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研究生: 李絳桃
論文名稱: 產後性生活衛教模式發展與介入成效研究
指導教授: 晏涵文
學位類別: 博士
Doctor
系所名稱: 健康促進與衛生教育學系
Department of Health Promotion and Health Education
論文出版年: 2003
畢業學年度: 91
語文別: 中文
論文頁數: 240
中文關鍵詞: 產婦性生活衛教模式性教育衛生教育產後性生活
英文關鍵詞: postpartun woman, sexual life, health education program, sexual education, health education, postpartun sexuality
論文種類: 學術論文
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  • 摘 要
    本研究旨在發展並評價適合於產婦需求與符合實務現況之產後性生活教學模式,以解決因產後衛教人力與時間短缺導致產婦接受性教育不足之問題,並期使產婦提升產後性生活知識,具備面對產後性生活之正向態度,並藉由提供產後性健康技能與信心之促進,增進其產後性自我效能與採行有效避孕行為。
    本研究採「對等控制組前後測設計」,與「對等控制組後測設計」。立意選取北部某一級大型教學醫院婦產科病房之產婦,共166位為研究對象,將研究對象依隨機方式分派為實驗組及對照組兩組。實驗組接受「互動式產後性生活衛教模式」,對照組則接受「傳統產後性生活衛教」。實驗組介入之「互動式產後性生活衛教模式」,乃以產婦衛教需求評估為基礎,並運用「跨理論模式」、「自我效能理論」與「說服傳播理論」等健康行為科學理論發展而成,教學模式包含互動式平面媒體「媽媽性福手冊與媽媽幸福寶典」及10-15分鐘「互動式個別衛教」。在教學介入前,兩組分別進行前測,並於出院前完成衛教介入與立即後測,再於產後6-8星期進行後後測。
    研究結果發現,「互動式產後性生活衛教模式」,確能有效地在「產後性知識」、「產後性態度」、「性自我效能」等變項反應其成效,並能在「有效避孕行為)」上顯出成效。此外,基於有限之衛教介入時間與產婦特殊的身體狀況,本研究運用「跨理論模式」區隔產婦學習階段特質,並掌握不同階段之介入策略,以強化個別衛教能因應產婦個別衛教之需求,並讓產婦有機會對產後性生活學習主題,重新設定學習單元之優先順序,期使在有限時間與資源內,發揮教學介入之成效,而研究成效評量結果亦肯定本教學模式在「產後性知識之提升」「產後性態度正向之轉變」、「性自我效能之增進」與採行「有效避孕行為」上之成效,值得臨床推廣。

    Development and Evaluation of
    Interactive Postpartum Sexual Health Education Program
    Abstract
    The purpose of this research is to establish and evaluate postpartum sexual health education program that would meet the postpartum women’s necessity, while it is also well suited to the current status. Aiming to resolve problems on sexual health education incompetence due to the shortage of teaching force and time, we expect to enhance postpartum women’s sexual health knowledge, so they would hold a positive attitude on postpartum sexual life. With the promotion of such issue, postpartum women would feel more readily and confident, while increasing sexual self-efficacy and effective contraception.
    This research utilizes “pretest-post-test control group design” and “post-test only control group design.” A total of 166 samples were recruited at a large-scale medical center in northern Taiwan, and then were randomly assigned to either experiment or control groups. The experiment group has taken the intervention of “interactive postpartum sexual health education program,” whilst the control group was assigned to “postpartum routine teaching.” The approach of intervention for experimental group with “interactive postpartum sexual health education program” utilized the need assessment for foundation, also with the application of Transtheoretical Model, Self-Efficacy Theory, and Persuasive Communication Theory. The “Interactive Postpartum Sexual Health Education Program” included an interactive printed media of a pamphlet titled “Happy Mother’s Sex” and 10-15 minutes of interactive individual health education. Before the intervention of health education, the two groups were given pre-test, and an impact evaluation before they left hospital. By the time they left for about 6 to 8 weeks, post-post-test is being done.
