「全校性健康五蔬果」介入計劃對國中學生每日攝取五蔬果及相關因素之影響—以彰化縣立鹿鳴國中學生為例

Abstract

本研究主要目的在發展一個「全校性健康五蔬果」介入計畫，並進一步探討其介入效果。

本研究採「前測－後測不等組」實驗設計，分實驗組一、實驗組二及對照組。實驗組一及實驗組二為彰化縣立鹿鳴國中一年級學生，對照組為社經地位背景相近的彰化縣立和群國中一年級學生，各採三個班級為研究對象。

「全校性健康五蔬果」介入計畫，分成班級性教學活動及全校性教學活動，各實施四週。實驗組一先接受班級性教學活動，再接受全校性教學活動介入，實驗組二只有接受全校性教學活動介入，且實驗組學校的營養午餐，每天至少供應一道青菜，每週至少供應兩次水果，而對照組則不接受任何實驗處理與支持性環境的改變。

研究工具為前後測自填式結構性問卷，問卷回收率達98.11%。經前後測資料比對後，扣除無效問卷，最後有效人數為306人，佔95.92%（實驗組一104人，實驗組二109人，對照組93人）。

研究結果如下： 1. 「全校性健康五蔬果」介入計畫實施後， （1）實驗組一「每日五蔬果認知」「每日五蔬果自覺利益」「每日五蔬果社會支持」「每日五蔬果行為」後測得分高於前測且達顯著差異；「每日五蔬果自覺障礙」後測得分低於前測且達顯著差異。

（2）實驗組二「每日五蔬果認知」「每日五蔬果自覺利益」「每日五蔬果社會支持」「每日五蔬果行為」後測得分高於前測且達顯著差異；「每日五蔬果自覺障礙」前後測得分則未達顯著差異。 2. 「全校性健康五蔬果」介入計畫實施後，在控制前測得分下， （1）實驗組一「每日五蔬果認知」後測得分高於實驗組二且達顯著差異；「每日五蔬果自覺障礙」後測得分低於實驗組二且達顯著差異；「每日五蔬果自覺利益」「每日五蔬果社會支持」「每日五蔬果行為」與實驗組二未達顯著差異。

（2）實驗組一「每日五蔬果認知」「每日五蔬果自覺利益」「每日五蔬果社會支持」「每日五蔬果行為」後測得分高於對照組且達顯著差異；「每日五蔬果自覺障礙」後測得分低於對照組且達顯著差異。

（3）實驗組二「每日五蔬果自覺利益」「每日五蔬果社會支持」「每日五蔬果行為」後測得分高於對照組且達顯著差異；「每日五蔬果認知」「每日五蔬果自覺障礙」後測得分與對照組未達顯著差異。

根據本研究結果，建議未來在發展每日五蔬果教育計畫課程時，應根據行為改變階段理論、社會認知理論、溝通說服模式、社會支持策略及影響每日五蔬果攝食行為的重要變項，發展一個包含全校健康促進理念的支持性環境改變及全面教學介入的計畫，而且教育活動必需包括媒體造勢及鼓吹（media - marketing campaign）活動，透過此全面性整合的教育方式，可增強學生改變的興趣與意願，且對學生每日五蔬果行為亦產生顯著提昇的效果。

The purposes of this study were to develop an effective comprehensive 5-A-Day intervention program, and to determine the effectives of the intervention program. Quasi-experimental method was used to explore the effect of the campaign on junior high school students. Lu-Ming junior high school(experimental group 1 and experimental group 2)and Ho-Ching junior high school(control group)in Chanhwang were selected as the subjects. The 5-A-Day intervention program consisted of 3 components: 5 classroom activities, 5 school-wide activities, and school food service changes. Experimental group 1 took part 5 classroom activities and 5 school-wide activities, but experimental group 2 took part 5 school-wide activities only. In experimental school, vegetables were served every day and fruits served two days a week at school lunch. A closed-ended pre-posttest questionnaire was the instruments used to evaluate the intervention effectiveness. There were 306 students finished the pre-test and the post-test questionnaires(104 students for the experimental group 1, 109 students for the experimental group 2, 93 students for the control group). The data was analyzed by using paired-t-test, Chi-square test, one-way ANCOVA, and Wilcoxon’s sign-rank test with SAS 8e statistical software package.The result of the study were as follow: 1. In the experimental group 1, the mean scores of knowledge, Prons, social support, and behavior about 5-A-Day in the post-test were better than the scores in the pre-test, and their differences were significant. In the experimental group 1, the mean score of the Cons about 5-A-Day in the post-test was less than the score in the pre-test, and its difference is significant. 2. In the experimental group 2, the mean scores of knowledge, Prons, social support, and behavior about 5-A-Day in the post-test were better than the scores in the pre-test, and their differences were significant. In the experimental group 2,the difference of the mean score about 5-A-Day Cons in the post-test and in the pre-test was no significant. 3. The mean score of knowledge about 5-A-Day in the post-test of the experimental group 1 is better than the core in the experimental group 2. The mean score of Cons about 5-A-Day in the post-test of the experimental group 1 was less than the core in the experimental group 2.The differences of the mean scores about 5-A-Day Cons, social support, and behavior in the experimental 1 and in the experimental 2 were no significant. . 4. The mean scores of knowledge, Prons, social support, and behavior about 5-A-Day in the post-test of the experimental group 1 were better than the cores in the control group. The mean score of Cons about 5-A-Day in the post-test of the experimental group 1 was less than the core in the control group. 5. The mean scores of Prons, social support, and behavior about 5-A-Day in the post-test of the experimental group 2 were better than the cores in the control group. The differences of post-test mean scores about 5-A-Day knowledge and Cons in the experimental 2 and in the control group were no significant. According to the findings of this study, some recommendations for the future 5-A-Day intervention program: health educators should accord strategies of behavior change, social cognitive theory, health communication theory, social support and other important items to development a comprehensive program that contains health school promotion concept, school environment changes, and media marketing campaign. Implementing the comprehensive intervention program will trigger off students’ changing motivation and their 5-A-Day effectiveness was proved.