研究背景：缺血性心臟病在全球及台灣分別是十大死因的第一名及第二名。心臟
復健可以改善冠狀動脈疾病患者之生活品質，降低死亡率。但參與第二期心臟復
健的人數仍遠低於應參與的人數。而衛教是心臟復健的一部分，醫療人員在進行
衛教時，運用不同的媒材，衛教成效各有差異。研究目的：本研究欲探討1. 透
過不同媒材介入的心臟復健衛教成效差異。2. 介入衛教後，冠狀動脈心臟病患者
參與第二期心臟復健運動意願的變化。研究方法：本研究分三階段進行。第一階
段製作文字、圖文及影音三種版本衛教媒材及「心臟復健認知程度量表」，並量
測「心臟復健認知程度量表」效度；第二階段以一般民眾為受試者，依序均分為
文字、圖文及影音三組衛教後，量測三種不同媒材的衛教成效，並選擇衛教成效
較優的媒材於第三階段使用；第三階段以H 醫院患者為受試者，觀察進行衛教
後，第二期心臟復健的參與情形。研究結果：1. 「心臟復健認知程度量表」效度
為1，可作為衛教成效量測工具。2. 第二階段受試者90 人，以「心臟復健認知
程度量表」之答題錯誤率為參數，利用SAS 進行變異數分析(ANOVA)，三種媒
材衛教成效沒有顯著差異(P=0.6001)，但以圖文組的(錯誤＋不確定)題數百分比
較低，故選擇圖文版做為第三階段之衛教媒材。 3. 第三階段受試者33 人，衛教
介入後，第二期心臟復健參與率與歷史值相比有顯著提升(P=0.0348)。結論：(一)
心臟復健衛教媒材：文字紙本、圖文紙本或影音視頻，三者的衛教成效沒有顯著
差異。(二)介入衛教後，冠狀動脈疾病患者參與第二期心臟復健的意願有提升。

Background: Ischemic heart disease is the leading cause of death in the world and
Taiwan respectively in first and second placeCardiac rehabilitation can improve the
quality of life of patients with coronary artery disease and reduce mortality. But the
number of patients attending to the phase II cardiac rehabilitation program is still well
below the number of patients who should attend. And health education is part of the
cardiac rehabilitation. The effectiveness of health education through various media is
different. Purpose: 1. To explore the effectiveness of health education through various
media. 2. To explore the change of the attendance at phase Ⅱ cardiac rehabilitation after
health education intervention. Methods: This study was divided into three stages. The
first stage: Expert validity of Cardiac Rehabilitation Awareness Scale. The second stage:
Test the effectiveness of three kinds of mediums through “Cardiac Rehabilitation
Awareness Scale” and find the best one. The third stage: Educate CAD patients with
the best medium and explore the change of their attendance at phase Ⅱ cardiac
rehabilitation. Results: 1. The validity of “Cardiac Rehabilitation Awareness Scale”
was 1. It can be used as a measurement tool of the effectiveness of health education. 2.
90 subjects were included to the second stage. There was no significant difference in
the effectiveness of health education of the three media (P=0.6001). 3. 33 subjects were
included to the third stage. The participation rate of phase II cardiac rehabilitation
compared with historical value significantly improved through cardiac health education
(P=0.0348). Conclusion: 1. There was no significant difference in the effectiveness of
health education among Words, Graphics and Video media. 2. The participation rate of
phase II cardiac rehabilitation improved through cardiac health education.

摘要........................................................................................................................... i
Abstract ..................................................................................................................... ii
誌謝......................................................................................................................... iii
圖目錄........................................................................................................................ vi
表目錄....................................................................................................................... vii
第一章 緒論.................................................................................................................. 1
1.1 研究背景與動機 .......................................................................................................... 1
1.2 研究目的 ................................................................................................................ 3
1.3 研究架構 ................................................................................................................ 3
第二章 文獻回顧.......................................................................................................... 4
2.1 心臟復健 ........................................................................................................................ 5
2.2 衛教媒材 ....................................................................................................................... 6
2.3 影響參與第二期心臟復健的因素 ................................................................................ 8
第三章 研究方法........................................................................................................ 11
3.1 第一階段：衛教媒材及量表 ...................................................................................... 12
3.2 第二階段：不同媒材衛教成效 .................................................................................. 13
3.3 第三階段：衛教與心臟復健參與率 .......................................................................... 14
第四章 資料分析與結果............................................................................................ 16
4.1 量表效度 ...................................................................................................................... 16
4.2 衛教媒材成效 .............................................................................................................. 16
4.3 衛教與心臟復健參與率 .............................................................................................. 19
第五章 討論................................................................................................................ 23
5.1 不同媒材衛教成效 ...................................................................................................... 23
5.2 衛教與復健參與率 ...................................................................................................... 25
5.3 研究方法與限制 .......................................................................................................... 26
v
5.4 臨床應用 ...................................................................................................................... 27
第六章 結論................................................................................................................ 28
6.1 結論 .............................................................................................................................. 28
6.2 未來研究方向與建議 .................................................................................................. 28
參考文獻...................................................................................................................... 29
附錄.............................................................................................................................. 33

中華民國統計資訊網. (2017). 歷年15 歲以上民間人口之教育程度. Retrieved
from http://win.dgbas.gov.tw/dgbas04/bc4/manpower/year/year_t1-
t23.asp?table=5&ym=1&yearb=103&yeare=105&out=1 on 2017/04/29
吳英黛. (2012). 呼吸循環系統物理治療-基礎實務: 金名圖書有限公司.
