發(fā)布時(shí)間：2018-02-15 23:51

  本文關(guān)鍵詞： 跨理論模型 體重控制 變化過程 肥胖兒童 體育鍛煉　出處：《中南大學(xué)》2012年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：以跨理論模型(The Transtheoretical Model, TTM)動(dòng)機(jī)性訪談(Motivational Interviewing, MI)為理論基礎(chǔ),對肥胖兒童體重進(jìn)行干預(yù),并對處于不同鍛煉、認(rèn)知階段的肥胖兒童采取相應(yīng)的干預(yù)策略,同時(shí)評估干預(yù)的效果；探索一種實(shí)用、簡單、易堅(jiān)持的肥胖兒體重控制干預(yù)模式,提高干預(yù)的針對性。 方法：本研究為實(shí)驗(yàn)性研究。經(jīng)預(yù)試驗(yàn)完善干預(yù)方案、評估工具及調(diào)查問卷后,采取隨機(jī)抽樣方法抽取長沙市2所小學(xué)符合標(biāo)準(zhǔn)的128例肥胖兒童(其中一所小學(xué)65例,另一所小學(xué)63例),按學(xué)校隨機(jī)分為干預(yù)組和對照組�；�評估后,對干預(yù)組肥胖兒童及其減肥支持者發(fā)放《肥胖兒童健康教育自評手冊》,并對處于鍛煉前意向、意向階段的肥胖兒童實(shí)施動(dòng)機(jī)性訪談以增強(qiáng)其體重控制的動(dòng)機(jī),而對照組不采取任何干預(yù)措施。分別在基線(T0)、干預(yù)1個(gè)月(T1)干預(yù)3個(gè)月(結(jié)束,T3)、隨訪(基線后第6個(gè)月,T6)對兩組肥胖兒童進(jìn)行同樣評估跟進(jìn)4次,在基線評估后5-8天、干預(yù)1個(gè)月評估后、干預(yù)2個(gè)月評估后發(fā)放跟進(jìn)報(bào)告3次；跟進(jìn)報(bào)告是根據(jù)肥胖兒童所填寫評估問卷,總結(jié)減肥現(xiàn)狀、存在的問題及應(yīng)采取相應(yīng)的對策等。干預(yù)前后對兩組肥胖兒童的體育鍛煉情況(室、內(nèi)外平均鍛煉時(shí)間、堅(jiān)持鍛煉30min、3d、7d及以上次數(shù))、與支持者的溝通情況(溝通頻率、溝通效果)、減肥過程(變化階段、自我效能、決策平衡、變化過程)、膳食情況(蔬菜、水果、葷菜)、體質(zhì)指數(shù)(BMI)進(jìn)行評價(jià),評估干預(yù)的效果。在T6時(shí)點(diǎn),對干預(yù)組進(jìn)一步評價(jià)干預(yù)方法對鍛煉情況、與支持者的溝通情況、減肥過程、膳食情況、體重指數(shù)(BMI)的干預(yù)效果。 結(jié)果： 1.基線資料分析：128例肥胖兒童中,大部分肥胖兒童都處于前意向/意向/準(zhǔn)備階段(65.6%),處于行動(dòng)/保持階段的肥胖兒童較少,通過鍛煉來控制體重的意識淡薄。 2.干預(yù)后資料分析 (1)體育鍛煉行為情況 重復(fù)測量方差分析結(jié)果顯示,鍛煉30min、3d、7d及以上次數(shù)的干預(yù)主效應(yīng)、時(shí)間主效應(yīng)以及干預(yù)和時(shí)間的交互作用均具有統(tǒng)計(jì)學(xué)意義(P0.05)。輪廓交互圖顯示,在干預(yù)6個(gè)月期間,隨著時(shí)間的變化,干預(yù)組鍛煉30min、3d、7d及以上次數(shù)的上升幅度大于對照組。對干預(yù)組和對照組的室內(nèi)、外平均鍛煉時(shí)間做變化趨勢圖,結(jié)果顯示干預(yù)組肥胖兒童室內(nèi)、外平均鍛煉時(shí)間隨時(shí)間延長增加幅度大于對照組。 對兩組肥胖兒童在不同時(shí)間點(diǎn)(T0、T1、T3、T6)的鍛煉情況進(jìn)行組間比較顯示,基線(T0)測評時(shí),兩組鍛煉30min、3d、7d及以上次數(shù)的差異無統(tǒng)計(jì)學(xué)意義(P0.05),而干預(yù)組在T1、T3、T6時(shí)點(diǎn)的鍛煉次數(shù)均顯著高于對照組(P0.05) (2)飲食行為情況 采用z2檢驗(yàn)對不同時(shí)點(diǎn)的水果、蔬菜、葷菜食用次數(shù)進(jìn)行分析并做變化趨勢圖,結(jié)果表明干預(yù)組肥胖兒童的葷菜食用次數(shù)隨時(shí)間延長有減少的趨勢,蔬菜、水果有增加的趨勢。 (3)與支持者溝通情況 對不同時(shí)點(diǎn)(T0、T1、T3、T6)的肥胖兒童與支持者溝通頻率及滿意度進(jìn)行分析,結(jié)果顯示,基線評估時(shí),干預(yù)組與對照組溝通頻率及滿意度的差異均無統(tǒng)計(jì)學(xué)意義(P0.05),而干預(yù)組在T1、T3、T6時(shí)點(diǎn)與支持者的溝通頻率、溝通滿意度均顯著高于對照組(P0.05) (4)體重控制過程 重復(fù)測量方差分析結(jié)果表明,變化過程的認(rèn)知過程、行為過程、自我效能、決策平衡的知覺利益、知覺障礙的干預(yù)主效應(yīng)、時(shí)間主效應(yīng)以及干預(yù)和時(shí)間的交互作用均具有統(tǒng)計(jì)學(xué)意義(P0.05)。輪廓交互圖顯示在干預(yù)的3個(gè)月期間及隨訪,隨著時(shí)間的變化,干預(yù)組認(rèn)知過程、行為過程、自我效能、知覺利益、知覺障礙得分顯著高于對照組。 對兩組肥胖兒童不同干預(yù)時(shí)間點(diǎn)的鍛煉減肥各指標(biāo)進(jìn)行組間比較,結(jié)果顯示：基線時(shí),兩組的變化階段、認(rèn)知過程、行為過程、自我效能、知覺利益、知覺障礙的差異均無統(tǒng)計(jì)學(xué)意義(P0.05),干預(yù)1個(gè)月、3個(gè)月、隨訪時(shí),兩組各指標(biāo)的差異均具有統(tǒng)計(jì)學(xué)意義(P0.05)。 (5)體質(zhì)指數(shù)(BMI)情況 對不同時(shí)點(diǎn)(T0、T1、T3、T6)的BMI進(jìn)行分析并做變化趨勢圖,結(jié)果表明干預(yù)組肥胖兒童的BMI隨時(shí)間延長降低幅度與對照組比較,差異無統(tǒng)計(jì)學(xué)意義。 (6)干預(yù)6個(gè)月后是否參與鍛煉的解釋和預(yù)測模型 隨訪后,擬合廣義估計(jì)方程(Generalized Estimating Equations,GEE)分析結(jié)果表明,性別、年齡、知覺利益對是否參與鍛煉無顯著影響(P0.05)；評估時(shí)間與是否堅(jiān)持鍛煉呈正相關(guān),系數(shù)為0.383,有統(tǒng)計(jì)學(xué)意義(P0.05),認(rèn)知過程、行為過程、自我效能、決策平衡中知覺障礙得分、減肥目標(biāo)、鍛煉7d及以上次數(shù)與是否堅(jiān)持鍛煉呈正相關(guān),均有統(tǒng)計(jì)學(xué)意義(P0.05)；經(jīng)調(diào)整以上各因素后,干預(yù)組和對照組是否能夠參與鍛煉有顯著差異(P0.05) 結(jié)論： 1.基于體育鍛煉的TTM干預(yù)模式可以使堅(jiān)持鍛煉30min、3d、7d及以上次數(shù)增加；使肥胖兒童與支持者的溝通情況得到改善,溝通頻率、滿意度增加。 2.干預(yù)使肥胖兒童所處變化階段向前推進(jìn)；同時(shí)促使變化過程向有益于體重控制的方向改善。 3.TTM對體質(zhì)指數(shù)(BMI)的干預(yù)效果有待進(jìn)一步的研究。
