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系統識別號 U0026-2908201622585100
論文名稱(中文) 以居家照顧者為中心之失智飲食健康促進教育方案發展與評價
論文名稱(英文) Development and Evaluation of a Community Family Care-Based Dietary Health Promotion Educational Program for Patients with Dementia
校院名稱 成功大學
系所名稱(中) 健康照護科學研究所
系所名稱(英) Institute of Allied Health Sciences
學年度 104
學期 2
出版年 105
研究生(中文) 蕭華岑
研究生(英文) Hua-Tsen Hsiao
學號 TA8991050
學位類別 博士
語文別 英文
論文頁數 149頁
口試委員 指導教授-王靜枝
召集委員-邱亨嘉
口試委員-陳靜敏
口試委員-張玲慧
口試委員-許雅娟
中文關鍵字 失智  居家  飲食健康促進  教育 
英文關鍵字 Dementia  Community-Dwelling  Dietary health-promoting  Education 
學科別分類
中文摘要 研究背景:飲食問題行為是許多居家失智照顧家屬每日苦於面對的失智合併精神問題之一,隨病程進展之多變化飲食行為將影響著失智者的營養狀態。家屬是居家失智者照顧的主力,提供失智照護知識與技巧是居家失智照顧者最想獲得滿足的需求之一,故發展以居家照顧者為中心之失智飲食健康促進教育方案刻不容緩。
研究目的:旨在發展以居家照顧者為中心的”失智飲食健康促進教育方案”,並評價其成效。
研究方法:本研究為一實驗性研究單盲設計採縱貫性隨機控制性試驗,於台灣南部某醫院之失智門診中心及某協會選取符合收案條件之失智者及其飲食照顧家屬並隨機分派至二組,共計57對參與對象符合條件且願意參加。研究期間從104年2月11日~105年02月10日止。實驗組接受本研究發展之失智飲食健康促進教育方案(每週一次,每次 1小時,共六週),第七週起每二週一次共計三次的電話諮詢與照護追蹤(每次約為10~15分鐘);控制組則提供例行性的照護,第七週起每二週一次共計三次的社交性電話問候(每次約為10~15分鐘)。二組研究對象分別於教育方案介入前一週(T1)、教育方案後三個月、以及六個進行後測(T2)及追蹤後測(T3)。以SPSS 18.0 版統計軟體依研究目的進行資料分析,統計方法包括:次數分配、百分比、平均值、T檢定、廣義估計方程式等描述性與推論性統計。
研究結果:在控制潛在干擾變項後,失智飲食健康促進教育方案能顯著提升照顧家屬的【失智飲食營養知識】(p=0.007)以及【失智者飲食功能之評估能力】(p=0.003)。在實驗組部分,於三個月及六個月的追蹤結果顯示家屬之【失智健康飲食行為】均顯著高於前測(p=0.000);而實驗組失智者的【營養狀態_MNA】有持續增加但未達顯著,而其【營養狀態_BMI】則維持在22~23之間。
結論:失智飲食健康促進教育方案可以提升照顧家屬的【失智飲食營養知識】以及【失智者飲食功能之評估能力】,且增進照護者採取【失智健康飲食行為】的能力,但在提升失智者的營養狀態上僅呈現些微的效果。本研究結果可作為醫院、失智日照機構、政府單位、學校教育等提供失智飲食照護政策宣導、教育訓練之重要參考依據,期能提升居家失智者飲食與營養照護之品質。
英文摘要 Backgroung: Eating problem behavior is one of the behavioral and psychological symptoms of dementia (BPSD) suffering for family caregivers every day. The diversity of eating behaviors coupled with the progression of dementia affect the nutritional status of the patients with dementia (PwD). While family caregiver is major carer for the PwD, care-related knowledge and skills became one of the top demands for family caregivers. Therefore, developing a community family care-based health-promoting dietary educational program for the PwD is an important issue.
