國中生預防便秘行為影響因素之探討

Abstract

摘要 本研究目的在探討國中生兩種預防便秘行為-攝取足夠的膳食纖維及養成正確排便習慣之影響因素。以研究者自編之量表進行調查，研究對象為台灣地區北、中、南區之國中生，以立意取樣的方式獲得有效樣本共計860名，男女學生人數比例分別為50.2%及49.8%。研究工具為根據計劃行為論編製的量表，包含「個人背景資料、預防便秘行為量表、預防便秘態度量表、主觀規範量表、知覺控制量表」共五部份，並以描述統計、卡方檢定、獨立樣本t-檢定、單因子變異數分析、皮爾森積差相關、多元迴歸、階層複迴歸、羅吉斯迴歸進行分析。結果發現，便秘的盛行率為13.1%，女生有便秘的比率(17.1%)顯著高於男生(9.3%)(χ2 = 11.451，p=0.001)。預防便秘行為的行為結果態度、主觀規範尚正向，而主觀規範受到父母的影響稍大於師長及同學。攝取足夠的膳食纖維最主要之阻礙為全穀類食物攝取不足，全穀類食物攝取達到每週7次者僅9.1%，而蔬菜有37.9%及水果有33.8%攝取符合每日建議量。攝取足夠的膳食纖維之主要促進因素是「富含膳食纖維的餐點好吃、和同學一起吃」，主要阻礙因素是與個人喜好有關，如不喜歡那種食物。養成正確的排便習慣的主要促進因素為「有吃早餐、三餐正常、廁所環境佳」；生活作息不正常是主要的阻礙，與環境有關的阻礙因素為「外出附近沒廁所、廁所髒亂惡臭、廁所沒提供衛生紙」。階層迴歸分析結果發現，不同的預防便秘行為其影響因素不同:(1)在攝取足夠的膳食纖維方面，男生比女生、七年級比八及九年級、學校地理區域南區比中及北區、家長教育程度為研究所以上比國小或沒有受教育或國中、攝取足夠的膳食纖維之行為結果態度較正向、主觀規範較正向、知覺控制較強的國中生，愈能攝取足夠的膳食纖維。(2)在養成正確的排便習慣方面，七年級比九年級、家人無便秘比家人有便秘或不知道家人有無便秘、過去無便秘比有便秘、養成正確的排便習慣之行為結果態度較正向、知覺控制較強的國中生，其養成正確的排便習慣的行為愈佳。多元羅吉斯迴歸分析顯示，女生、學校區域在南區比中區、家人有便秘比家人無便秘、忽略便意、排便習慣較差、整體預防便秘行為較差的國中生，目前有便秘的風險較高。故欲促進國中生從事預防便秘行為，在未來的相關課程規劃方面，可朝增強攝取足夠的膳食纖維之行為結果態度、主觀規範、知覺控制及養成正確的排便習慣之行為結果態度、知覺控制去設計，而便秘高風險之族群則是加強教育的對象；環境方面，應朝改善不利於國中生預防便秘的環境或情境努力，如在校園內及公共場所設置足夠的廁所、改善廁所的清潔度、廁所提供衛生紙。Abstract The purpose of the research is to find out the factors influencing the two major constipation prevention behaviors, consuming adequate dietary fiber, and developing normal bowel habit, in junior high school students. We designed a questionnaire based on the Theory of Planned Behavior, which includes five issues: demographic information, behavior of constipation prevention, attitude toward constipation prevention, subjective norm, and perceived control. The subjects were from northern, central, southern areas of Taiwan through purposive sampling. A total of 860 valid samples, 50.2 % from male and 49.8 % from female, were collected. Descriptive analysis, Chi square test, student t-test, one-way analysis of variance, Pearson correlation, Multiple regression, Hierarchical regression, and Logistic regression were used to analyze the data. The results showed that the prevalence of constipation was 13.1%, higher in female (17.1%) than in male (9.3%) (χ2=11.451，p=0.001). The attitude toward behavioral outcomes and subjective norm of constipation prevention was positive, and parents had slightly greater impact than teachers and classmates on subjective norm. The major factor hindering enough dietary fiber intakes was the low intake of whole-grain foods. Only 9.1% of students consumed them seven times a week. 37.9% of students consumed vegetables and 33.8% of students consumed fruits fulfilling the RDA. Delicious dietary fiber-rich meals and eating with their classmates were two major factors facilitating the sufficient intake of dietary fibers. The major barrier was personal dislike of the taste. Eating breakfast, having regular meals, and a high-quality toilet environment served were major factors facilitating the development of a normal bowel habit. The major barriers were behavior of irregular lifestyle, and environmental factors, such as no toilets around, the terrible smell, dirty toilets and no toilet paper provided. The results of the hierarchical regression analyses indicated that these two constipation prevention behaviors were influenced by different factors. (1) Adequate dietary fiber intake was found more in boys than in girls, more in 7-grade than in 8- and 9-grade, more in schools located in southern Taiwan than in central and northern Taiwan, more in those with parental education of graduate school level than in those of uneducated, primary, or high school level, more in those with better subjective norm, and more in those with better perceived control. (2) A normal bowel habit was developed more in 7- than in 9-grade, more in those having family members with constipation, more in those with constipation experience, more in those with better attitudes toward behavioral outcomes, and more in those with better perceived control. The results of the Multiple logistic regression analysis found higher risk of constipation in girls than in boys, in schools located in southern Taiwan than in central Taiwan, in those with constipation family members, in those ignoring the urge to have a bowel movement, in those with poorer bowel habits, and in those with worse constipation prevention. Therefore, to improve the prevention of constipation, the following design could be included in curriculum: To reach adequate dietary fiber intake, curriculum can focus on improving students’ attitude toward behavioral outcomes, subjective norm, and perceived control of adequate dietary fiber intake. To establish normal bowel habit, curriculum can focus on improving students’ attitude toward behavioral outcomes, perceived control of developing a normal bowel habit. Besides, providing enough toilets on campus, improving toilet cleanness, and offering toilet paper are highly recommended.