本研究運用「設計思考」(Design Thinking)發展以國小身心障礙學童及家長為主之口腔保健策略，並評價介入後之成效。研究對象為新竹市某國小身心障礙資源班學童26名及其家長26名，研究方式依史丹佛設計學院所提出的設計思考五步驟實施。研究顯示：在「同理」及「定義」階段，發現26名身心障礙學童刷牙後仍有三成牙菌斑殘留、刷牙效果不佳，以及家長不熟悉潔牙技巧而無法落實督導式潔牙。在「發想」階段，7位專家小組透過腦力激盪，建構親子共學、簡化刷牙程序、製作衛教影片以及編寫潔牙口訣等解方。在「原型」階段，設計「貝式彩虹刷牙法」指導身心障礙學生刷牙，以及製作「督導式潔牙工具包」(含潔牙用具與工具書)幫助26名家長督導孩子，工具書中有3部影片、2張資訊圖、1組教學齒模等教材，同時規劃「護齒行動0123」活動建立親子共學等策略。在「測試」階段，發現介入後26名學生的牙菌斑指數平均從30.36%下降至7.82%，平均每週有4.17天能做到零含糖飲料、4.77天能每天使用一次牙線、6.9天能完成睡前刷牙兩分鐘。八成以上家長表示工具包、貝氏彩虹刷牙法、教學齒模及護齒0123活動皆有助於落實孩子刷牙，家長也因此學會貝氏刷牙法及牙線操作，並覺得最實用、最滿意的教材為彩虹教學齒模。本研究可提供未來身心障礙學生口腔保健教學及推動家長督導式潔牙之參考，亦適用於一般學童及家長。

This study used "Design Thinking" tools to develop oral health strategies for students with special needs and parents in a primary school, and evaluated the effectiveness of the intervention. The participants included 26 students with special needs and 26 parents in a primary school in Hsinchu City. The research method was implemented according to the five-step design thinking proposed by Stanford D. School. The results showed that in the "Empathize" and "Define" stages, 30% of the dental plaque remained among 26 students, showing the effect of tooth brushing was poor. Parents did not know the correct method of tooth brushing, thus it was not feasible to implement supervised tooth-brushing. In the "Ideate" stage, the team of 7 experts proposed parent-child co-learning, simplified tooth-brushing procedures, and health education videos through brainstorming stage. In the "Prototype" stage, the expert team designed the "Bass rainbow method of brushing" to guide students how to brush their teeth, and provided "Supervised Toothbrushing toolkit" (including tooth-brushing tools and reference guide) to help 26 parents supervise their children. The reference guide contained teaching materials including 3 videos, 2 infographics, and 1 set of teaching tooth model. In addition, "Tooth Protection Action 0123" activity was conducted to establish parent-child learning strategies. In the "Test" stage, the results showed that after intervention the dental plaque index of 26 students dropped from 30.38% to 7.7%. Students achieved zero sugar-sweetened beverages on 4.17 days a week, used teeth floss once a day on 4.77 days a week, and brushed their teeth two minutes before going to bed on 6.9 days a week. More than 80% of parents agreed that the tool kits, the rainbow Bass method of brushing, tooth-brushing videos and "Tooth Protection Action 0123" activity were helpful for their children’s tooth-brushing, while the most satisfactory teaching material for parents was the rainbow Bass method of brushing. This study could provide a good reference for future oral health education for students with special needs and the promotion of supervised tooth-brushing for parents. The supervised tooth brushing toolkit could also suitable for general students and their parents.