Purpose: This research aimed to develop and evaluate of a community family care-based health-promoting dietary educational program for the PwD.
Methods: This is an experimental design with single-blind study, using a longitudinal randomized controlled trial to assess the suitability and effectiveness of the educational program. This research was held in one dementia outpatient center in hospital and one local dementia association in southern Taiwan. Subjects who were willing to participate were selected by inclusion criteria and were randomly assigned into two groups. Data were collected between February 2015 and February 2016. A total of 57 pairs of subjects completed the study. The experimental group received the dementia health-promoting dietary educational program (once a week with 1 hour in length for a continous 6 weeks) and one telephone counseling and care every two weeks from week 7 (approximately 10-15 minutes at a time). The control group only received routine care, as well as a social call every two weeks from week 7 (approximately 10-15 minutes at a time). Subjects form the two groups received pre-test before the educational program, post-test 3 months after the educational program, and follow-up test 6 months after the educational program. SPSS 18.0 version statistical software was used for data analysis included frequencies, percentage, mean, t-test, Chi-square, Pearson’s correlation, and Generalized Estimating Equation.
Results: After controlling for the potential confounding factors, the ”Nutritional knowledge for dementia” and ”Ability to assess the eating function for dementia” of the caregivers significantly increased after receiving the educational program (p=0.007;p=0.003). In the experimental group, the score of “Healthy eating behavior for dementia” of the caregivers were significantly higher than that of the pre-test (p=0.000). However, “Nutritional status _MNA” of the PwD increased but not statistically significantly while ”Nutritional status _MNA” remained between 22 and 23.
Conclusion: The dementia health-promoting dietary educational program can increase caregiver’s “the dietary knowledge for dementia” and “ability to assess the eating function for the PwD”, as well as perform healthy eating behaviors. However, only slightly improvement was identified on the nutritional status of PwD. The results will be used as an important reference of dementia dietary care in hospitals, dementia day care centers, government units and education of school. Finally, it may improve the quality of dietary care of the PwD in community.
論文目次 Abstract in Chinese…………………………I
Abstract…………………………II
Acknowledgement………………………IV
Tables of contents…………………………V
List of tables………………………VII
List of figures………………………VIII
Appendix………………………IX
Chapter 1. Introduction…………………………1
1.1 Background of the study………………………2
1.2 Purpose of the study………………………5
1.3 Research hypothesis………………………6
Chapter 2. Literature Review………………………7
2.1 Eating problems and nutrition status of the patient with dementia………………………8
2.2 Caregiver burden and the dietary educational needs…………………10
2.3 Empirical studies on mediterranean diet and nutritional program in dementia………………………12
2.4 Theoretical-based on health-promoting dietary educational program…………………………16
2.5 Research framework………………………22
2.6 Definition of terms……………………23
Chapter 3. Methods……………………25
3.1 Study design and sampling………………………26
3.2 Subjects……………………27
3.3 Data collection and procedure……………………28
3.4 The health-promoting dietary educational program for dementia…………….30
3.5 Instruments and measurements………………………33
3.6 Statistical analysis………………………46
3.7 Ethic considerations………………………47
Chapter 4. Results……………………48
4.1 Demographic characteristics of subjects………………………49
4.2 The effectiveness of the health-promoting dietary educational program……………61
4.3 The relationships of all variables between patients with dementia and caregivers…………………………87
Chapter 5. Discussion………………………92
5.1 Demographic characteristics of subjects………………………93
5.2 The effectiveness of the health-promoting dietary educational program for caregiver…………………………97
5.3 The effectiveness of the health-promoting dietary educational program for patient with dementia……………………105
5.4 The relationships among all variables between patients with dementia and caregivers………………………109
Chapter 6. Conclusion………………………110
6.1 Conclusions………………………111
6.2 Limitations of the study………………………113
6.3 Applications and recommendations for the study……………………115
References…………………118
Appendix……………………129
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