運用心理增能理論於國民中小學教師之全民健保教學增能介入成效研究

Abstract

全民健保制度實施廿年，大幅改善國人健康品質並獲得國際享譽，但在就醫便利與保費低廉的同時，也衍生民眾恣意浪費健保資源等迷思。為使全民健保教育落實校園，本研究旨針對國中小學教師發展全民健保教學增能模組，增進教師推動健保教育效能與信心。 本研究採準實驗研究設計，立意選取中小學健康與體育領域教師計106人參與健保教育教學增能課程，對照組90人則無任何介入，考量教師發展教學自主、專業能力等需求，依據心理增能理論，發展包含3個單元計9小時之健保教學增能模組，探討介入對教師健保教學意義、能力、決策力、影響力及健保認知之成效，並分析教師增能歷程，最後共計完成186份（實驗組100人，對照組86人）有效問卷進行分析。 研究結果顯示，實驗組在各增能變項後測得分均高於前測得分，對照組則無此分佈；透過詹森內曼法分析兩組增能效果，受限於天花板效應，排除實驗組前測得分屬高分族群者，當教學意義變項前測分數低於9.61分者（佔85％）、教學能力變項前測分數低於9.46分者（佔91％）、教學決策力前測分數低於9.73分者（佔95％）、教學影響力前測分數低於6.23分者（佔72％）及健保認知前測分數低於6.83分者（佔85％），後測得分會顯著高於對照組得分，顯示增能模組能顯著提升大部分教師健保教學成效。此外，教師增能歷程包括「酸甜交織的增能歷程」、「解開健保制度的天文密碼」、「課程的明滅與眺望」與「將悸動的燈火化為繁星」等過程，顯見研究對象在面對健保教育初始的不安感、經實際參與介入課程後，則能獲得健保知能，發展健保教學能力，並承諾願意返校推廣，共同珍惜這份得來不易的健保資源。 依本研究結果建議健保議題應與學習階段承接推廣，課程規劃也應融入跨領域教學，及納入健康促進學校必選議題，以營造校園珍惜健保氛圍。在教師推展層面上應加強縣本培育及建構互動平台，提升各級學校教師健保教學知能。未來研究則可進行學生成效評價，或增加延宕效果評量，落實健保教育學習成效。The quality of life in Taiwan has been significantly improved since 1995, when National Health Insurance(NHI)initiated. Nevertheless, NHI report states that people generally overuse medical resources by going to more doctors, requiring more examinations, and taking more medication than they used to. The study applies Spritzer’s empowerment theory into teachers’ empowerment module for NHI education. There were 100 teachers in the experimental group and 86 teachers in control group. A quasi-experimental, pre-test/post-test research design was also used in this study. The research result showed that the experimental group in all variables scores were higher than pre-test score, and this result didn’t showed in the control group; Through Johnson-Neyman technique to analyze , while "meaning " pre-test cores below 9.61 (85%) , "competency" pre-test cores below 9.46(91%) , "decision-making" pre-test cores below 9.73 (95%) , "influence" pre-test cores below 6.23 (72%) or “NHI knowledge” pre-test cores below 6.83 (85%), that’s post-test scores will be significantly higher than the control group scores. The process of teacher empowerment which was summed up by “experiencing powerlessness” , “gaining NHI awareness” , “learning new curriculum goals” and ”making contributions” inferred that teachers felt frustrated with the issue of health insurance at the beginning； however after participating the curriculum, they clarified many previous myths, brought new opinions on promoting health care education and affected more teaching partners with their enthusiasm. Finally, the psychological empowerment theory based on this study can take as a reference in the future to adjust teachers’ learning needs, enhance the effectiveness of teaching in school, and promote NHI education programs as well. Furthermore, this study is a model to modify the local NHI programs in the future.