研究背景：近年來中國大陸地區幼兒園專任教師人數已達到240多萬，他們的嗓音障礙問題逐漸凸顯，但是針對幼兒園教師嗓音障礙的調查和研究卻遠少於中小學及大學教師。本研究目的是探討當前幼兒園教師嗓音障礙的狀況、相關因素及相關因素的結構方程模型，進而引起大眾對幼兒園教師職業健康的關注和重視，並提出有價值的建議。
研究方法：本研究以文獻、焦點團體和個別訪談資料研擬問卷，運用分層集群抽樣的方法對中國大陸江蘇省鹽城市的幼兒園教師進行線上問卷調查。調查回收到問卷1501份，有效問卷1392份。研究分析運用SPSS 23.0和AMOS 24.0兩個套裝軟體進行信度分析、因素分析、描述性分析、迴歸分析，並建構和驗證了幼兒園教師嗓音障礙影響因素的結構方程模型。
研究結論：
一、依據「嗓音障礙指數量表」，鹽城市幼兒園教師的嗓音障礙率為43%。88.1%的教師有嗓音症狀，嗓音疾病率近一個學期為54.3%，整個職業生涯為60.4%。
二、社會人口學因素、健康狀況、嗓音知識、嗓音保健信念、用嗓行為、職業壓力、工作環境、工作安排均對幼兒園教師嗓音障礙有顯著影響，其中嗓音保健信念達到中度解釋力（R2=0.336），健康狀況、用嗓行為、職業壓力和工作環境具有一定解釋力（0.19＜R2＜0.33）。具體的因素中，年齡、受教育程度、自覺健康狀況、所患與嗓音相關疾病數、睡眠品質、對嗓音障礙的自覺罹患性、對嗓音保健行為的自覺障礙、自我效能、說話方式、工作強度造成的職業壓力、環境噪音、空氣品質與空間大小、音響設備條件、年資、班級幼兒數、集體教學時間、帶班時間、有沒有嗓音訓練或嗓音保健培訓、有沒有其他職務等19個因素顯著影響幼兒園教師的嗓音障礙。
三、職業因素、個人因素與幼兒園教師嗓音障礙之間完整的結構模型，整體適配度良好，自變項「工作環境」、「工作安排」對依變項路徑係數達到顯著，模式的整體解釋力為46.5%。無自變項相關的結構模型，潛在變項「嗓音保健信念」、「職業壓力」、「工作環境」三條路徑係數達到顯著，模式整體的解釋力為28%，但模型的適配度不佳。
研究建議：幼兒園教師個人要提升嗓音保健意識；師範教育與托幼機構師資培訓應納入嗓音訓練及嗓音保健的內容；托幼機構的制度與管理中融入教師嗓音障礙預防，全面提升教師的職業健康。未來研究建議改善結構模型適配度並開展教師嗓音保健的介入。

Background: In recent years, the number of full-time kindergarten teachers in mainland China has reached more than 2.4 million, whose voice disorders gradually become prominent. However, the investigation and research on the voice disorders of kindergarten teachers is far less than that of teachers in elementary, middle and university schools. This research aims at exploring and discussing the current state and relevant factors of kindergarten teachers’ voice disorders, and the structural equation model in order to arouse the public's attention and care to the occupational health of kindergarten teachers and propose valuable suggestions.
Method: In this research, it formulates questionnaire based on literature, focus groups and individual interview data to carry out the online questionnaire survey of kindergarten teachers in Yancheng City, Jiangsu Province, China by adopting the stratified cluster sampling method. 1,501 questionnaires are collected, among which it includes 1,392 valid questionnaires. Meanwhile, it adopts the SPSS 23.0 and AMOS 24.0 software packages to carry out the reliability analysis, factor analysis, descriptive analysis, regression analysis, as well as constructs and verifies the structural equation model of related factors influencing the kindergarten teachers' voice disorders.
Results:
1. According to the Voice Handicap Index scale, the rate of voice disorders of the kindergarten teachers in Yancheng is 43%. 88.1% of teachers have voice symptoms. And the rate of voice disease of the recent semester is 54.3%, while in the entire career, it accounts for 60.4%.
2. Factors such as social demographic factors, health conditions, voice knowledge, voice health beliefs, voice behavior, occupational pressure, work environments, and work organizations have a significant impact on the voice disorders of kindergarten teachers, among which the voice health care beliefs reach the moderate explanatory power (R2=0.336), while health status, voice behavior, occupational pressure and work environments have certain explanatory power (0.19＜R2＜0.33). What’s more, 19 factors out of the specific factors, such as ages, education level, conscious health status, number of voice-related diseases, sleep quality, conscious susceptibility to voice disorders, conscious barriers to voice health care behaviors, self-efficacy, voice usage, occupational pressure caused by work intensity, environmental noise, air quality and space size, sound equipment conditions, seniority, number of children in the class, mass teaching time, shift time, voice training or voice health care training, other jobs, etc. are affecting the voice disorders of kindergarten teachers.
3. The full structural equation model between occupational factors, personal factors and kindergarten teachers' voice disorders has a good fitness. The independent variable "work environments" and "work organizations" are significant to the path coefficient of the dependent variable. The overall explanatory power of the model is 46.5%. As for the structural equation model without correlation between independent variables, the three path coefficients of potential variables, the voice health beliefs, occupational stress and working environments have reached significant levels. The overall explanatory power of this model is 28%. However, the fitness of the model is short of expectations.
Suggestions: The individual kindergarten teachers shall improve their voice health care awareness; the voice training and voice health care content shall be added to the teacher education and kindergarten teacher training; the voice disorders prevention shall be covered in the system and management of kindergarten institutions to comprehensively improve teachers’ occupational health. The future research suggests that it is necessary to improve the goodness-of-fit of the structural equation model and carry out the intervention of the voice health care for teachers.

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