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研究生: 杭極敏
Hang, Chi-Ming
論文名稱: 提升國小高年級學生鈣質攝取之教育介入成效探討
The Effects of A Calcium Intake Promoting Nutrition Education Program For Fifth Graders of Taiwan
指導教授: 林薇
Lin, Wei
學位類別: 博士
Doctor
系所名稱: 人類發展與家庭學系
Department of Human Development and Family Studies
論文出版年: 2009
畢業學年度: 97
語文別: 中文
論文頁數: 181
中文關鍵詞: 鈣質攝取國小高年級學生社會生態模式營養教育
英文關鍵詞: calcium intake, elementary student,, social-ecological model, nutrition education
論文種類: 學術論文
相關次數: 點閱:168下載:20
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  • 本研究的目的乃在發展適用於台灣地區國小高年級學童之提升鈣質攝取量教育介入計畫並評估其成效。以社會生態模式的架構,綜合健康信念模式和社會認知理論中飲食行為形成重要影響因子,發展教學策略及設計課程設計,計四單元,每單元40分鐘。在台灣地區北、中、南三區中每區之都市及鄉村中選取1所國民小學,每所學校以五年級一個班級為實驗組、一個班級為控制組,共計實驗組6班(N=178)、控制組6班(N=174),於實驗教學前、教學後一星期及教學後一個月分別對實驗組與控制組學生進行前測、後測及後後測評量,以了解教育介入之成效。成效評量項目包括以鈣質攝取頻率表評估之鈣質攝取量,及鈣質攝取行為之相關因素。研究結果發現:(1)實驗組學生於教育介入後,鈣質食物攝取量、鈣質相關之知識、對鈣質食物的喜好、知覺利益、「口味不合時會吃」的自我效能顯著提升,知覺障礙顯著降低,且除鈣質食物攝取量及預防骨質疏鬆症的知覺利益外,在其他項目也有短期延宕效果。(2)介入成效不因學生性別而有差異,對不同地區學生教學成效亦多無顯著差異,只有在知識方面,雖然都有提升,但是對鄉村地區學生的成效更優於城市地區的學生,而「家人都不吃時會吃」的自我效能的提升則只有對鄉村地區的學生有顯著成效。雖然介入後學童鈣質食物攝取量較控制組為高,但改變幅度不大,且並未達到學童的建議攝取量。探究原因,除因教學時間短較難在行為上產生大幅改變外,環境中食物供應-包括學校午餐和家庭供應,仍是無法掌握的因素。故欲提升學童鈣質攝取量至建議量,除加強學童之營養教育外,可能尚須有教育、農業或衛生政策上的配合,例如降價供應學校午餐乳製品等積極性改善學童飲食環境的措施。

    The purpose of this study was to assess the effects of a calcium intake promoting nutrition education program on fifth graders. The program was based on the concept of Social-Ecological Model and also major components of the Health Belief Model and the Social Cognitive Theory. Fifth-grade students from six elementary schools in northern, central, southern areas of Taiwan participated the study. The intervention group (N=178) was provided with a nutrition education program which included four 40-min classroom sessions and 2 parent’s newsletters. The control group (N=174) was not provided with any nutrition education program. The outcomes of the intervention were measured by questionnaires administered one week before (pre-test), a week after (post-test) and four weeks after (follow-up test) the intervention. The results indicated that: the intervention group’s knowledge, preference, self-efficiency and perceived benefits increased, as the perceived barriers decreased. As a result, the calcium intake increased. Although the calcium intake of the intervention group was significantly higher than the control group at the end of the intervention, it was still far below the DOH recommended level. Other than the intervention period was short and insufficient for significant improvement in behavior, school lunch’s failure to meet the recommended standard and the uncertainty of sufficient calcium-rich foods offered at home meals may all be reasons for the discrepancy. Therefore, besides school curriculum, related health and agriculture policies to increase the availability of calcium-rich foods, both in school and family, may be essential to solve the problem of calcium inadequacy of school children.

