臺灣博碩士論文加值系統

目的：本研究針對與運動諮商較相關之科別的醫師，使用計劃行為理論 (Theory of Planned Behavior, TPB) 為基礎研發之量性問卷，探討其提供運動諮商之意圖與相關因素。
方法：以TPB為架構，針對其構念之直接與間接測量，發展量性問卷，並驗證其信效度，再使用此問卷工具，針對與運動諮商相關之科別的門診醫師進行調查研究，使用描述性統計、雙變項分析與多變項羅吉斯迴歸模型進行統計分析。
結果：共發出1,128份問卷，扣除未回收與填答不完整之無效問卷，納入統計分析計1,016份問卷。本研究發現，42.8%之醫師有較高意圖提供病患運動諮商。研究工具發展部分，將間接測量之27個題組納入探索性因素分析後，發現五類因素，分別為：正面行為結果評價、負面行為結果評價、一般主觀規範、有利情境下之自覺行為控制以及阻礙情境下之自覺行為控制，其內部一致性信度Cronbach’s α，除負面行為結果評價外 (0.67)，其餘均介於 0.70-0.90。構念效度驗證上，五類因素與其相關變項之結果解釋上，皆與過去相關實證研究或臨床場域之實務觀察具一致性。
TPB之直接測量的羅吉斯迴歸模型顯示：行為態度、主觀規範及自覺行為控制之高低，皆與提供運動諮商意圖高低，呈顯著正相關。間接測量部分，正面行為結果評價愈正向、一般主觀規範愈感受到支持，及自覺行為控制則以有利情境下之自覺控制愈高，會有較高之提供運動諮商意圖。人口學資料與醫師特質：性別、學歷、醫師專科、工作區域、年資無顯著相關性，而與執業場所及門診人數有關。個人運動相關變項：具運動習慣者且運動頻率較多者、接受過運動相關教育者，會有較高提供運動諮商之意圖。
結論：本研究係使用TPB為基礎，針對台灣醫師給予病患運動諮商之意圖及其相關因素，進行問卷調查。本研究之問卷經多項信效度檢視與驗證，具完整且良好之工具發展過程與結果。結果發現，本身具固定運動習慣、接受過運動相關教育，或知道如何幫助病患行為改變之醫師，具較高之意圖提供病患運動諮商。同時，TPB中之主要構念，亦即正面行為結果評價愈正向、一般主觀規範愈支持，以及有利情境下之行為控制愈高時，醫師提供運動諮商之意圖顯著較高。

Objectives: The study utilized a quantitative questionnaire and the theory of planned behavior (TPB) to investigate the intention to provide exercise counseling with respect to specialties for which exercise counseling was more relevant.
Methods: Using the TPB framework, a quantitative questionnaire which focused on the single-item measures and multiple-item scales of TPB constructs was developed. The reliability and validity of the questionnaire was tested, after which it was used to study the provision of exercise counseling among clinical physicians in specialties for which exercise counseling was more relevant. Descriptive statistics, bivariate analyses and multivariate logistic regression models were used to carry out the statistical analyses.
Results: In total, 1128 questionnaires were administered and 1016 effective questionnaires were collected after the exclusion of unreturned questionnaires or those with invalid responses. It was found that 42.8% of the physicians had a higher intention of providing exercise counseling. With respect to research tool development, 27 individual TPB items underwent exploratory factor analysis, resulting in the identification of these five factors: attitude toward behavior (ATB) about positive outcomes, ATB about negative outcomes, general subjective norm (SN), perceived behavioral control (PBC) under facilitating conditions, PBC under constraining conditions. With the exception of the ATB about the negative outcomes (0.67), the other factors had an internal consistency (Cronbach''s α) of 0.70-0.90. A test of construct validity showed that the five factors and their variables were consistent with the data from past studies and clinical observations. The multivariate logistic regression model, applying the single-item measures of the TPB constructs, indicated significant positive correlations between positive ATB, SN, and PBC, and the provision of exercise counseling. For multiple-item scales of TPB constructs, ATB about positive outcomes, general SN (perceived support), and PBC under facilitating conditions were found to be positively correlated to the intention to provide exercise counseling. Demographic information and physicians'' characteristics: no significant correlations were observed with respect to gender, education level, medical specialty, work area, and length of professional experience, while correlations were found for accreditation and number of patients per clinic. Individual exercise-related variables: physicians who exercise regularly and received educational training in sports and exercise were more willing to provide exercise counseling to their patients.
Conclusions: Using TPB, this study carried out a questionnaire survey on the intention (and the related factors) of physicians in Taiwan to provide exercise counseling to patients. The questionnaire used in this study underwent various types of reliability and validity tests, thus ensuring that it was a complete and effective tool for data collection. The results showed that physicians who exercise regularly, physicians who received educational training in sports and exercise, and physicians who understood how they could help change the behaviors of patients, showed a stronger intention to provide exercise counseling to patients. At the same time, the higher the level of these main TPB constructs, namely ATB about positive outcomes, general subjective norm (perceived support), and PBC under facilitating conditions, the stronger the intention of physicians to provide exercise counseling to patients.