唐心如, & 蔡曉婷. (2013). 影響冠狀動脈繞道術後病患參與復健運動之因素探討.
護理雜誌, 60(6), 35~46.
張淑芳. (2008). 比較兩種衛教方式對於包皮切除術母親在知識、焦慮、提早回診
率以及護理時數之成效. (碩士), 高雄醫學大學.
衛生福利部統計處. (2016). 104 年統計年報. Retrieved from
http://www.mohw.gov.tw/CHT/DOS/Statistic.aspx?f_list_no=312&fod_list_no
=6201, from 衛生福利部 on 2017/04/01
衛生福利部統計處. (2017). 104 年醫療統計年報. Retrieved from
http://www.mohw.gov.tw/CHT/DOS/Statistic.aspx?f_list_no=312&fod_list_no
=6419, from 衛生福利部統計處 0n 2017/04/01
Aldcroft, S. A., Taylor, N. F., Blackstock, F. C., & O'Halloran, P. D. (2011).
Psychoeducational Rehabilitation for Health Behavior Change in Coronary
Artery Disease A SYSTEMATIC REVIEW OF CONTROLLED TRIALS. Journal of
Cardiopulmonary Rehabilitation and Prevention, 31(5), 273-281.
doi:10.1097/HCR.0b013e318220a7c9
Benjamin, E. J., Blaha, M. J., Chiuve, S. E., Cushman, M., Das, S. R., Deo, R., . . . Stroke
Stat, S. (2017). Heart Disease and Stroke Statistics-2017 Update A Report From
the American Heart Association. Circulation, 135(10), E146-E603.
doi:10.1161/cir.0000000000000485
Bethell, H., Lewin, R., Evans, J., Turner, S., Allender, S., & Petersen, S. (2008). Outpatient
Cardiac Rehabilitation Attendance in England VARIABILITY BY REGION AND
CLINICAL CHARACTERISTICS. Journal of Cardiopulmonary Rehabilitation and
Prevention, 28(6), 386-391.
Bittner, V., Sanderson, B., Breland, J., & Green, D. (1999). Referral patterns to a
university-based cardiac rehabilitation program. American Journal of
Cardiology, 83(2), 252-+. doi:10.1016/s0002-9149(98)00830-3
30
Boyde, M., Grenfell, K., Brown, R., Bannear, S., Lollback, N., Witt, J., . . . Aitken, L. (2015).
What have our patients learnt after being hospitalised for an acute myocardial
infarction? Australian Critical Care, 28(3), 134-139.
doi:10.1016/j.aucc.2014.05.003
Carlson, R., Chandler, P., & Sweller, J. (2003). Learning and understanding science
instructional material. Journal of Educational Psychology, 95(3), 629-640.
doi:10.1037/0022-0663.95.3.629
Clark, A. M., King-Shier, K. M., Thompson, D. R., Spaling, M. A., Duncan, A. S., Stone, J.
A., . . . Angus, J. E. (2012). A qualitative systematic review of influences on
attendance at cardiac rehabilitation programs after referral. American Heart
Journal, 164(6), 835-+. doi:10.1016/j.ahj.2012.08.020
De Vos, C., Li, X., Van Vlaenderen, I., Saka, O., Dendale, P., Eyssen, M., & Paulus, D.
(2013). Participating or not in a cardiac rehabilitation programme: factors
influencing a patient's decision. European Journal of Preventive Cardiology,
20(2), 341-348. doi:10.1177/2047487312437057
Frieske, D. A., & Park, D. C. (1999). Memory for news in young and old adults.
Psychology and Aging, 14(1), 90-98. doi:10.1037/0882-7974.14.1.90
Giannuzzi, P., Saner, H., Bjornstad, H., Fioretti, P., Mendes, M., Cohen-Solal, A., . . .
Veress, G. (2003). Secondary prevention through cardiac rehabilitation -
Position paper of the Working Group on Cardiac Rehabilitation and Exercise
Physiology of the European Society of Cardiology. European Heart Journal,
24(13), 1273-1278. doi:10.1016/s0195-668x(03)00198-2
Grace, S. L., Abbey, S. E., Shnek, Z. M., Irvine, J., Franche, R. L., & Stewart, D. E. (2002).
