4.1.2 Health Educators Demographic 17
4.1.3 Cardiovascular Physicians Demographic 17
4.2 Clinicians’ Sedentary Behavior Profile 18
4.3 Clinicians’ Personal Exercise Profile 19
4.3.1 Family Medicine Personal Exercise 20
4.3.2 Health Educator Personal Exercise and Sedentary Behavior 20
4.3.3 Cardiovascular Personal Exercise and Sedentary Behavior 21
4.4 Clinicians’ Exercise Counseling Profile 24
4.4.1 Family Medicine Exercise Counselling 25
4.4.2 Health Educator Exercise Counselling 26
4.4.3 Cardiovascular Physicians Exercise Counselling 28
4.5 Intervention: Personal Exercise and Exercise Counselling 31
4.5.1 Changes in Personal Exercise and Counselling 33
4.6 Practicality of Material 36
4.7 Frequency of Material 36
4.7.1 Family Medicine Frequency Use 37
4.7.2 Health Educators Frequency Use 37
4.7.3 Cardiovascular Frequency Use 37
4.8 Evaluation of Intervention: Pros and Cons 39
4.8.1 Course Evaluation 39
4.8.2 Brochure Evaluation 40
4.8.3 Exercise Prescription Evaluation 40
4.9 In-Depth Interview 43
4.9.1 Practical [P]: clinic, convenience, time 44
4.9.2 Effective [E]: patient/doctor found useful, knowledge, clear 45
4.9.3 Satisfaction [S]: found material to be good and abundant 45
4.10 Overall Feedback 46
4.10.1 Health Educators Feedback 46
4.10.2 Family Medicine Doctors Feedback 46
4.10.3 Cardiovascular Doctors Feedback 46
4.10.4 Metabolism Doctors Feedback 46
4.11 Limitations 46
CHAPTER 5 DISCUSSION 48
5.1 Intervention Impact 48
Effectiveness, practicality and satisfaction continued use of program 49
5.2 Improvements on the Pilot Study: Some changes that can be made 50
5.2.1 Time and Training 50
5.2.2 Clinicians’ Motivation 51
5.2.3 Exercise Material 51
5.2.4 Behavioral Changes 52
5.3 Overcoming Barriers 53
5.4 What this study adds: 55
5.4.1 Sedentary Behavior for Clinicians 55
5.4.2 Yang 2006 Study Trend Comparison (Yang et al., 2006) 57
5.5 Physical activity health promotion in Dalin Tzu Chi Hospital and hospitals in Taiwan 58
5.6 Future Plans for Dalin: 59
CHAPTER 6 CONCLUSION 60
REFERENCES 61
APPENDIX 69
Appendix A: Pre/Post intervention Questionnaire 69
Appendix B: Follow up class Questionnaire 76
Appendix C: Post-test Questionnaire 78
Appendix D: In-depth interview Questionnaire 80
LIST OF FIGURES
Figure 1: Theory of Reasoned Action Model and Theory of Planned Behavior 13
Figure 2: Sedentary Behavior of Clinicians 19
Figure 3: Physicians’ Barriers to Exercise 22
Figure 4: Health Educators Barriers to Personal Exercise 23
Figure 5: Cardiovascular Physicians’ Barriers to Personal Exercise 24
Figure 6: Physicians'' Barriers to Exercise Counselling 29
Figure 7: Health Educators'' Barriers to Exercise Counselling 30
Figure 8: Cardiovascular Physicians'' Barriers to Exercise Counselling 31
Figure 9: Counselling Behavior of Clinicians 32
Figure 10: Exercise Behavior of Clinicians 32
Figure 11: Frequency use of course 38
Figure 12: Frequency Use of Brochures 38
Figure 13: Frequency Use of Exercise Prescription 39
Figure 14: Course Evaluation (Pro/Cons) 41
Figure 15: Brochure Evaluation (Pros/Cons) 42
Figure 16: Exercise Prescription Evaluation (Pros/Cons) 43

LIST OF TABLES
Table 1: Intervention Timeline 11
Table 2: Demographics 16
Table 3: Behavioral Change in Aerobic Exercise 33
Table 4: Behavioral Change in Stretch Exercise 33
Table 5: Behavioral Change in Strength Exercise 34
Table 6: Counselling Change in Aerobic Exercise 34
Table 7: Counselling Change in Stretch Exercise 35
Table 8: Counselling Change in Strength Exercise 35
Table 9: Practicality of Material 36



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