臺灣博碩士論文加值系統

家庭是兒童健康行為養成的重要關鍵，以家庭為基礎的健康促進及生活型態，有助於兒童健康成長及減少成年期慢性疾病的發展。近年來e化健康醫療科技，已廣為運用於預防及處置健康問題，證據顯示智慧型手機應用程式可有效地改變健康行為。在台灣尚未有智慧型手機程式應用於改善父母及兒童健康成果並促進健康生活型態之研究，本研究旨在於：(1)發展以家庭為中心，學校為基礎的兒童健康智慧型手機應用程式措施計畫 (Kidshealth Smartphone Apps Intervention, KiSPAI)；(2)驗證KiSPAI之臨床可行性及推廣普及性；(3)評估KiSPAI於改善有特定疾病學童的健康生活行為及健康狀況之效用。
研究對象主要招募於新北市三峽區中園國小及台大兒童醫院，選取年齡介於9-12歲之學童，在其家長或法定代理人同意後納入研究。KiSPAI措施將包括八週系列性的活動，運用智慧型飲食系統、身體組成分析系統及Fitbit charge2監測學童活動 (physical activity)與睡眠型態 (sleep pattern)。透過親子自我檢視評估、居家訪視及線上溝通回饋等互動，以達成親子學習健康吃、多活動、好睡眠的健康生活型態。本研究主要採KiSPAI措施前後成效對比分析，評量指標包括：(1)健康生活行為：飲食、身體活動、靜態行為及睡眠，(2)健康狀態：身體組成分析(身體質量指數、腰圍及身體脂肪)、疾病狀況控制。成效評量時間為進入研究後的基礎測量 (T1)及為期2個月的4次追蹤 (T2-T4)。資料分析採重複性測量變異數分析、意向分析及廣義估計方程式。希望藉由智慧型手機平台提供兒童與家庭的互動回饋，強化父母與孩童的健康生活型態，改善家庭健康進而降低醫療及社會的經濟成本，為其他慢性疾病兒童e-健康發展計畫提供參考。

Family is a primary agent in the promotion of healthy behaviors and lifestyles for children, family-based health promotion and lifestyle modification will be beneficial to live healthily in childhood and prevent from chronic condition in adulthood. As e-health technology has been widely applied in the prevention and management of health problem, smart phone applications offer a potentially powerful approach for behavioral change. As the limited research on the smart phone application to modify healthy lifestyles for parents and children, this research aims to: (1) develop a family-centered school-based KidsHealth Smart Phone Apps Intervention (KiSPAI) to improve healthy lifestyles for school-age children; (2) validate the clinical feasibility and generalization of KiSPAI; (3) evaluate the effectiveness of the KiSPAI in improving the healthy behaviors and outcomes for school-age children with specific diseases.
Research subjects were recruited from the selected elementary schools and a university hospital in Taipei. Children aged 9-12, with permission of parents or legal guardian are eligible to participate in the study. The 8-week KiSPAI was conducted by parent-child self-assessments, home visits, online discussion and feedbacks, the components consist of healthy eating, regular physical activity, decrease sedentary behaviors and preserve good sleep quality, which were conducted by smart eating system, Fitbit Charge2 to monitor physical activity and sleep quality. Data of the outcome measures are collected at the time of randomization (T1) and further 4 waves at 3-month follow-up (T2-T4). Outcome measures include healthy lifestyle behaviors: food and beverage intake, physical activity, sedentary behaviors and adequate sleep. The health outcomes are body composition measured by body mass index, waist circumferences, body fat and health status.
This KiSPAI smart phone platform can provide dynamic feedback to the school-age asthma children to deliver healthy behavior change, the program development and implementation can be a reference for the e-Health action plan for children with other chronic health conditions to foster their healthy lifestyle behaviors and health outcomes.

口試委員會審定書 #
誌謝 i
中文摘要 ii
ABSTRACT iii
CONTENTS iv
LIST OF FIGURES v
LIST OF TABLES ix
Chapter 1 Introduction 1
1.1 Background 1
1.2 Motivation and Objective 2
Chapter 2 Literature Review 3
2.1 Lifestyle Modification and Healthy Children 3
2.2 Smartphone Applications and Healthy Behavioral Change 5
2.3 Family-based Intervention for Child Health Care 6
2.4 Asthma and Obesity in Children 7
Chapter 3 Methodology 8
3.1 Conceptual Framework 8
3.2 System Architecture 10
3.3 KidsHealth Smartphone Application Intervention 11
3.3.1 Main Functions of KidsHealth 11
3.3.2 Air Quality Reminder 13
3.3.3 Health Status 14
3.3.4 Online Focus Group 15
3.3.5 Dietary Management 16
3.3.6 Exercise and Sleep Management 17
3.3.7 Health Management Platform 18
3.3.8 System Sequence Diagram 19
3.4 Outcomes and Measures 20
3.4.1 Healthy Lifestyle Behaviors 20
3.4.2 Field Observations and Family and School Environment Audits 20
3.4.3 Health Outcomes 20
3.4.4 Preference Evaluations 21
3.4.5 System Outcomes……………………………………………………21
3.4.6 Process Measures 21
3.4.7 Statistical Analysis 22
3.5 Study Design and Participants 25
3.6 Study Procedures 27
3.6.1 Recruitment and Randomization 27
3.6.2 Training and Fidelity Monitoring 27
3.6.3 Intervention and Follow-up 28
Chapter 4 Results 30
Chapter 5 Discussion 34
Chapter 6 Conclusion and Future Work 35
REFERENCE 36

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