臺灣博碩士論文加值系統

生活品質(quality of life, QoL)是一個多向度的健康指標，並且能有效地幫助健康照護專業人員瞭解個人的整體健康狀況。除了「生活品質」之外，另一個健康照護專業人員關切的議題是「過重」。因此，現在有愈來愈多的文獻探討生活品質和過重之間的關係。然而，縱使現在有許多文獻探討過重孩童的生活品質，目前仍未有研究針對台灣過重孩童的生活品質進行探討。所以，本論文欲用三個研究探討台灣孩童其生活品質和過重之間的相關議題。
研究一評估了一個常用的一般兒童生活品質問卷(Pediatric Quality of Life Inventory 4.0, PedsQL)的心理計量表現。透過方便取樣的方式，共有479位八至十二歲的兒童參與此研究。結果顯示兒童自評的PedsQL在各個分量表以及總量表皆具有良好的內在一致性(Cronbach’s α =.62-.90)、再測信度(intraclass correlation coefficient =.67-.84)。更甚者，經由驗證性因素分析(confirmatory factor analysis, CFA)，兒童自評PedsQL被發現具有良好的建構效度(GFI =.905-.938, TLI =.910-.932, CFI =.921-.944, IFI =.922-.945, RMSEA =.056-.059)。因此，我們認為兒童自評PedsQL是一個具有良好信效度的工具，並適用於之後的研究。
在PedsQL的信效度建立後，研究二使用PedsQL測量過重男孩的生活品質。除此之外，研究二也測量了過重男孩的活動量(physical activity, PA)以及生活品質和活動量之間的關係。十八個過重男孩和十八個正常體重男孩參與研究二。每個男孩均填寫PedsQL並於他們的腰際佩戴加速規(accelerometer)。加速規是用來測量男孩在一周間進行多少分鐘的中強度活動(moderate-to-vigorous PA, MVPA)。結果顯示過重男孩的生活品質(81.04±10.85 vs. 89.67±8.40, p =.012)和中強度活動量分鐘數(735.15±270.32 vs. 938.71±214.65, p =.02)顯著地低於正常體重男孩。除此之外，過重男孩單一周末天的中強度活動量分鐘數顯著地低於其單一周間天的中強度活動量分鐘數(113.19±38.46 vs. 84.61±54.67, p =.016)。而且，過重男孩的周末活動量和其生活品質間有一正向的邊緣顯著相關(r =.47, p =.06)。經由上述結果，我們建議健康照護專業人員可以設計相關的活動量計畫給過重孩童以增進其周末活動量。
研究三瞭解家長和兒童間對兒童生活品質感受的差異。共有187對八至十二歲孩童和其家長參與研究三，每位孩童和每位家長都填寫PedsQL。和研究二相同的結果是，肥胖孩童的自評生活品質低於正常體重孩童(82.95±14.80 vs. 87.60±10.29, p 〈.05)。除此之外，研究三更發現肥胖孩童的自評生活品質低於家長代評的生活品質(82.95±14.80 vs. 86.35±10.91, p 〈.05)。此項結果顯示肥胖孩童的家長對於其孩童面臨的生活品質困境並不是很瞭解。
總結以上結果，台灣肥胖孩童如同其他國家的肥胖孩童一般，有生活品質低落的情形。而活動量似乎是益於生活品質的因素，健康照護專業人員應鼓勵過重孩童增加活動量以促進其生活品質表現。另一方面，尤於肥胖孩童的家長對於其孩童的生活品質表現瞭解不深，因此有必要協助家長的瞭解，以益於肥胖孩童的生活品質表現。

