以親子配對設計探討過重與肥胖學童之健康相關信念與行為：健康信念模式應用

Abstract

本研究旨在探討國小高年級學童過重與肥胖之健康相關信念與行為，以立意取樣邀請18位過重與肥胖學童及其家長35位為對象，應用健康信念模式設計九個問題進行個別訪談，並輔以家長與學童健康體位行為檢核表。並將學童與家長訪談資料進行配對性分析比對，最後將訪談內容整理分類並加以分析討論。研究結果歸納如下： 在過重與肥胖學童之健康相關信念與行為中發現：學童對於身體形象的認知多受家長影響，並認為造成肥胖的原因來自遺傳與家庭生活環境因素、飲食行為及家長的教養態度有關。家庭成員中如有肥胖者，飲食行為及生活習慣也會有共同性。通常女童較為重視他人對自己身材的看法及評論，希望能有好看的身材及穿上漂亮的衣服，因此在採取體重控制行為意向及效能較男生更為積極。過重與肥胖學童的飲食問題是；吃的多、吃得快、飲食不均衡、用餐時間不規律、睡前飲食等問題。課後休閒時間大部分都偏好在家看電視、打電腦或玩電動遊戲，愈是肥胖的學童愈是不愛活動，身體活動量減少不愛運動是造成學童過重與肥胖的因素之一。過重與肥胖學童的健康信念、生活習慣與飲食行為深受家長及家庭成員間的影響。家長適度的監督，足以影響學童生活規律性及睡眠品質。通常學童的自制力與持續性較為不足，家長若能做到飲食習慣的調整、鼓勵並陪伴多運動、減少靜態活動、提供支持性環境、增進體位控制的知能及適時給予鼓勵等方式，將更能激發行動力。 在學童及家長訪談和檢核表與親子配對分析結果中發現：子女體型受父親影響較多(70.6%)，受母親影響較少(38.8%)。每天睡足8小時的學童有83%，而家長沒有做到的較多(63%)。天天五蔬果的學童有50%，而家長沒有做到的較多(57%)。四電少於二的學童有61%，而家長沒有做到的較多(63%)。每天運動30分鐘 的學童有45%，而家長沒有做到的較多(66%)。每天喝白開水的學童有44%，而家長沒有做到比較少(2%)。 本研究結果可提供健康體位計畫及策略訂定的參考建議，未來可將親子共同列為研究對象，並研擬家庭介入計畫，以提升健康體位管理的成效。ABSTRACT This study aims to determine the health-related beliefs and behaviors of children of fifth- and sixth-grades of elementary school regarding overweight and obesity. Purposive sampling was used to invite 18 overweight and obese schoolchildren and their parents (n = 35) to be the study participants. The Health Belief Model was used in designing nine questions for performing individual interviews. The interviews were supplemented with a behavior checklist regarding healthy body weight for the parents and schoolchildren. The interview data of the parents and schoolchildren were compared using dyadic analysis. Finally, following further analysis and discussion, the interview content was organized and categorized. The results are summarized as follows: The health-related beliefs and behaviors of the overweight and obese schoolchildren indicated the following: The schoolchildren’s awareness of their body image was mostly influenced by their parents, and the children believed that the causes of them becoming obese were related to heredity and environmental factors related to family life, dietary behaviors, and the parents’ child-rearing attitudes. Commonalities were discovered between the dietary behaviors and life habits of the children and any obese family members. Generally, the girls cared more about other people’s perceptions and comments regarding their bodies, and they expressed the hope of having good-looking figures and wearing beautiful clothes. Consequently, when adopting weight control behaviors, the girls were more active in intention and performance than the boys. The diet problems of the overweight and obese schoolchildren included eating large quantities, eating quickly, unbalanced diets, irregular meal times, and eating before bedtime. During leisure time after school, most of them preferred to stay at home and watch television, use the computer, or play video games. The more obese the schoolchildren were, the more they disliked being active. Reduced physical activity and a dislike of exercise are two factors that cause overweight and obesity in schoolchildren. The health beliefs, life habits, and dietary behavior of the overweight and obese schoolchildren were considerably influenced by the parents and family members. Appropriate parental supervision was sufficient for introducing regularity to the schoolchildren’s lives and quality of sleep. The schoolchildren typically lacked self-control and persistence. However, the parents could stimulate the children to act through methods such as regulating dietary habits, encouraging the children and accompanying them in exercise, reducing sedentary activities, providing a supportive environment, increasing the children’s competency at controlling body weight, and providing timely encouragement. The results of the schoolchildren and parent interview and checklist as well as the parent–child dyadic analysis indicated the following: The children’s body types were more influenced by the fathers (70.6%) than by the mothers (38.8%). Most of theschoolchildren slept 8 hours each night (83%), whereas most of the parents did not (63%). Half of the schoolchildren got their five a day (50%), whereas most of the parents did not (57%). Most of the schoolchildren used a computer, television, gaming console, and telephone for less than 2 hours every day (61%), whereas most of the parents did not manage this (63%). Nearly half of the schoolchildren exercised 30 minutes every day (45%), whereas most of the parents did not (66%). Nearly half of the schoolchildren drank plain drinking water every day (44%), whereas only a minority of the parents did (2%). The results of this study can serve as a reference and provide suggestions for establishing healthy body-weight plans and strategies. In the future, parents and children can be adopted as study participants for drawing up family intervention programs, thus improving the results of managing healthy body weights.