    From the research we have discovered, that an “interactive postpartum sexual health education program” is capable to see the effectiveness of “postpartum sexual knowledge,” “postpartum sexual attitude,” and “postpartum sexual self-efficacy”, while effective contraceptive behavior has also proved to be effective. Furthermore, this research used Transtheoretical model to separate the condition for learning, while approaching with different intervention at different stages, in order to meet mother’s individual sexual health educational needs, and the interactive health program will allows the postpartum women to set their own teaching agenda. Thus even within limited amount of time and sources in patient education, the intervention has proven to be effective. The result of this research has demonstrated that method of health education has a positive impact on “postpartum women’s sexual knowledge,” “postpartum women’s sexual attitude,” “sexual self-efficacy” and “effective contraceptive,” which are worthwhile to be applied clinically.

    錄 頁次 誌謝 Ⅰ 中文摘要 ………………………………………………………………… Ⅲ 英文摘要 ………………………………………………………………… Ⅳ 目 錄 …………………………………………………………… Ⅵ 圖表目錄 …………………………………………………………… Ⅷ 第一章 緒論……………………………………………………………… 1 第一節 研究動機與重要性 ……………………………………… 1 第二節 研究目的 …………………………………………………… 4 第三節 待答問題 …………………………………………………… 5 第四節 研究假設 …………………………………………………… 6 第五節 名詞界定 …………………………………………………… 7 第二章 文獻探討 ……………………………………………………… 11 第一節 產後性生理、心理改變之內容與相關影響因子…………… 11 一、產後性生理、心理改變之內容 ……………………………… 11 二、影響產後性生理、心理改變之相關因素探討 ……………… 13 第二節 醫院衛生教育及產後性生活衛教實施背景 ……………… 15 一、醫院衛生教育實施背景 ……………………………………… 15 二、產婦接受性生活衛教之實施概況 …………………………… 17 三、產後性生活教學方式與教學媒體之探討 …………………… 19 第三節 產後性生活介入相關研究之探討…………………………… 22 第四節 教育介入策略之理論基礎 ……………………………… 26 壹、教育介入策略理論基礎之選擇 ……………………………… 26 貳、跨理論模式 … ……………………………………………… 28 參、自我效能理論 ……………………………………………… 32 肆、 PRECEDE-PROCEED Model ………………………………… 35 伍、健康媒體訊息設計之理論基礎 …………………………… 37 第三章 研究方法第一節 研究設計與研究架構 …………………………………… 41 第二節 研究對象 ……………………………………………… 46 第三節「傳統產後性生活衛教」與「互動式產後性生活教學模組」介入教學活動設計……………………………………… 47 第四節 研究工具 ……………………………………………… 53 第五節 資料收集與實施步驟…………………………………… 58 第六節 資料處理與分析………………………………………… 61 第四章 「 互動式產後性生活衛教模式」之發展 ………………… 62 第一節 「 互動式產後性生活衛教模式」之發展步驟……………… 63 第二節 根據產婦性生活衛教需求評估結果擬定教學模式 ……… 66 第三節 教學目標、教學內容與教學策略之設計 ……………… 69 第四節 互動式產後性生活教學媒體設計與製作 ……………… 