中文文獻
牙醫師公會全國聯合會 (2021)。督導式潔牙。取自https://www.cda.org.tw/cda/multimedia_detail.jsp?mdid=53
王佳琪、宋世祥(2019)。設計思考融入職前師資培育課程之實施與成效: 以適性教學為例。教育科學研究期刊，64(4)，145-173。
吳佩蓁、李慈心.(2016)。台灣身心障礙者口腔健康調查之研究。臺灣兒童牙醫學雜誌，16(1)，3-8。
李睿仁、王敏靜、施文宇 (2019)。1,000ppm含氟牙膏在兒童齲齒中的預防角色。臨床醫學月刊，83(5)，337-340。
沈苔蓉、蔡伊婷(2012)。口腔衛生教育教學對國小身心障礙學童在口腔衛生知識與潔牙技巧的成效。國小特殊教育(54)，81-90。
季麟揚、姚振華、李忠興、黃耀慧、王文岑、姜昱至、Chiang, Y.-C (2020)。我國6~18歲兒童及青少年口腔健康調查（第二年）。取自https://www.grb.gov.tw/search;keyword=Dmft%20index;type=GRB05;scope=1
邱奕儒、謝婉華 (2020)。設計思考融入農村議題之課程設計與反思－以「創意農村大作戰」通識課程為例。慈濟大學教育研究學刊，(16)，141-167。
邱清華(2005)。口腔疾病與保健。臺北市：國立空中大學。
俞靜庭(2020)。以服務設計思維建立標準化人員服務SOP：以臺灣長照巴士司機為例（未出版之碩士論文）。國立臺灣科技大學設計系，臺北市。
姚振華、陳秀賢、季麟揚、黃耀慧 (2017)。2013年機構內身心障礙者口腔健康狀況及照護需求。中華民國家庭牙醫學雜誌，12(3)，4-13。
涂嘉俊 (2019)。以Kinect V2結合體感遊戲之特殊學生刷牙訓練與成效評估（未出版之碩士論文）。中原大學電子工程學系，桃園市。
特殊教育法(民108年4月24日)。
張頤婷、洪銘建、邱美倫 (2015)。應用3D動畫改善國中特教學生口腔衛教問題之研究。特殊教育學報(41)，23-53。
教育部 (2020)。一○九年度特殊教育統計年報。取自https://www.set.edu.tw/actclass/fileshare/default.asp
陳玟君(2019)。桌上遊戲介入對智能障礙者之口腔衛生認知與牙菌斑指數成效：先驅性研究（未出版之碩士論文）。高雄醫學大學，高雄市。
彭筱雯 (2017)。從設計思考探討減重的服務設計（未出版之碩士論文）。國立成功大學創意產業學院，臺南市。
黃絜如 (2012)。設計思考整合概念地圖設計教學法研究。耕莘學報(10)，061-073。
黃麗鳳、陳雅鈴、Wedekind, H.(2020)。運用設計思考提升職前幼教師科學遊戲設計能力之個案研究。科學教育學刊，28(2)，99-118。
新竹市政府辦理身心障礙特殊教育班實施要點(民89年11月24日)。
葉重新(2007)。教育研究法。臺北市：心理出版社。
虞淑婷、楊昕禕、蘇遂龍(2010)。國內身心障礙兒童齲齒影響因素與改善方法。身心障礙研究季刊，8(3)，150-164。
廖長彥(2019)。結合遊戲化與設計思考於跨領域小組的衛教影片製作。國立臺灣科技大學人文社會學報，15(3)，241-256。 
二、英文文獻
Al-Maweri, S., & Zimmer, S. (2015). Oral health survey of 6-14-year-old children with disabilities attending special schools Yemen. Journal of Clinical Pediatric Dentistry, 39(3), 272-276.
AlHumaid, J., Gaffar, B., AlYousef, Y., Alshuraim, F., Alhareky, M., & El Tantawi, M. (2020). Oral Health of Children with Autism: The Influence of Parental Attitudes and Willingness in Providing Care. ScientificWorldJournal, 2020, 8329426. doi:10.1155/2020/8329426
Babaei, A., Pakdaman, A., & Hessari, H. (2020). Effect of an Oral Health Promotion Program Including Supervised Toothbrushing on 6 to 7-Year-Old School Children: A Randomized Controlled Trial. Frontiers in dentistry, 17(19), 1-9. doi:10.18502/fid.v17i19.4313
Bennadi, D., Konekeri, V., Maurya, M., Reddy, V., Satish, G., & Reddy, C. V. K. (2020). Oral hygiene negligence among institutionalized mentally disabled children in Mysore city-A call for attention. J Family Med Prim Care, 9(4), 2045-2051. doi:10.4103/jfmpc.jfmpc_720_19
Brown, T. (2008). Design thinking. Harvard business review, 86(6), 84.
Brown, T., & Wyatt, J. (2010). Design thinking for social innovation. Development Outreach, 12(1), 29-43.
Carroll, M., Goldman, S., Britos, L., Koh, J., Royalty, A., & Hornstein, M. (2010). Destination, imagination and the fires within: Design thinking in a middle school classroom. International Journal of Art & Design Education, 29(1), 37-53.