誌謝 i
中文摘要 iv
Abstract v
Contents vii
List of Tables x
Chapter 1 Introduction 1
1.1 Research motivation and purpose 1
1.1.1 Physical inactivity as a cause of chronic diseases 1
1.1.2. People who exercise regularly have better health and fewer chronic diseases 2
1.1.3. Current status and research of exercise counseling provided by clinical and medical staff in Taiwan 3
1.2 Research objectives 4
1.3 Literature review 4
1.3.1. Exercise counseling, physical activity, and health status 4
1.3.2. Application of the theory of planned behavior 11
Chapter 2 Methods 14
2.1. Participants 14
2.1.1. Inclusion criteria 14
2.1.2. Sampling method 14
2.2. Measures 15
2.2.1. Background variables 15
2.2.2. Independent variables 15
2.2.3. Dependent variables 17
2.3. Procedure 17
Chapter 3 Results 19
3.1. Sample distribution of the physicians'' background characteristics and their intention to provide exercise counseling 19
3.2. Logistic regression analysis of physicians’ intention to provide exercise counseling 25
3.2.1. Logistic regression model with only background variables 25
3.2.2. Logistic regression model with background variables and single-item measures of TPB constructs 26
3.2.3. Logistic regression model with background variables and multiple-item scales of TPB constructs 26
3.2.4. Logistic regression models including background variables and TPB individual items 27
Chapter 4 Discussion 29
4.1 Positive behavioral attitude toward EC provision is related to likelihood of providing EC 29
4.1.1. Relation between EC and exercise benefits 29
4.1.2. Physicians were driven by positive rather than negative attitude toward EC provision 30
4.1.3. Physicians prioritized treatment over precautions 31
4.1.4. Physicians may gain respect from patients by providing individualized EC 32
4.2 Potential methods and challenges in improving behavioral attitude toward EC provision 32
4.2.1. To strengthen their belief in the linkage between EC and positive outcomes 33
4.2.2. Patient-centered structure to promote a medical service model based on health promotion 34
4.3. Support from significant others affects the intention to provide EC 36
4.3.1. Higher motivation of the patient increases the physician’s willingness to communicate 36
4.3.2. Senior physicians as role models positively affect physicians’ intention to provide EC 37
4.4 The system of clinical teachers and counseling in Taiwan and increased intention to provide EC 37
4.4.1. Senior physicians can provide EC education to inpatients during teachable moments, and implement HPH and follow-up care after hospital discharge 38
4.4.2. Senior physicians create a good learning environment for EC 39
4.4.3. Comprehensive teacher training and improved top-down education 39
4.5 Physicians who are confident in EC or find themselves in more facilitating conditions to provide EC have a higher intention to provide EC 40
4.5.1. Relation between EC and physicians’ abilities and related environment 40
4.5.2. Intention is promoted by facilitating rather than constraining conditions 40
4.5.3. Constraining conditions hinder all physicians 41
4.5.4. Physicians have a higher intention when they understand how they can help patients change their behavior and increase their motivation 41
4.6 Creating a supportive environment and improving physicians’ counseling abilities 42
4.6.1. Health promotion leaflets and implementation of “exercise is medicine” referral measures to bring benefit to both physicians and patients 43
4.6.2. EC intervention capabilities should be used in research, teaching, and service 44
4.7 Difference in physicians with stronger exercise habit and physicians who received educational training in sports and exercise 45
4.7.1. Physicians who exercise frequently attach more importance to exercise 45
4.7.2. Those who engage in exercise gain more exercise benefits, which reflects on the EC provided to patients 46
4.7.3. Educational training in sports and exercise improves physicians’ knowledge of EC content 47
4.7.4. Physicians with educational training in sports and exercise possess self-identity 47
4.8 Physicians with a higher number of outpatients have a higher intention to provide EC 49
4.9. Research limitations and future directions 50
Chapter 5. Conclusion 52
References 63

Table 1 Distributions of sociodemographic characteristics, exercise counseling intention among sampled physicians in Taiwan (N=1,016) 53
Table 2. Single-item measures of TPB constructs, Multiple-item scales of TPB constructs and their associations with giving patients exercise counseling intention (N=1,006) 55
Table 3. Multivariate logistic regression estimating the odds of having high giving patients exercise counseling intention: Control for background variables 56
Table 4. Multivariate logistic regression estimating the odds of having high giving patients exercise counseling intention: Using single-item measures of TPB constructs 57
Table 5. Multivariate logistic regression estimating the odds of having high giving patients exercise counseling intention: Using multiple-item scales of TPB constructs 59
Table 6. Multivariate logistic regression estimating the odds of having high giving patients exercise counseling intention: Using individual TPB items 61

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