焦點解決取向團體輔導對高職學生戒菸成效之研究—計畫行為理論之應用

Abstract

本研究目的旨在研發一套應用計畫行為理論與焦點解決取向的青少年戒菸團體輔導方案，並探討對高職吸菸學生的戒菸成效。研究方法採不相等準實驗設計，以立意取樣有意願配合實驗計畫的臺北市私立高級職業學校兩所，分為實驗組（10人）與校內（10人）、校外（13人）對照組三組。本研究由研究者自行設計介入的團體方案，包括十二節課（每節50分鐘）六個單元。實驗研究期間三組（實驗組、校內對照組及校外對照組）分別進行三次測量（前、後及兩個月追蹤測），以評估團體輔導方案介入成效，並於團體結束之後六個月，以電話訪談方式追蹤，以回溯式方式追蹤研究對象於團體結束後一、三、六個月的吸菸狀態。本研究以克-瓦二氏單因子變異數法、重複量數變異數分析法、配對t檢定法與內容分析法進行資料分析。 本研究發現如下： 一、戒菸團體輔導介入後，可顯著影響實驗組不吸菸意願與自訂戒菸目標。 二、本研究經團體輔導介入後，未能顯著影響實驗組的戒菸知識、戒菸自我效能與計畫行為理論各變項。 三、 戒菸團體輔導介入後，未能顯著影響實驗組的減菸率、點戒菸率 、每日最大吸菸量及尼古丁依賴程度。 四、 實驗組成員做到最低吸菸量的方法包括自我約束、重要他人的影響、環境因素與想吸菸時採行替代吸菸的行為。 五、 實驗組於戒菸團體輔導後，具有的團體療效因子包括團體支持、團體學習、團體樂觀、幫助他人的機會、及團體賦能等五項。 本研究提出吸菸學生戒菸教育實務及未來研究兩個面向的建議，戒菸教育實務部分的建議包括強化吸菸學生的戒菸知識、對戒菸的正向態度、與不吸菸同儕的互動內涵、知覺行為控制與自我效能、及戒菸行為意圖與不吸菸意願，以及塑造支持戒菸的環境氛圍、強化團體輔導研究設計等。未來研究建議包含擴大研究對象的選擇、運用不同理論研發團體輔導方案、強化戒菸成效的指標、改良研究工具、運用多元資源、進行城鄉介入成效的比較、及延長追蹤時間等。

The purposes of this study were to develop a feasible cessation group guidance program and to explore the effects of the program intervention among the smoking students of vocational high schools. The study adopt the unequal quasi-experiment, with two private vocational high schools in Taipei City being purposely selected. The subjects included an experimental group (10 students), an in-school control group (10 students), and an out-school group (13 students). The group guidance program was designed by using the Theory of Planned Behaviors and Solution-Focused Group Guidance by the researcher. The program consisted of six units which included twelve fifty-minutes sessions. The control group didn’t participate in any group guidance.The three groups filled out three-wave questionnaires that included pretest, post test, and post post-test to evaluate the effects of group guidance. In addition, the smoking students were surveyed by telephone six months later to explore retrospectively their smoking status within one, three and six months. The data was analyzed by Kruskal-Wallis H test, repeated measures ANOVA, paired t test and contents analyzed. The main findings of the study were as follows: 1. The group guidance intervention could significantly influence the nonsmoking willingness and cessation goal among the experimental group. 2. The group guidance intervention couldn’t significantly influence the knowledge and self-efficacy of cessation and the variables of the Theory of Planned Behaviors among the experimental group. 3. The group guidance intervention couldn’t significantly influence the amount of daily smoking, the rates of reducing smoking, the rates of cessation smoking, and the nicotine dependence among the experimental group. 4. The strategies that the experimental group members used to reduce smoking included self-restraint, the influence of important others, environmental factors, and alternative behaviors. 5. After group guidance, the therapeutic factors of solution-focused group guidance among the experimental group included group support, group learning, group optimism, opportunity to help others, and group empowerment. The study provides the following research suggestions. In terms of practices, it is suggested that cessation program should assist the smoking students to enhance cessation knowledge, promote positive cessation attitudes, improve their interaction with non-smoking peers, reinforce perceived behavioral control and cessation self-efficacy, enhance intention of cessation, and elevate nonsmoking willingness. In addition, schools should promote group guidance and develop supportive environment to help students stop smoking. Future study may involve different age-group smoking students, apply different theories to develop the program of group guidance, strengthen the physical indicators of cessation effects, improve the research tools, use various resources, compare the effects between urban and rural programs, and extend the time for tracking cessation.