Curnow, M. M. T., Pine, C. M., Burnside, G., Nicholson, J. A., Chesters, R. K., & Huntington, E. (2002). A Randomised Controlled Trial of the Efficacy of Supervised Toothbrushing in High-Caries-Risk Children. Caries Research, 36(4), 294-300. doi:10.1159/000063925
Das, A., & Svanæs, D. (2013). Human-centred methods in the design of an e-health solution for patients undergoing weight loss treatment. Int J Med Inform, 82(11), 1075-1091. doi:10.1016/j.ijmedinf.2013.06.008
de Souza Barbosa, T., Gaviao, M., Castelo, P. M., & Leme, M. S. (2016). Factors associated with oral health-related quality of life in children and preadolescents: a cross-sectional study. Oral Health Prev Dent, 14(2), 137-148.
Dentistry, A. A. o. P. (2013a). Guideline on caries-risk assessment and management for infants, children, and adolescents. Pediatric dentistry, 35(5), E157-E164.
Dentistry, A. A. o. P. (2013b). Guideline on fluoride therapy. Pediatric dentistry, 35(5), E165-E168.
Ferreira, B., Silva, W., Oliveira, E., & Conte, T. (2015). Designing Personas with Empathy Map. Paper presented at the SEKE.
Fiorillo, L. (2019). Oral Health: The First Step to Well-Being. Medicina (Kaunas), 55(10), 676. doi:10.3390/medicina55100676
Glick, M., Williams, D. M., Kleinman, D. V., Vujicic, M., Watt, R. G., & Weyant, R. J. (2016). A new definition for oral health developed by the FDI World Dental Federation opens the door to a universal definition of oral health. British dental journal, 221(12), 792-793.
Guarnizo-Herreño, C. C., Lyu, W., & Wehby, G. L. (2019). Children's Oral Health and Academic Performance: Evidence of a Persisting Relationship Over the Last Decade in the United States. The Journal of Pediatrics, 209, 183-189. doi:10.1016/j.jpeds.2019.01.045
Hendricks, S., Conrad, N., Douglas, T. S., & Mutsvangwa, T. (2018). A modified stakeholder participation assessment framework for design thinking in health innovation. Healthc (Amst), 6(3), 191-196. doi:10.1016/j.hjdsi.2018.06.003
Huang, T. T., Aitken, J., Ferris, E., & Cohen, N. (2018). Design Thinking to Improve Implementation of Public Health Interventions: An Exploratory Case Study on Enhancing Park Use. Design Health (Abingdon), 2(2), 236-252. doi:10.1080/24735132.2018.1541047
Jackson, R. J., Newman, H. N., Smart, G. J., Stokes, E., Hogan, J. I., Brown, C., & Seres, J. (2005). The Effects of a Supervised Toothbrushing Programme on the Caries Increment of Primary School Children, Initially Aged 5–6 Years. Caries Research, 39(2), 108-115. doi:10.1159/000083155
Kassebaum, N. J., Smith, A. G., Bernabé, E., Fleming, T. D., Reynolds, A. E., Vos, T., . . . Collaborators, G. O. H. (2017). Global, regional, and national prevalence, incidence, and disability-adjusted life years for oral conditions for 195 countries, 1990–2015: a systematic analysis for the global burden of diseases, injuries, and risk factors. Journal of dental research, 96(4), 380-387.
Kaur, P., Singh, S., Mathur, A., Makkar, D. K., Aggarwal, V. P., Batra, M., . . . Goyal, N. (2017). Impact of Dental Disorders and its Influence on Self Esteem Levels among Adolescents. Journal of Clinical and Diagnostic Research, 11(4), ZC05-ZC08. doi:10.7860/JCDR/2017/23362.9515
Kitsaras, G., Goodwin, M., Kelly, M. P., & Pretty, I. A. (2021). Bedtime Oral Hygiene Behaviours, Dietary Habits and Children’s Dental Health. Children, 8(5), 416.
Kwan, S., & Petersen, P. (2003). WHO information series on school health. Oral health promotion through schools. Document, 11.
Lee, J. N., Scott, J. M., & Chi, D. L. (2020). Oral health behaviours and dental caries in low-income children with special healthcare needs: A prospective observational study. Int J Paediatr Dent, 30(6), 749-757. doi:10.1111/ipd.12656
Lin, Y.-C., Chang, C.-S., Ho, P.-S., Lee, C.-H., Chen, J.-H., & Huang, H.-L. (2019). Immigrant–Native Differences in Sugar-Sweetened Beverage and Snack Consumption and Preventive Behaviors Associated with Severe Early Childhood Caries: A Large-Scale Survey in Taiwan. International journal of environmental research and public health, 16(6), 1047.
