七年級睡眠教育課程設計與發展－以臺北市某國中為例

Abstract

研究背景：晚睡及睡眠不足是青少年常見的睡眠問題，且與其生理發展、心理、社會層面的健康有關，甚至會影響學業表現及提高成年罹患憂鬱症的風險。為改善青少年睡眠健康，國外已有校本之睡眠教育課程且證實可提升知識、增加睡眠時數，以及改善睡眠不規律之問題。然而，根據過去研究顯示學生於介入後仍難以維持好的睡眠行為。近年來，歐美國家更積極朝向結合行為科學理論或教育理論研發學校睡眠教育課程，反觀國內，目前並未將睡眠納入重點教學內容。

研究目的：本研究欲設計七年級學校睡眠教育課程並進行教學，評估該課程對學生日間嗜睡之影響，並透過課程評價，瞭解課程實施後，學生於每堂課所習得之睡眠知識與促進睡眠健康之自我效能改變情況。

研究方法：本研究為單組前後測實驗設計，課程設計乃參考過去文獻並透過質性訪談七年級學生及家長規劃課程初步內容，再依據需求評估問卷之結果修正課程內容。本研究透過立意取樣選取臺北市一所學校的三個七年級班級進行教學介入並評估課程實施之成效。本研究以生活技能為導向設計3堂睡眠教育課程，其中第二堂至第三堂課一周期間由學生實際執行改善睡眠行為實驗。本研究透過具良好信效度之兒童日間嗜睡量表評價課程介入之成效，並使用成對樣本t檢定評估學生在介入前後日間嗜睡程度的差異。此外，本研究亦透過自編問卷進行過程評價，包含睡眠知識與自我效能提升狀況以及學生對課程及教師之回饋。

研究結果：本研究研發之課程，第一堂課旨在提升學生對睡眠問題的覺察並瞭解睡眠的重要性，最後藉由小組討論，瞭解影響其學生睡眠之因素。第二堂課則是介紹睡眠質量，常見的睡眠問題，並教導時間管理技巧、睡前放鬆技巧，以及相關睡眠衛生策略。第三堂課則是請學生思考過去執行一週的改善睡眠習慣實驗之反思，並以小組討論過度使用3C產品之危害與改善策略。經過三週的睡眠教育課程教學，整體來說學生的日間嗜睡程度有顯著改善(n=66, p<0.001)，且根據課後的過程評價中，亦發現在第一堂睡眠知識的教學後，學生在睡眠相關知識的得分有顯著提升(n=65, p<0.001)，然而，在自我效能方面，本研究發現上完第一堂課及第二堂課後，所有學生對於執行有益睡眠健康之行動之自我效能未達統計顯著。

結論與建議：本研究所設計的以生活技能為導向的七年級睡眠教育課程，經教學介入後，確實可降低日間嗜睡程度。根據過程評價的結果顯示，經第一堂課程實施後，可顯著提升學生對睡眠的相關知識，然而，學生對於執行有益睡眠健康之行動之自我效能則並未顯著提升，究其原因可能是教學時間不足及學生在操作時間管理技巧或問題解決法後可能發現其它阻礙因素。因此，本研究建議未來課程內容中宜強化於練習時間管理技巧與問題解決法後，引導學生反思與改進，以提升學生執行有益睡眠健康之行動之自我效能。此外，在第二堂課與第三堂課的生活技能教學，可改以問題解決法的教學為主，找出可行的解決方法後，再練習時間管理技巧或自我覺察與自我監督等技巧，以提升學生落實改善睡眠習慣之信心。最後，建議未來宜鼓勵學生執行睡眠行為改變實驗，並邀請家長支持學生的行為改變實驗，給予適當的提醒，以提供學生執行睡眠行為改變實驗的社會支持。Background: Later bedtimes and insufficient sleep are common causes of sleep problems among adolescents, and these have been related to physical development, psychological, social health, and have even been related to low academic achievements, as well as an increased risk of depression in adulthood. To promote sleep health for adolescents, western countries have already developed their own school-based sleep education programs, and have found that they could enhance the students’ sleep knowledge, increase sleep duration, as well as decrease irregularity at bedtimes and wake up times. However, it is hard for the students to maintain good sleep habit after the program intervention. Nowadays, US and other European countries have been developing theory-based sleep education programs by using the behavioral science theories or educational theories, but there has been no formal sleep education courses, as yet, for the junior-high-school students in Taiwan.

Objectives: This research aims to develop a sleep education program for seventh-grade students, and evaluate its effect on their daytime drowsiness, as well as on the changes of the sleep knowledge and self-efficacy about promoting sleep health for each class based on process evaluation.

Methods: This research was designated as a pre-post experiment without a control group. We conducted in-depth interviews with the students and their parents to develop preliminary contents of the program. Based on the needs assessment survey mongst the target group, we further modified our sleep education program. This study purposely select on school in Taipei City to implement the sleep health education program to the seventh-grade classes at a junior high school in Taipei City and evaluate the effectiveness of this program. This program was a life skill-based sleep program, which was composed of three 45-minutes courses and a behavioral experiment between the second week and third week. The effectiveness of this program was evaluated by using the Pediatric Daytime Sleepiness Scale, which has a good reliability and validity. We used the paired t-test to evaluate the daytime drowsiness after the program. Moreover, we used a self-administered questionnaire as our instrument for the process evaluation, including assessing the students’ sleep knowledge, self-efficacy, and evaluation about each lesson, in order to understand the students’ learning and feedback from the instructions.

Results: In the sleep education program this study developed, Lesson One aimed to enhance the students’ awareness about sleep problems, understand the importance of sleep, and to learn the factors which may influence sleep by group discussion. In Lesson Two, we introduced the meaning of ideal sleep, common sleep problems among adolescents, sleep hygiene, practiced time-management, and relaxation skills before bedtime. In Lesson Three, we asked the students to recall their barriers when they tried to change their sleep habits during the experiment in the past week, and then asked the students to dicuss the negative effecs of electronic devices and the improvement strategies. After the three-week intervention, all the students significantly improved their daytime drowsiness (n=66, p<0.001), and according to the results of the process evaluation, we found that all the students significantly improved their sleep knowledge (n=65, p<0.001), but not for self-efficacy when implementing thing sleep health.

Conclusion and Suggestion: The life skill-based sleep education program we designed effectively improved the students’ daytime drowsiness, and their sleep knowledge in the process evaluation of the first course, however, self-efficacy in promoting sleep health was not enhanced. The possible reasons might be that we only had a limited amount of time in teaching life skills and they might well find other barriers when they practiced their time-management and problem-solving skills. Therefore, we suggested that the program could be revised to lead the students to reflect upon themselves after practicing time-management and problem-solving skills in order to enhance their self-efficacy. Moreover, this sleep education program could focus more on the problem-solving skills and let students practice the time-management skills, or the self-awareness and self-supervision skills to enhance the students’ self-efficacy to improve their sleep habit. Finally, it is suggested that we should motivate the students to do the behavioral experiment and invite their parents to support their children to conduct experiments, giving reminders in order to provide the social support needed in this behavioral experiment for the students.