國中生乳製品營養教育課程成效評估

Abstract

鈣攝取不足和骨質疏鬆症、高血壓、肥胖和胰島素抗性及乳癌等疾病的發生有關，而我國連續三次國民營養狀況調查都發現國人的鈣質攝取明顯低於衛生署建議的參考攝取量。乳製品是鈣質最豐富的來源，但各年齡層男女對乳品類的每日平均攝取量卻不到一份。青少年時期是增加骨質密度高峰的關鍵時期，同時成人期的飲食習慣多延續自青少年期。本研究主要目的是評估以生態模式、健康信念模式、計畫行為理論及社會認知理論為基礎發展之營養教育課程，對國中生乳製品攝取成效的影響。以四所公立國中之八年級各兩班學生(N=232)為研究對象。研究設計分兩組，實驗組為實施每週一單元(45分鐘)，共五個單元的國中生乳製品攝取營養教育課堂教學，以及兩份家長簡訊；控制組則無任何相關的營養教育活動。在介入前、後一週及後五週，分別對兩組學生進行前測、後測及後後測評量。研究結果發現：介入後一週(後測)，實驗組學生乳製品攝取之相關因素(包括營養知識、主觀規範及自我效能)和乳製品攝取行為(包括一般攝取行為、行為改變階段、總乳鈣攝取量)有顯著進步(p＜.01)；其中乳製品攝取之營養知識、主觀規範及行為改變階段有為期至少五週的短期延宕成效(p＜.001)；但乳製品攝取之態度則無顯著立即成效(p＞.05)，短期延宕效果亦不明確。分析此介入方案於不同背景(性別、區域、體型、居住狀況、家庭社經地位、家長參與程度)學生的成效，除態度外，對不同背景學生均能顯著提升其乳製品攝取之相關因素和乳製品攝取行為(p＜.05)。Inadequate calcium intake is associated with the incidences of osteoporosis, hypertension, obesity and insulin resistance, and breast cancer. Three national nutrition surveys find that calcium intake among Taiwanese is about half of the 2002 Dietary Reference Intakes proposed by the Department of Health in Taiwan. The average daily intake of dairy products was less than one serving. Adolescence is the critical period of establishing healthy eating habit and increasing peak bone mass. The purpose of this study was to access the effect of the nutrition education program which was developed based on Ecological Models, The Health Belief Model (HBM), Theory of Planned Behavior (TPB) and Social Cognitive Theory (SCT). Eighth grader from four middle schools in Taiwan participated the study. The intervention group (N=120) was treated with nutrition education program which included five 45-min classroom sessions and 2 parent’s newsletters. The control group (N=112) was not treated with any nutrition education program. The outcomes of intervention was measured by questionnaires administered one week before (pre-test), a week after (post-test) and five weeks after (follow-up test) the intervention. The results indicated that: the intervention group’s dairy products knowledge, subjective norms, self-efficacy, behaviors, stage of change, and dairy calcium intake improved (p<.01) in post-test. Five weeks after the intervention, student’s knowledge, subjective norms, and stage of change were still significantly better than control group (p<.05). However, student’s attitude have no significant improvement (p>.05) after intervention. The results also indicated that the dairy product nutrition education program was effective for 8th grades of different gender, body shape, living status, family social economic level, and degree of parent’s involvement.