教育設計研究在發展醫學教育課程的運用：結合設計思考與行為改變輪以提升醫學生健康識能反應能力

Abstract

本研究旨在發展並評估一套結合設計思考與行為改變輪之教學模組，以培養醫學生對健康識能困境的理解與健康識能反應能力。鑒於傳統醫學教育普遍缺乏系統化策略以回應民眾的低健康識能需求，本研究採教育設計研究為方法論，透過設計循環建構具實務導向的課程模組。研究對象為臺灣某醫學院醫學系三年級學生，課程採雙循環設計，分別針對111學年度（57位）與112學年度（58位）之學生實施。第一循環以設計思考為核心，引導學生探究社區長者健康問題並發展初步介入構想；第二循環則引導學生運用COM-B模型進行健康行為障礙分析，並銜接行為改變輪進行策略設計。研究透過質、量性資料進行評量，資料來源包括課程前後測問卷、反思作業、學習單、人物誌、教學評量回饋及教師觀察紀錄，並以成對樣本t檢定分析量化資料，以主題分析和內容分析評估質性資料。研究結果顯示，第一循環中的分析確立學生在同理心實踐上存有「知行落差」。據此發展的設計思考教學模組，雖顯著提升了學生同理實踐信心及使用同理意圖，但也揭示「同理心」目標過於抽象，以及學生缺乏結構性分析框架等挑戰。為回應上述挑戰，第二循環不僅導入行為改變輪與COM-B模型作為學習鷹架，更將教學目標轉向具體的「健康識能反應能力」。評估證實，此優化模組能顯著提升學生健康識能反應能力。本研究透過雙循環之實證歷程，產出一套實務教學模組並提煉出三項教學設計原則，為未來醫學教育發展學生之健康識能反應能力，提供了具體的參考建議。This study aimed to develop and evaluate a teaching module integrating Design Thinking and the Behavior Change Wheel (BCW) to enhance medical students' Health Literacy Responsiveness (HLR). Responding to the lack of systematic strategies in medical education for addressing low health literacy, this study employed Educational Design Research (EDR) to construct a practice-oriented module. The subjects were two cohorts of third-year medical students in Taiwan from the 111th (N=57) and 112th (N=58) academic years. The course utilized a dual-cycle design: the first cycle used Design Thinking to guide students in exploring health problems of community elders and developing initial interventions; the second guided students to use the COM-B model for behavioral barrier analysis, followed by strategy design using the BCW. A mixed-methods evaluation used data from pre/post-test questionnaires, student assignments, and observations, analyzed via paired-samples t-tests and qualitative analysis.Results indicated an initial analysis identified a"knowing-doing gap" in students' empathy practice. The first-cycle Design Thinking module improved students' confidence but also revealed that "empathy" was too abstract as a learning goal and students lacked a structured analytical framework. In response, the second cycle introduced the BCW and COM-B models as learning scaffolds and shifted the pedagogical goal to the more concrete HLR. This optimized module was proven to significantly enhance students' HLR. Through its dual-cycle empirical process, this study produced a practical teaching module and derived three instructional design principles, offering concrete recommendations for medical education to develop students' HLR.