Quality of life (QoL), a multi-dimensional health index, is important to health professionals for understanding a person’s overall health status. Another important issue for health professionals is the risk factors for being overweight. Therefore, more and more studies examine the relationship between QoL and being overweight. However, although many studies discuss the QoL of overweight children, no studies have been done in Taiwan. Therefore, this dissertation, which includes three studies on the QoL of overweight children, aimed to probe the information of QoL and being overweight in Taiwanese children.
The first study evaluated the psychometric properties of one broadly used generic pediatric QoL instrument, the Pediatric Quality of Life Inventory 4.0 (PedsQL). A convenience sample of 8- to 12-year-old children was recruited (n = 479). The results showed that the internal consistency of child-reported PedsQL was satisfactory for all subscales and for the total score (Cronbach’s α =.62-.90), and had acceptable test-retest reliability (intraclass correlation coefficient =.67-.84). Moreover, the result of confirmatory factor analysis (GFI =.905-.938, TLI =.910-.932, CFI =.921-.944, IFI =.922-.945, RMSEA =.056-.059) confirmed the construct validity for child-reported PedsQL. Therefore, I conclude that child-reported PedsQL is a reliable and valid instrument for measuring children’s QoL.
After the PedsQL was validated, the second study used it to measure QoL for overweight boys in Taiwan. The physical activity (PA) level and the association between QoL and PA were also examined. Eighteen overweight boys and 18 of their normal-weight counterparts were recruited. Each boy filled out the PedsQL and wore an accelerometer on his waist. The accelerometers were used to measure how many minutes of moderate-to-vigorous PA (MVPA) the participants engaged in for one whole week. The results showed that overweight boys reported significantly lower QoL (81.04 ± 10.85 vs. 89.67 ± 8.40, p =.012) and significantly less MVPA (735.15 ± 270.32 minutes vs. 938.71 ± 214.65, p =.02) than normal-weight boys did. In addition, overweight boys reported significantly more MVPA on weekdays than on weekend days (113.19 ± 38.46 vs. 84.61 ± 54.67, p =.016). Moreover, a positive and marginally significant correlation (r =.47, p =.06) was found between QoL and weekend PA in overweight boys. Therefore, health professionals should consider designing PA programs for overweight children to engage in more PA on weekends.
The third study was done to further understand the differences between child-reported and parent-reported QoL in obese children. One hundred eighty-seven dyads of 8- to 12-year old children (60 obese and 127 normal-weight) completed child-reported PedsQL and one of their parents completed a parent-reported PedsQL. In agreement with the second study, the obese children rated their QoL lower than their normal-weight counterparts did (82.95 ± 14.80 vs. 87.60 ± 10.29, p 〈.05). Moreover, the obese children also rated their QoL lower than their parents did (82.95 ± 14.80 vs. 86.35 ± 10.91, p 〈.05). The results suggest that parents of obese children were insensitive to their children’s QoL difficulties.
In summary, overweight children in Taiwan say that their QoL is lower than that of normal-weight children. In addition, PA is a potential positive factor related to overweight children’s QoL, and health professionals should encourage overweight children to engage in more PA. In addition, parents of obese children seemed not to be aware of the effects of obese on their children’s QoL. Therefore, helping parents to understand their obese children’s difficulties may also be beneficial for obese children.

Abstract in Chinese i
Abstract iii
Acknowledgement vi
Table of Contents ix
List of Tables xii
List of Figures xiii

Chapter 1 Introduction 1
1.1 Overview of quality of life instruments for children 1
1.2 The risks when children are overweight 3
1.3 Quality of life in overweight children 4
1.4 The purposes of this dissertation and the introduction of three individual studies 5
1.4.1 The psychometric properties of PedsQL 4.0 6
1.4.2 The relationship between PA and QoL for overweight boys 7
1.4.3 The difference between child- and parent-reported PedsQL for obese children in a community sample 8

Chapter 2 Psychometric properties and gender invariance of the Chinese version of the self-report Pediatric Quality of Life Inventory Version 4.0: Short form is acceptable 10
2.1 Introduction 10
2.2 Methods 13
2.3 Results 17
2.4 Discussion 18

Chapter 3 Physical activity patterns and quality of life of overweight boys: A preliminary study 22
3.1 Introduction 22
3.2 Method 26
3.3 Results 29
3.4 Discussion 31
3.5 Conclusion 38

Chapter 4 Self-rated and parent-rated quality of life for community-based obese children in Taiwan 39
4.1 Introduction 39
4.2 Methods 42
4.3 Results 45
4.4 Discussion 47
4.5 Conclusions 52

Chapter 5 Conclusion and future research 54
5.1 Conclusion 54
5.2 Future research 55
5.2.1 The development of QoL instrumentation 55
5.2.2 The promotion of QoL for overweight children 57

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