[Abstract]:Objective: Based on the transtheoretical model (The Transtheoretical Model, TTM) motivational interviewing (Motivational Interviewing, MI) as the theoretical basis, intervention on obese children's weight, and in different stages of cognitive exercise, obese children take corresponding intervention strategies, and to evaluate the effect of intervention; to explore a practical, simple obesity infant weight control intervention model easy to adhere to, improve the relevance of the intervention.
Methods: This was an experimental study. The pre test perfect intervention programs, assessment tools and questionnaires, 128 obese children selected by random sampling method Changsha 2 primary school standard (65 cases, 63 cases of a primary school in another primary school), according to the school were randomly divided into intervention group and the control group. After baseline assessment, intervention group of obese children and their supporters issued "obese children health education Handbook > and self rating, in the exercise before the intention, the intention stage of obese children in the implementation of motivational interviewing to enhance their motivation to weight control, while the control group did not take any intervention measures at baseline (T0 respectively.), 1 months of intervention (T1) intervention for 3 months (over T3), follow-up (sixth months after baseline, T6) were also assessed in follow up 4 times in two groups of obese children were evaluated at baseline and 5-8 days after intervention, 1 months after the assessment, intervention 2 months after assessment issued to In the report of the 3; the follow-up report is based on obese children fill in questionnaire, summarize the weight loss status, existing problems and corresponding strategies. The physical exercise of the two groups of obese children before and after the intervention (both inside and outside the room, the average exercise time, exercise 30min, 3D, 7d and above the number), and communication supporters of the situation (the frequency of communication, communication effect, the weight loss process (stage), self-efficacy, decisional balance, process of change), diet (vegetables, fruit, meat), body mass index (BMI) were evaluated to assess the effect of intervention. The intervention group in T6 time, further evaluation of intervention on exercise the situation, and communication, supporters of the weight, diet, body mass index (BMI) of the intervention effect.
Result錛，

本文編號：1514171