葉酸點數表之研發以及應用於營養教育之成效性評估

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標題:	葉酸點數表之研發以及應用於營養教育之成效性評估 Development of Counting System for Folic Acid and Evaluation of Its Applications on Nutrition Education
作者:	黃姵秀
貢獻者:	保健營養系鄭裕耀
關鍵字:	葉酸點數表營養教育介入研究育齡婦女跨理論模式 point-counting list folic acid counting system intervention study Transtheoretical model women of childbearing age nutrition education
日期:	2012
上傳時間:	2013-01-07 16:42:20 (UTC+8)
摘要:	摘要本研究目的為建立「葉酸點數表」並將點數表工具應用於營養教育介入，由計算點數的方法讓育齡婦女能夠估算自身的葉酸攝取量。第一部分為發展「葉酸點數表」，葉酸點數表的研發乃參考鎂及鉀點數表研發，希望可應用於營養專業人士於營養諮詢指導民眾攝取葉酸。食物中葉酸含量參考台灣、日本及美國的食物營養成分資料庫，點數表的建立是將各項食物由單位重量所含的葉酸含量換算為葉酸點數─ 少於10微克為0點，少於30微克為1點，每增加20微克則增加1點，依此類推。第二部分為「葉酸點數表」的應用，於南部某大學的進修部及研究所內招募育齡年齡的女性學生，其平均年齡23.0±3.6歲 (年齡範圍18~43歲)，共計135位受試者，採方便取樣。分為對照組（40名）及衛教介入組，其中衛教介入組包含傳統衛教組（47名）、及點數衛教組（48名），傳統衛教組及點數衛教組分別接受傳統葉酸營養教育及葉酸點數表營養教育，介入方式為電話教學配合衛教單張，對照組則不接受任何教育活動介入。本研究以跨理論模式 (Transtheoretical model, TTM) 的因素作為問卷設計的理論基礎。所有受試者分別於營養教育介入前填寫飲食問卷收集其基本資料、營養知識及攝取葉酸行為之社會心理因子，並以24小時飲食回憶記錄收集受試者一日葉酸攝取量。介入後一周內予以飲食問卷及飲食回憶記錄，介入後兩周再次以電話訪問飲食問卷。結果顯示，前測葉酸平均攝取量226.6±201.9微克，未達到行政院衛生署每日400微克之建議攝取量。點數衛教組葉酸攝取量前測與介入後一周內後測相比 (231.4±179.6微克vs. 350.95±201.8微克)，達顯著差異 (p<0.05)。「營養素攝取量」與「點數攝取量」的相關性分析，顯示彼此間葉酸攝取量與葉酸點數達高度相關 (r=0.988, p<0.01) 。在行為改變階段的比較性分析中，發現衛教介入組不論在介入後一週內後測或介入後兩週後測皆比處在沉思期的對照組更趨於行動或準備期。當檢驗影響葉酸攝取之障礙因子的效應時，發現對照組與兩組衛教介入組之間在介入後一週內後測達顯著差異 (p<0.05)。自我效能方面，介入後一週內後測，對照組與兩組衛教介入組之間達顯著差異 (p<0.05)。介入後一週內後測及介入後兩週後測營養知識的得分，對照組與兩組衛教介入組之間皆達顯著差異 (p<0.05)。綜合上述，本研究發展一個創新的「葉酸點數表」來評估葉酸攝取量。此「葉酸點數表」可以增加葉酸攝取量、促進自我效能、提升營養知識、以及降低葉酸攝取行為之障礙。此外，亦可幫助葉酸攝取相關行為改變階段自沉思期往前移動至下一階段，如準備期或行動期。在實際應用上，期望「葉酸點數表」可以成為一有用的工具來幫助民眾作為評估葉酸攝取量之用，以及協助健康或營養專業人員執行有效的營養教育或諮詢工作。 Abstract The purpose of this research is to develop counting system for folic acid and to apply it on nutrition education intervention. By using the counting system, women in their childbearing age can calculate the intake of folic acid and evaluate its effectiveness. The first part of the study was to establish counting system for folic acid, determined by reference to the research and development of magnesium- and potassium-counting system. Based on the amount of folic acid, the counting system was established, which could be used for health professionals to guide people in nutrition counseling for evaluation of folic acid consumption. The reference resources of the amounts of folic acid of food obtained are from USDA Agricultural Research Service Nutrient Data Laboratory, Japan Science and Technology Agency Food Composition Database, and Taiwan Nutrient Data Laboratory Database. The counting system of folic acid is the conversion of folic acid contents from the weights (μg) of foods to points: less than 10 μg is scored as 0 point, and less than 30 μg is scored as one point, and then every 20 μg adds one point and so on. The second part of the study was to evaluate the effectiveness of folic acid counting systems applying into nutrition intervention. A total of 135 female university students from the school located on Southern Taiwan participated in this study. With an averaged age of 23.0±3.6 years old, their age ranged from 18 to 43 years old. The subjects were assigned into two groups: control group and nutrition education intervention group. There are two nutrition education intervention group, including traditional nutrition education group, which was treated with traditional folic acid nutrition education, and the counting system nutrition education group, which was treated with nutrition education based on folic acid counting system.Based on the Transtheoretical model, a diet survey questionnaire was developed as the measuring tool. All subjects completed the pre-intervention diet survey, which included folic acid-related knowledge, folic acid intake-related psychosocial factors , and personal information. Data on consumption of folic acid were collected according to 24-hour dietary recall before the intervention. One week after intervention, subjects (including subjects from control group who did not receive any intervention) were asked to complete the second 24-hour dietary recall. Also, a second diet survey was conducted within one week after intervention.Two weeks after intervention, the subjects completed the third diet survey over the phone by the researcher. The results showed the average of pre-intervention folic acid consumption was 226.6±201.9 μg per day, less than the recommended requirement of 400μg per day. For the counting system nutrition education group, significant difference was found while comparing the folic acid consumption between the periods of pre-intervention and one-week-after-intervention (231.4±179.6 μg vs. 350.95±201.8 μg, p<0.05). In the correlation analysis of two different calculation approaches on folic acid consumption, by food contents and by counting system, it showed that they were highly correlated (r=0.988, p<0.01). In terms of the stages of change, both nutrition education intervention groups either in 1-week-after-ntervention or 2-week-after-intervention period tended to move towards the preparation and/or action stages, while control group tended to be stay in the contemplation stage. It also showed significant differences between the control group and two nutrition education intervention groups with 1-week-after intervention on the effects of cons in decisional balance relative to folic acid intake (p<0.05). For self-efficacy, there were significant differences between the control group and two nutrition education intervention groups with 1-week-after intervention (p<0.05). Both two nutrition education intervention groups scored higher than the control group in nutrition knowledge at the periods of 1-week-after- and 2-week-after-intervention. In summary, this study developed an innovative approach of folic acid counting system to evaluate the folic acid consumption. It suggested that this counting system could increase the folic acid intake, facilitate self-efficacy, improve nutrition knowledge, and reduce individual barriers relative to folic acid consumption. Besides, it might also be helpful to assist individuals to move their stages of behavioral change related to folic acid intake from contemplation toward later stages such as preparation or action. In application, the folic acid counting system may become an useful tool to help people evaluate their daily folic acid intake, as well as to assist health professionals on their nutrition education or counseling practice.
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