Mandić, J., Jovanović, S., Mandinić, Z., Ivanović, M., Kosanović, D., Miličić, B., & Živojinović-Toumba, V. (2018). Oral health in children with special needs. Vojnosanitetski pregled, 75(7), 675-681.
Martins, M. T., Sardenberg, F., Bendo, C. B., Abreu, M. H., Vale, M. P., Paiva, S. M., & Pordeus, I. A. (2017). Dental caries remains as the main oral condition with the greatest impact on children’s quality of life. PLoS ONE, 12(10), 1-8. doi:10.1371/journal.pone.0185365
Mathur, V. P., & Dhillon, J. K. (2018). Dental caries: a disease which needs attention. The Indian Journal of Pediatrics, 85(3), 202-206.
Ningrum, V., Bakar, A., Shieh, T.-M., & Shih, Y.-H. (2021). The Oral Health Inequities between Special Needs Children and Normal Children in Asia: A Systematic Review and Meta-Analysis. Paper presented at the Healthcare.
O'Toole, S., & Mullan, F. (2018). The role of the diet in tooth wear. British dental journal, 224(5), 379-383.
O’leary, T. (1972). Drake RB, Naylor JE. The plaque control record. J Periodontol, 43(1), 38-42.
Pareek, S., Nagaraj, A., Yousuf, A., Ganta, S., Atri, M., & Singh, K. (2015). Effectiveness of supervised oral health maintenance in hearing impaired and mute children-A parallel randomized controlled trial. Journal of International Society of Preventive & Community Dentistry, 5(3), 176.
Petersen, P. E. (2003). The World Oral Health Report 2003: Continuous improvement of oral health in the 21st century - The approach of the WHO Global Oral Health Programme. Community Dentistry and Oral Epidemiology, 31(SUPPL. 1), 3-24. doi:10.1046/j..2003.com122.x
Pitts, N. B., Baez, R. J., Diaz-Guillory, C., Donly, K. J., Feldens, C. A., McGrath, C., . . . Songpaisan, Y. (2019). Early childhood caries: IAPD Bangkok declaration. Journal of dentistry for children (Chicago, Ill.), 86(2), 72.
Public Health England. (2021). Improving oral health: supervised tooth brushing programme toolkit. Retrieved from https://www.gov.uk/government/publications/improving-oral-health-supervised-tooth-brushing-programme-toolkit
Qiao, Y., Shi, H., Wang, H., Wang, M., & Chen, F. (2020). Oral Health Status of Chinese Children With Autism Spectrum Disorders. Front Psychiatry, 11, 398. doi:10.3389/fpsyt.2020.00398
Singh, B. T., Pranitha, V., Dwijendra, K. S., Nagarjuna, G., Shaik, N., & Kavya, R. (2020). Oral health status and treatment needs of children with special health care needs in rural and urban areas of Hyderabad - A cross sectional study. J Family Med Prim Care, 9(12), 6158-6163. doi:10.4103/jfmpc.jfmpc_1234_20
Smith, S. R., Kroon, J., Schwarzer, R., & Hamilton, K. (2021). Social-cognitive predictors of parental supervised toothbrushing: An application of the health action process approach. British Journal of Health Psychology, n/a(n/a). doi:https://doi.org/10.1111/bjhp.12516
Suharja, E., Februanti, S., & Kartilah, T. (2019). Interactive Video Improve the Brushing Skills of Mild Mentally Disabled Students. Paper presented at the Journal of Physics: Conference Series.
Vechakul, J., Shrimali, B. P., & Sandhu, J. S. (2015). Human-Centered Design as an Approach for Place-Based Innovation in Public Health: A Case Study from Oakland, California. Matern Child Health J, 19(12), 2552-2559. doi:10.1007/s10995-015-1787-x
Wilson, N. J., Lin, Z., Villarosa, A., Lewis, P., Philip, P., Sumar, B., & George, A. (2019). Countering the poor oral health of people with intellectual and developmental disability: a scoping literature review. BMC Public Health, 19(1), 1530. doi:10.1186/s12889-019-7863-1
World Dental Federation, F. (2016). FDI’s definition of oral health. Retrieved from https://www.fdiworlddental.org/fdis-definition-oral-health
Zhou, N., Wong, H. M., & McGrath, C. (2020). Toothbrush deterioration and parents' suggestions to improve the design of toothbrushes used by children with special care needs. BMC Pediatr, 20(1), 443. doi:10.1186/s12887-020-02347-8