Cardiac rehabilitation II: referral and participation. General Hospital Psychiatry,
24(3), 127-134. doi:10.1016/s0163-8343(02)00179-2
Hamm, L. F., Sanderson, B. K., Ades, P. A., Berra, K., Kaminsky, L. A., Roitman, J. L., &
Williams, M. A. (2011). Core Competencies for Cardiac
Rehabilitation/Secondary Prevention Professionals: 2010 Update POSITION
STATEMENT OF THE AMERICAN ASSOCIATION OF CARDIOVASCULAR AND
PULMONARY REHABILITATION. Journal of Cardiopulmonary Rehabilitation and
Prevention, 31(1), 2-10. doi:10.1097/HCR.0b013e318203999d
Harskamp, E. G., Mayer, R. E., & Suhre, C. (2007). Does the modality principle for
multimedia learning apply to science classrooms? Learning and Instruction,
31
17(5), 465-477. doi:10.1016/j.learninstruc.2007.09.010
Houts, P. S., Witmer, J. T., Egeth, H. E., Loscalzo, M. J., & Zabora, J. R. (2001). Using
pictographs to enhance recall of spoken medical instructions II. Patient
Education and Counseling, 43(3), 231-242. doi:10.1016/s0738-3991(00)00171-
3
Huang, J. P., Chen, H. H., & Yeh, M. L. (2009). A Comparison of Diabetes Learning With
and Without Interactive Multimedia to Improve Knowledge, Control, and Self-
Care Among People With Diabetes in Taiwan. Public Health Nursing, 26(4), 317-
328. doi:10.1111/j.1525-1446.2009.00786.x
Kongstvedt, P. R. (2001). The Managed Health Care Handbook: Gaithersburg: Aspen
Publishers.
Kools, M., Ruiter, R. A. C., van de Wiel, M. W. J., & Kok, G. (2007). Testing the usability
of access structures in a health education brochure. British Journal of Health
Psychology, 12, 525-541. doi:10.1348/135910706x132930
Kripalani, S., Robertson, R., Love-Ghaffari, M. H., Henderson, L. E., Praska, J., Strawder,
A., . . . Jacobson, T. A. (2007). Development of an illustrated medication
schedule as a low-literacy patient education tool. Patient Education and
Counseling, 66(3), 368-377. doi:10.1016/j.pec.2007.01.020
Mayer, R. E. (2003). The promise of multimedia learning: using the same instructional
design methods across different media. Learning and Instruction, 13(2), 125-
139. doi:10.1016/s0959-4752(02)00016-6
Mayer, R. E., Hegarty, M., Mayer, S., & Campbell, J. (2005). When static media promote
active learning: Annotated illustrations versus narrated animations in
multimedia instruction. Journal of Experimental Psychology-Applied, 11(4),
256-265. doi:10.1037/1076-898x.11.4.256
Mozaffarian. (2016). Heart Disease and Stroke Statistics-2016 Update: A Report From
the American Heart Association (vol 133, pg e38, 2016). Circulation, 133(15),
E599-E599. doi:10.1161/cir.0000000000000409
Rauch, B., Davos, C. H., Doherty, P., Saure, D., Metzendorf, M. I., Salzwedel, A., . . .
Heinrich-Heine, U. (2016). The prognostic effect of cardiac rehabilitation in the
era of acute revascularisation and statin therapy: A systematic review and
meta-analysis of randomized and non-randomized studies - The Cardiac
32
Rehabilitation Outcome Study (CROS). European Journal of Preventive
Cardiology, 23(18), 1914-1939. doi:10.1177/2047487316671181
Ruano-Ravina, A., Pena-Gil, C., Abu-Assi, E., Raposeiras, S., van 't Hof, A., Meindersma,
E., . . . Gonzlaez-Juanatey, J. R. (2016). Participation and adherence to cardiac
rehabilitation programs. A systematic review. International Journal of
Cardiology, 223, 436-443. doi:10.1016/j.ijcard.2016.08.120
Taking Care of Yourself. (2016, 2016/8/29). Retrieved from
http://www.heart.org/HEARTORG/Conditions/More/CardiacRehab/Taking-
Care-of-Yourself_UCM_307091_Article.jsp#.WPGAvNKGOuW
Weibel, L., Massarotto, P., Hediger, H., & Mahrer-Imhof, R. (2016). Early education and
counselling of patients with acute coronary syndrome. A pilot study for a
randomized controlled trial. European Journal of Cardiovascular Nursing, 15(4),
213-222. doi:10.1177/1474515114556713
WHO. (2017, 2017/01). The top 10 causes of death. Retrieved from
http://www.who.int/mediacentre/factsheets/fs310/en/
Wilson, E. A. H., Makoul, G., Bojarski, E. A., Bailey, S. C., Waite, K. R., Rapp, D. N., . . .
Wolf, M. S. (2012). Comparative analysis of print and multimedia health
materials: A review of the literature. Patient Education and Counseling, 89(1),
7-14. doi:10.1016/j.pec.2012.06.007
Wilson, E. A. H., Park, D. C., Curtis, L. M., Cameron, K. A., Clayman, M. L., Makoul, G., . . .
Wolf, M. S. (2010). Media and memory: The efficacy of video and print
materials for promoting patient education about asthma. Patient Education
and Counseling, 80(3), 393-398. doi:10.1016/j.pec.2010.07.011
Wilson, E. A. H., & Wolf, M. S. (2009). Working memory and the design of health
materials: A cognitive factors perspective. Patient Education and Counseling,
74(3), 318-322. doi:10.1016/j.pec.2008.11.005