    目錄 --------------------------------------------------- I 表次 --------------------------------------------------- III 圖次 --------------------------------------------------- VII 第一章 緒論 第一節 研究動機 --------------------------------------- 1 第二節 研究目的------------------------------------------ 2 第三節 研究問題------------------------------------------ 3 第四節 名詞界定------------------------------------------ 3 第五節 研究限制------------------------------------------ 5 第二章 文獻探討 第一節 鈣質簡介------------------------------------------- 7 第二節 國小學童鈣質攝取之現況------------------------------ 17 第三節 營養教育理論--------------------------------------- 18 第四節 提升鈣質攝取相關研究-------------------------------- 27 第三章 研究方法 第一節 研究設計與架構理論---------------------------------43 第二節 研究對象----------------------------------------- 44 第三節 研究工具----------------------------------------- 44 第四節 實施步驟----------------------------------------- 53 第五節 資料處理與分析------------------------------------ 56 第四章 結果與討稐 第一節 受試者學生背景資料---------------------------------57 第二節 鈣質攝取行為影響因素評估--------------------------- 59 第三節 鈣質攝取量成效評估 ----------------------------- 81 第四節 家長及老師回饋 ------------------------------------ 90 第五章 結論與建議 第一節 結論----------------------------------------------93 第二節 建議--------------------------------------------- 94 參考文獻------------------------------------------------ 97 附錄 附錄一 教育介入教學活動、教師手冊、學生手冊及家長單張審 查專家名單-------------------------------------- 107 附錄二 國小高年級提升鈣質攝取營養教育介入教師手冊--------- 109 附錄三 教學光碟--------------------------------------- 151 附錄四 學生手冊--------------------------------------- 159 附錄五 家長單張--------------------------------------- 165 附錄六 國小五年級學童教育介入成效評量問卷各變項的計分方 式與相對題號對照表------------------------------ 167 附錄七 教育介入成效評量問卷審查專家名單------------------- 168 附錄八 教育介入成效評量問卷-------------------------------169 附錄九 國小五年及教育介入評估原始資料鍵入編碼代號說明------- 181 表次 表2-1.1 國人膳食營養素鈣質參考攝取量表--------------------- 13 表2-1.2 食物中鈣質含量----------------------------------- 14 表2-1.3 鈣質來源食物分類表-------------------------------- 15 表2-3.1 改變階段與改變歷程-------------------------------- 22 表2-3.2 改變歷程的介入方法-------------------------------- 22 表2-3.3 社會認知理論的主要概念及應用----------------------- 24 表2-4.1 影響鈣質攝取因素之相關研究------------------------- 31 表2-4.2 國內外鈣質攝取教育介入相關研究--------------------- 36 表3-3.1 國小高年級提升鈣質攝取營養教育介入之重點因子--------- 45 表3-3.2 國小學童鈣質飲食營養教育課程課堂教學部分之教學目 標、教學內容、理論及模式與教學方法------------------ 46 表3-3.3 國小高年級學生提升鈣質攝取家長宣導教育單張內容------- 49 表3-4.1 教育介入實驗設計--------------------------------- 55 表3-4.2 實驗教學活動時間表-------------------------------- 55 表4-1.1 實驗組與控制組學生背景資料之分佈情形與比較--------- 58 表4-2.1 實驗組與控制組個人因素、人際因素、環境因素各項目 之前測、後測及後後測之得分------------------------ 59 表4-2.2 組別 × 性別二因子共變數分析國小高年級提升鈣質攝 取教育介入之結果--------------------------------- 61 表4-2.3 實驗組與控制組個人因素、人際因素、環境因素各項目 之後測及後後測調整後平均得分及F值----------------- 62 表4-2.4 知識--後測組別 × 地區二因子共變數分析摘要表-------- 64 表4-2.5 知識--後後測組別 × 地區二因子共變數分析摘要表------ 64 表4-2.6 知識--後測單純主要效果共變數分析摘要表------------- 64 表4-2.7 知識--後後測單純主要效果共變數分析摘要表----------- 65 表4-2.8 實驗組學校不同地區之知識前測、後測與後後測得分及事後比較- ------------------------------------------------65 表4-2.9 實驗組前測、後測及後後測知識各題答對人數與百分比 分布-------------------------------------------- 66 表4-2.10 喜好--後測組別 × 地區二因子共變數分析摘要表-------- 67 表4-2.11 喜好--後後測組別 × 地區二因子共變數分析摘要表------ 67 表4-2.12 實驗組前測、後測、後後測各項食物喜好人數分布和百 分比-------------------------------------------- 69 表4-2.13 知覺利益-長高--後測組別 × 地區二因子共變數分析摘 要表-------------------------------------------- 70 