76 第五節 「互動式個別衛教」教學策略與活動之擬定……………… 78 第五章 結果與討論……………………………………………… 84 第一節 研究對象之基本資料…………………………………… 84 第二節「互動式產後性生活衛教模式」與「傳統產後性生活衛教」介入整體成效之比較…………………………………… 89 第三節 兩組在衛教介入前後於「產後性知識」與「產後性態度」之得分情形……………………………………………… 108 第四節 過程評量結果…………………………………………… 112 第六章 結論與建議……………………………………………… 118 第一節 結果與結論……………………………………………… 118 第二節 建議與限制……………………………………………… 120 參考文獻 …………………………………………………………… 124 附錄一 互動式產後性健康自學手冊(上)(下)……………………… 141 附錄二 傳統產後性生活衛教手冊 …………………………………… 206 附錄三 問卷暨手冊專家效度名單 …………………………………… 219 附錄四 產後性生活衛教介入成效評估問卷 ………………………… 220 附錄五 媽媽性福與媽媽性福寶典手冊評價問卷 ………………… 233 附錄六 產後性生活個別衛教評價問卷……………………………… 234 附錄七 「產後性生活衛教介入」臨床研究情境控制細則…………… 235 附錄八 手冊資料轉換與文獻實證依據實例………………………… 237 附圖一 手勢示範會陰按摩法………………………………………… 238 附圖二 互動式產後性健康自學教材樣式……………………………… 239 附圖三 媽媽性福學園首頁 ……………………………………………… 240 圖表目錄 頁次 表2-1 產後性生活衛教介入相關研究摘要表……………………… 23 表2-2 跨理論模式之概念建構 ………………………………… 29 表3-1 實驗組(互動式產後性生活衛教模式)介入變項、課程及教學活動 …………………………………………………… 51 表3-2 問卷各量表之內部一致性 ………………………………… 55 表3-3 研究問題與資料分析方法一覽表…………………………… 57 表4-1 產後性生活之關注與衛教需求內容之概念與次概念………… 63 表4-2 產婦性生活衛教訊息內容三大綱與十九項要點 …………… 70 表4-3 介入變項、策略與其依據理論一覽表……………………… 72 表4-4 互動式個別衛教介入教學流程與內容……………………… 79 表4-5 「互動式產後性生活衛教模式」之特色 …………………… 83 表5-1 研究對象基本資料分佈與兩組同質性檢定………………… 85 表5-2-1 實驗組與對照組在各成效變項三階段得分平均數與標準差… 90 表5-2-2 產後性知識之重複量數變異數分析摘要表 ……………… 92 表5-2-3 產後性知識之單純主要效果分析摘要表…………………… 92 表5-2-4 兩組性知識總分在三階段之事後比較 …………………… 93 表5-2-5 產後性態度之重複量數變異數分析摘要表………………… 95 表5-2-6 產後性態度之單純主要效果分析摘要表 ………………… 95 表5-2-7 兩組性態度總分在三階段之事後比較 …………………… 96 表5-2-8 兩組產後「性自我效能」與「避孕自我效能」得分比較……… 98 表5-2-9 產後有效避孕行為意向之重複量數變異數分析摘要表 …… 99 表5-2-10兩組產婦在產後二個月採行避孕方法之情形……………… 101 表5-2-11兩組在「有效避孕行為」得分比較………………………… 102 表5-2-12兩組於「學習階段」前後測之比較 ……………………… 103 表5-2-13 學習階段之之重複量數變異數分析摘要表 ……………… 105 表5-2-14實驗介入前後兩組於各成效變項效果比較之綜合摘要 …… 107 表5-3-1 兩組於產後性知識量表各題項前後測比較 ……………… 109 表5-3-2 兩組於產後性態度量表各題項前後測比較 ……………… 110 表5-4-1 產後性生活個別衛教評價………………………………… 101 5-14 表5-4-2 產婦對教學之綜合建議………………………………………… 107 圖3-1 產後性教育介入實驗設計A ……………………………… 42 圖3-2 產後性教育介入實驗設計B……………………………… 42 圖3-3 介入研究架構圖 ………………………………………… 43 圖3-4 教學模式發展架構圖…………………………………… 45 圖3-5 對照組介入教學活動流程圖 …………………………… 49 圖3-6 實驗組介入教學活動流程圖……………………………… 50 圖3-7 研究實施步驟流程圖 …………………………………… 58 圖4-1 互動式產後性生活衛教模式之發展流程圖………………… 64 圖5-2-1 兩組在產後性知識得分之表現…………………………… 93 圖5-2-2 兩組於產後性態度得分之表現…………………………… 96 圖5-2-3 兩組在有效避孕行為意向得分之表現 …………………… 100

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