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研究生:劉仲偉
研究生(外文):LIU,ZHONG-WEI
論文名稱:臺北市獨居長者健康識能及憂鬱情形對飲食多樣性之影響
論文名稱(外文):Effects of Health Literacy and Depression on Dietary Diversity among the Elderly Living Alone in Taipei City
指導教授:高森永高森永引用關係曾雅梅曾雅梅引用關係
指導教授(外文):Kao,SenYeongTzeng,YaMei
口試委員:高森永曾雅梅吳秀鳳
口試委員(外文):Kao,SenYeongTzeng,YaMeiWu,Hsiu-Feng
口試日期:2023-05-05
學位類別:碩士
校院名稱:國防醫學院
系所名稱:公共衛生學研究所
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:2023
畢業學年度:111
語文別:中文
論文頁數:175
中文關鍵詞:憂鬱情形飲食多樣性健康識能獨居長者
外文關鍵詞:DepressionDietary diversityHealth literacyElderly living alone
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研究背景:截至112年1月底老年人口數為410.7萬人,占總人口17.63%,人口老化有逐年上升的趨勢,獨居的生活型態可能會造成長者營養不良與憂鬱症的發生,加速身體快速退化造成家人照顧上的負擔。若長者擁有足夠的健康識能與健康的身心狀態,便能夠提升以健康模式給予自身賦能而從事行為,達到預防醫學最重要之「預防勝於治療」之理念。本研究欲探討臺北市獨居長者健康識能及憂鬱情形對飲食多樣性之影響,以觀察飲食多樣性是否會受到健康識能和憂鬱情形的影響。
研究方法:本研究為橫斷性研究,研究對象為臺北市(內湖區、南港區及松山區)列冊管理之獨居長者,收案期間為2022年10月至2023年3月,內湖區拒訪率為5%,南港區及松山區皆無拒訪者,有效問卷共140份。自變項為個人基本特質(性別、年齡、教育程度、經濟狀況、收入來源、婚姻狀況、居住情形、飲食來源);健康識能以中文多面向健康識能量表進行測量;憂鬱情形採用老人憂鬱量表進行測量;飲食多樣性使用自擬式之二十四小時飲食多樣性問卷進行測量,分數愈高表示飲食多樣性愈多。並以廣義線性迴歸模型探討健康識能及憂鬱情形對飲食多樣性之影響。
研究結果:研究對象平均年齡為76.2歲,以女性、學歷為高中職者、喪偶者、收入以1種來源、居住狀態以獨居者最多。健康識能平均分數為31.15分,健康識能良好之人數最多(35.7%)。憂鬱情形之平均分數為3.30分,憂鬱情形為健康之人數最多(80.0%)。飲食多樣性平均分數為5.15。廣義線性迴歸模型顯示健康識能與憂鬱情形對飲食多樣性為正向影響,在健康識能程度方面,健康識能有限組(β=0.493)、良好組(β=0.422)、充足組(β=0.511)之飲食多樣性顯著高於健康識能不足組。在憂鬱情形分組中,健康組(β=0.559)之飲食多樣性顯著高於需積極關懷、治療組(p=0.015)。
結論與建議:根據本研究結果顯示,健康識能及憂鬱情形顯著影響飲食多樣性。建議需針對健康識能較不充足者及關懷較有憂鬱傾向者,提升其飲食多樣性,如制定飲食多樣性的營養相關衛教課程以幫助提升飲食多樣性。
關鍵字:憂鬱情形、飲食多樣性、健康識能、獨居長者

Background and purposes: Living alone may cause malnutrition and depression among the elderly, accelerate the rapid deterioration, resulting in the burden of care for family members. If the elderly have sufficient health awareness and a healthy physical and mental state, they may empower themselves to achieve the most important concept of preventive medicine, which is "prevention is better than cure". This study aimed to investigate the effects of health literacy and depression on dietary diversity among the elderly living alone in Taipei, in order to observe whether dietary diversity is affected by health literacy and depression.
Methods: This study was a cross-sectional study with 140 valid questionnaires from the elderly living alone in Taipei City (Neihu, Nangang, and Songshan Districts) during the period of October 2022 to March 2023, with a refusal rate of 5% in Neihu District, and no refusal in Nangang and Songshan Districts. The independent variables were personal characteristics, health literacy (measured by the Chinese Multi-Dimensional Health Awareness Scale, MHAS), depression (measured by the Depression Scale for the Elderly, DSE); and dietary diversity (measured by the self-administered 24-hour Dietary Diversity Questionnaire, with a higher score indicating a higher degree of dietary diversity). A generalized linear regression model was used to investigate the effects of health awareness and depression on dietary diversity.
Results: The mean age of the study participants was 76.2 years old, and most of them were female, with high school education, widowed, only one source of income, and lived alone. The mean score of health literacy was 31.15, with 35.7% having good health literacy. The mean score of depression was 3.30, and the majority of respondents (80.0%) without depression. The mean score of dietary diversity was 5.15. The generalized linear regression model showed that health literacy and depression had a positive effect on dietary diversity, and in terms of the degree of health literacy, the dietary diversity of the group with limited health literacy (β=0.493), the group with good health literacy (β=0.422), and the group with adequate health literacy (β=0.511) was significantly higher than that of the group with insufficient health literacy. In the depression subgroup, the healthy group (β=0.559) had a significantly higher dietary diversity than the group requiring active care and treatment (p=0.015).
Conclusions: According to the findings of this study, health awareness and depression significantly affected dietary diversity. It is recommended that dietary diversity should be improved for those with less health literacy and those with more depressive tendencies, such as developing nutrition-related health education programs on dietary diversity to help improve dietary diversity.
Keywords: Depression, Dietary diversity, Health literacy, Elderly living alone

正文目錄 I
表目錄 III
圖目錄 IV
附錄目錄 VI
縮寫表 1
中文摘要 2
ABSTRACT 4
第一章 緒論 6
第一節 問題背景 6
第二節 研究動機與研究問題 8
第三節 研究之必要性與重要性 12
第四節 研究目的 14
第五節 名詞解釋 15
第二章 文獻查證 18
第一節 飲食多樣性定義與測量 18
第二節 健康識能定義與測量 23
第三節 憂鬱情形定義與測量 29
第四節 個人基本特質與飲食多樣性之關係 35
第五節 健康識能與飲食多樣性之關係 43
第六節 憂鬱情形與飲食多樣性之關係 45
第三章 研究架構 47
第一節 研究架構 47
第二節 研究假設 48
第四章 研究方法 49
第一節 研究對象與研究設計 49
第二節 研究工具 51
第三節 變項操作型定義 56
第四節 資料收集方法與步驟 60
第五節 資料處理與統計分析方法 65
第五章 結果 67
第一節 個人基本特質、健康識能與憂鬱情形之分布情形 67
第二節 個人基本特質對飲食多樣性之影響 72
第三節 健康識能對飲食多樣性之影響 82
第四節 憂鬱情形對飲食多樣性之影響 86
第五節 飲食多樣性之影響因子分析 89
第六章 討論 91
第一節 個人基本特質對飲食多樣性影響之探討 91
第二節 健康識能對飲食多樣性影響之探討 96
第三節 憂鬱情形對飲食多樣性影響之探討 98
第四節 研究優勢與限制 100
第七章 結論與建議 101
第一節 結論 101
第二節 建議 102
參考文獻 105
附錄 122

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