應用健康信念模式於孕婦拒吸二手菸衛生教育介入效果研究─以臺北市立聯合醫院和平婦幼院區為例

Abstract

本研究旨在研發一套以健康信念模式及自我效能理論為依據之孕 婦拒吸二手菸衛生教育介入課程，並探討該介入課程的成效。本研究 採「真實驗設計」之「實驗組與對照組前測、後測及後後測設計」，以 臺北市立聯合醫院和平婦幼院區孕婦為研究母群體，抽樣方式以2010 年11月至2011年3月於婦產科門診掛號之單、雙號來隨機分派，單 號為實驗組，雙號為對照組，實驗組與對照組各50位，共計100位為 研究樣本。實驗組接受本研究設計之孕婦拒吸二手菸衛生教育(含介入 手冊、教學活動及電話關懷諮詢)。兩組孕婦於前測、後測及後後測時 進行問卷調查及菸煙暴露量的測量，並以單因子共變數分析等方法進 行統計分析。本研究的重要結果如下：

一、全體研究對象在衛生教育介入前階段有關二手菸菸害知識、拒吸 二手菸健康信念方面的問卷調查結果都呈現不盡理想的情形。拒 吸二手菸的行動線索來源有偏少之現象，而拒吸二手菸的自我效 能以及採取拒吸二手菸的行為亦呈現偏低的結果。然而，菸煙暴 露量則尚屬正常值內。 二、「孕婦拒吸二手菸衛生教育」介入後的立即效果及延宕效果之評 估結果則顯示，實驗組孕婦在後測及後後測時的「二手菸菸害知 識」、「自覺二手菸相關疾病罹患性」、「自覺二手菸相關疾病嚴重 性」、「自覺拒吸二手菸行為利益性」、「自覺拒吸二手菸行為障礙 性」、「拒吸二手菸行動線索」、「拒吸二手菸自我效能」、「拒吸二 手菸行為」及「菸煙暴露量」等效標變項之量測結果均顯著優於 對照組孕婦，驗證了該介入課程確實具有立即效果與延宕效果。

整體而言，本研究結果顯示「孕婦拒吸二手菸衛生教育」介入課程能達到相當的成效。因此建議有關當局可參考運用本研究之介入課程於孕婦的二手菸害防制衛生教育，且主動至各醫療院所、婦產科診所的媽媽教室、及坐月子中心等場所推廣該介入課程，以增強孕婦拒吸二手菸的意識、信念和行動，期讓拒絕菸害逐漸地成為日常生活的規範。The purpose of this study was to create and evaluate the effectiveness of a passive smoking intervention program among pregnant women. The study employed a true experimental design at the Heping Branch and the Women and Children Branch of Taipei City Hospital from November 2010 to March 2011. Subjects were identified at the obstetrics and gynecology clinic area and were randomly allocated based on the registration sequence. The odd-numbered individuals were assigned to the experimental group, while the even-numbered ones the control group. Subjects in the experimental group (n = 50) enrolled in the program which was developed based on the health belief model and self-efficacy theory, while subjects in the control group (n = 50) received usual counseling care. Questionnaires were distributed and smoking exposures dosage was measured at three time points: pre-test, post-test and post post-test. One-way Analysis of Covariance (1-ANCOVA) was conducted.

The main research findings were as follows: (1) At the baseline all of the recruited pregnant women revealed insufficient knowledge with respect to harm caused by passive smoking and the health belief of rejecting passive smoking. Sources of “cues to action for rejecting passive smoking” were limited. In addition, “self-efficacy of rejecting passive smoking” and ”acting to reject passive smoking” were measured poorly. Only did “smoking exposure dosage” be found within normal ranges. (2) Compared to the control group, pregnant women in the experimental group performed better in the post-test and post post-test with respect to “knowledge concerning harm caused by p[passive smoking”, “perceived susceptibility for passive smoking”, “perceived severities for passive smoking”, “perceived benefits for rejecting passive smoking”, “perceived barriers for rejecting passive smoking”, “ cues to action for rejecting passive smoking”, “self-efficacy of rejecting passive smoking”, “acting to reject passive smoking”, and “smoking exposure dosage”.

In conclusion, the study demonstrated that the passive smoking prevention program was effective. This program can enhance the insights, beliefs and actions of a pregnant woman who intends to reject passive smoking. Finally, it is recommended that this program be adopted by local governmental health departments for pregnant women. The program can also be implemented in other kinds of healthcare organizations such as obstetrics and gynecology clinics and postpartum care centers.