表4-2.14 知覺利益-長高--後後測組別 × 地區二因子共變數分析 摘要表------------------------------------------ 70 表4-2.15 知覺利益-預防骨質疏鬆症--後測組別 × 地區二因子共 變數分析摘要表----------------------------------- 71 表4-2.16 知覺利益-預防骨質疏鬆症--後後測之組別 × 地區二因 子共變數分析摘要表-------------------------------- 71 表4-2.17 知覺障礙-因味道而不吃--後測組別 × 地區二因子共變 數分析摘要表------------------------------------- 72 表4-2.18 知覺障礙-因味道而不吃--後後測之組別 × 地區二因子 共變數分析摘要表--------------------------------- 72 表4-2.19 知覺障礙-因身體不適而不吃--後測組別 × 地區二因子 共變數分析摘要表--------------------------------- 72 表4-2.20 知覺障礙-因身體不適而不吃--後後測組別 × 地區二因 子共變數分析摘要表-------------------------------- 72 表4-2.21 口味不合會吃--後測之組別 × 地區二因子共變數分析 摘要表------------------------------------------ 74 表4-2.22 口味不合會吃--後後測組別 × 地區二因子共變數分析 摘要表------------------------------------------ 74 表4-2.23 家人都不吃時會吃--後測組別 × 地區二因子共變數分 析摘要表---------------------------------------- 75 表4-2.24 家人都不吃時會吃--後後測之組別 × 地區二因子共變 數分析摘要表------------------------------------- 75 表4-2.25 家人都不吃時會吃--後後測單純主要效果共變數分析摘 要表-------------------------------------------- 75 表4-2.26 實驗組學校不同地區之家人都不吃時會吃前測、後測與 後後測得分及事後比較------------------------------ 75 表4-2.27 家裡沒準備時會吃--後測組別 × 地區二因子共變數分 析摘要表---------------------------------------- 76 表4-2.28 家裡沒準備時會吃--後後測組別 × 地區二因子共變數 分析摘要表--------------------------------------- 76 表4-2.29 有其他食物時會吃--後測組別 × 地區二因子共變數分 析摘要表---------------------------------------- 76 表4-2.30 有其他食物時會吃--後後測組別 × 地區二因子共變數 分析摘要表--------------------------------------- 77 表4-2.31 朋友都不吃時會吃--後測組別 × 地區二因子共變數分析 摘要表-------------------------------------------77 表4-2.32 朋友都不吃時會吃--後後測組別 × 地區二因子共變數分 析摘要表---------------------------------------- 77 表4-2.33 長輩鼓勵--後測組別 × 地區二因子共變數分析摘要表----- 78 表4-2.34 長輩鼓勵--後後測組別 × 地區二因子共變數分析摘要表---- 78 表4-2.35 手足同儕鼓勵--後測組別 × 地區二因子共變數分析摘要表---79 表4-2.36 手足同儕鼓勵--後後測組別 × 地區二因子共變數分析摘要表- 79 表4-2.37 老師鼓勵--後測組別 × 地區二因子共變數分析摘要表------ 79 表4-2.38 老師鼓勵--後後測組別 × 地區二因子共變數分析摘要表---- 79 表4-2.39 廣告明星影響--後測組別 × 地區二因子共變數分析摘要表-- 80 表4-2.40 廣告明星影響--後後測組別 × 地區二因子共變數分析摘要表--80 表4-2.41 家中有而吃--後測組別 × 地區二因子共變數分析摘要表-- 80 表4-2.42 家中有而吃--後後測組別 × 地區二因子共變數分析摘要表-- 81 表4-2.43 學校有而吃--後測組別 × 地區二因子共變數分析摘要表-- 81 表4-2.44 學校有而吃--後後測組別 × 地區二因子共變數分析摘要表---81 表4-3.1 實驗組與控制組前測、後測及後後測鈣質攝取量及以重複量 數單因子變異數分析結果---------------------------- 82 表4-3.2 鈣質攝取量--後測之組別 × 性別 二因子共變數分析摘 要表-------------------------------------------- 82 表4-3.3 鈣質攝取量--後後測之組別 × 性別二因子共變數分析摘 要表-------------------------------------------- 82 表4-3.4 鈣質攝取量--後測之組別 × 地區 二因子共變數分析摘 要表------------------------------------------ 83 表4-3.5 鈣質攝取量--後後測之組別 × 地區二因子共變數分析摘 要表-------------------------------------------- 83 表4-3.6 控制前測後實驗組與控制組鈣質攝取量之後測及後後測 調整平均數-------------------------------------- 83 表4-3.7 實驗組前測、後測、後後測各項食物平均一日鈣質攝取量及佔 每日總鈣量的百分比及以重複量數單因子變異數分析結果---- 85 表4-3.8 實驗組主要鈣質食物(奶類、連骨吃的魚類、豆腐豆干類 及深色蔬菜類)攝食頻率、攝食量及鈣質量-------------- 87 表4-3.9 國小高年級提升鈣質攝取教育介入組別 × 地區別二因子 共變數分析結果總摘要表---------------------------- 89 圖次 圖2-3.1 健康信念模式------------------------------------- 20 圖2-3.2 理性行動論--------------------------------------- 20 圖2-3.3 計畫行為理論------------------------------------- 21 圖2-3.4 健康行動過程取向--------------------------------- 23 圖2-3.5 Precede-Proceed 計畫模式------------------------ 25 圖2-3.6 社會生態模式------------------------------------- 26 圖2-4.1 鈣質攝取之影響因素及教育介入----------------------- 30 圖 3-1.1 提升鈣攝取教育介入研究架構------------------------- 43 圖3-4.1 研究實施步驟之流程圖------------------------------ 54

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