臺灣博碩士論文加值系統

在2005年~2010年臺灣國民營養健康狀況變遷調查顯示青少年鈣質攝取量明顯不足，因此本研究目的為經由營養教育促進國中生之鈣質攝取行為。課程設計以健康信念模式 (Health Belief Model, HBM)、跨理論模式 (Transtheoretical Model, TTM) 及社會生態模式 (Social-Ecological Model, SEM) 為基礎，並評估該課程對國中生鈣質攝取之認知、行為及態度 (knowledge, attitude, and practice; KAP) 之成效。187名學生分為實驗組 (營養教育介入，共163人) 及控制組 (未介入，共24人) ，於2015年9月至11月間接受七周營養課程。兩組學生於課程前後填寫KAP問卷，實驗組並於課程後以二十四小時飲食回憶法紀錄飲食內容，再以成對樣本T檢驗分析課程前後之得分差異。結果顯示，營養教育後，學生鈣質營養知識分數提升30%，以「富含鈣質食物來源」、「骨質量顛峰期年齡」答對比率最高，以「不利鈣質吸收的蔬菜」答對比率提升最多(由16.3%至74.8%)。其中，八年級組在鈣質食物可獲性及可及性、人際關係分數改變較七年級及九年級組高，而七年級組在認知分數上提升幅度最為明顯 (平均2.6分提升至4.3分)，九年級組則在採取健康飲食之行為態度表現提升較多 (27.7至28.2)。體型分組統計則發現，體重過輕組雖在營養知識分數較其他體型組進步為大，但在態度及行為分數反而降低 (28.3至26.3)，推測其執行力較弱。再將學生依跨理論模式行為改變階段分期發現，營養教育介入後多數學生進入維持期 (113人增至123人)，且維持期之學生在營養教育後較能感受到周遭家人、教師、同儕對健康行為的鼓勵，也能主動攝取或購買高鈣食物以維持健康；而行動期之學生在鈣質知識、行為態度之分數進步較多 (分別為2.9至5.0、29.8至31.8)。分析飲食紀錄發現，接受鈣質營養教育的學生能選擇牛奶、起士片等乳製品作為早餐，並能明確寫出營養午餐中富含鈣質的食物種類，且進一步應用在烹飪實習菜單中。綜合以上，在國中執行七周鈣質營養教育課程具有增加學生營養知識之成效。

關鍵字：鈣質攝取、營養教育、國中、青少年、二十四小時飲食回憶法

The Nutrition and Health Survey in Taiwan from 2005 to 2010 revealed that inadequste calcium consumption in adolescent. The aim of this study was to promote calcium intake behaviors in junior high school students via nutrition education. This study evaluated the effects of a nutrition education program based on the Health Belief Model, Transtheoretical Model and Social-Ecological Model on knowledge, attitude, and practice (KAP) of dietary calcium intake in junior high school students. 187 students were placed into intervention (163) and control (24) groups in this study during the September to November 2015. The intervention group participated in a 7-week nutrition education program. Students in both the groups completed a KAP questionnaire at baseline and after a 7-week intervention; students in intervention group performed dietary record by 24-hour dietary recall. The data were analyzed by paired t-tests. The results showed a significant increase in the mean score of knowledge 30%. More than 90% of held correct concept about “calcium-rich foods”, and “the age of peak bone mineral density” in the intervention group. Compare with the pre- and post-test, the correct rate is raise from 16.3% up to 74.8% in the “low bioavailability of the calcium-rich vegetable”. In intervention group, the mean score in 8th grade group increase in available and reachable calcium-rich food than 7th and 9th grade group. The 7th grade group improve in knowledge of calcium nutrition (2.6 to 4.3). The 9th grade group exhibited improve in nutritional attitude and practice of calcium intake (27.7 to 28.2). The underweight students in intervetion group has show decrease in evaluation of the outcome, the strength of the belief (28.3 to 26.3) and self-efficacy (15.8 to 13.5). These results suggested that the underweight students are lack of motivation. In different groups of the five behavior-change stages on Transtheoretical Model, after nutrition education, most of the students move to maintance stage (113 to 123). It shows the good effect on classmates’, parents’ and teachers’ calcium-rich food intake who are arround the in maintance-stage students that promote their intention to their calcium intake. The scores of knowledge, attitude and practice were increased in the action-stage students (2.9 to 5.0, and 29.8 to 31.8, respectively), and the scores of the action-stage students were significant higher than the other stages’. By using 24-hour dietary recall, the results revealed that the intervetion group students can choose dairy products for breakfast, and identify calcium-rich food ingredients in lunch offering at school. Besides, students of intervetion group are able to plan and prepare calcium-rich meals. The results of this study showed that a 7-week calcium intake education program had positive impact on the nutrition knowledge of adolescent.

Key words: Calcium intake, nutrition education, junior high students, adolescents, 24-hour dietary recall method.

摘要 I
Abstract II
目次 III
圖次 IV
表次 V
第一章 緒論 1
第二章 文獻回顧 2
第一節 鈣的生理作用 2
第二節 鈣質吸收之外在因子 2
第三節 鈣質吸收之內在因子 3
第四節 阻礙鈣質吸收的因素 4
第五節 青少年飲食選擇相關的家庭因素 5
第六節 青少年飲食選擇相關的學校因素 5
第七節 青少年飲食選擇相關的社會因素 8
第三章 研究設計 10
第一節 實施流程 10
第二節 研究對象 11
第三節 營養教育課程內容 11
第四節 資料分析 15
第四章 結果 17
第一節 受試者基本資料 17
第二節 鈣質營養教育之成效 17
第三節 鈣質攝取量成效評估 18
第五章 討論 21
第六章 結論與建議 23
參考文獻 24
附錄 45
附錄一：鈣質攝取營養教育課程-鈣質營養知識教材 45
附錄二：鈣質攝取營養教育課程-鈣質食物份量圖鑑 47
附錄三：鈣質攝取營養教育課程家長同意書 48

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