The Suitability of Self-management Materials for School-age Children with Asthma

背景：氣喘之盛行率逐年增加，已是全球公認盛行率與花費最高的兒童健康問題，許多學者探討自我管理計畫對學齡期氣喘兒童疾病控制之成效，而教材之適用性，將影響氣喘管理指導之成效。因此，國外近十年已開始重視教材之適用性，但國內尚未針對學齡期兒童氣喘教材進行適用性之調查。 目的：本研究主要目的在探討，臨床學齡期兒童氣喘教材適用性情形，以及教材是否為學齡期氣喘兒童接受、理解及期待之學習教材。 方法：本研究採混合型方法進行二個階段研究，第一階段為問卷調查法，先公開收集全國的兒童氣喘教材，再邀請5位氣喘照護專家以臺灣版教材適用性評估量表（Suitability Assessment of Materials in Taiwan）評估教材之適用性。第二階段以半結構式會談方式，收集學齡期氣喘兒童針對專家評選出最適用的3份教材之學習經驗及回饋。 結果：共收集到25份適用於學童之氣喘教材，包括手冊類9份、單張類11份及影音光碟類5份，出版年份由2000年至2010年，僅6份教材有註明參考資料來源，14份教材由藥物廠商出版，11份由氣喘照護機構出版，教材內容以手冊類及影音光碟類較為完整，單張類以單一教學主題為主。專家適用性評估結果，9份手冊類教材中，7份為優等教材，2份為合適教材，閱讀能力級別僅1份由專家一致認為適用於5年級以下學校教育，其餘教材皆有專家認為部分內容需6年級以上學校教育；11份單張類教材中，5份為優等教材，6份為合適教材，閱讀能力級別皆有專家認為部分內容需6年級以上學校教育；5份影音光碟類教材皆為優等教材。教材基本屬性與適用性分數之關係，經無母數統計分析結果為，影音光碟類教材適用性分數高於手冊類教材及單張類教材；氣喘照護機構出版之教材，適用性分數高於藥物廠商；教材內容越豐富完整，適用性分數越高；氣喘照護機構出版之教材內容項目，高於藥物廠商；影音光碟類教材內容項目，高於手冊類教材及單張類。 質性訪談結果歸納出兩個現象：氣喘疾病概念建立三部曲與氣喘疾病概念建立的手扶梯。「氣喘疾病概念建立三部曲」包含三個主題：（1）知覺氣喘疾病的狀況，其次主題為：由自身經驗體認氣喘症狀、思索氣喘與慢性呼吸道發炎的關連、認識尖峰呼氣流速計的功能、臆想且體驗喘鳴聲、認定氣喘不會傳染、體驗到規則用藥的好處（2）反思後提出疑問，其次主題為：我有用吸入型氣喘保養藥物跟抗發炎藥物嗎？過敏原與非過敏原刺激物有何不同？為什麼吸藥後要漱口？咽、支氣管跟肺泡是什麼？（3）找出自我照顧的難題，其次主題為：幫我算尖峰呼氣流速值、幫我確認吸藥技巧。「氣喘疾病概念建立的手扶梯」包含三個主題：（1）獲得大人的指引，其次主題為：告訴我氣喘是什麼、教我認識呼吸道、學習吸藥後漱口（2）在趣味中學習，其次主題為：卡通動畫及故事融入影片、電腦互動遊戲及紙本教材搭配學習（3）貼近兒童的學習需求，其次主題為：注音符號易於閱讀、看影片學操作技巧、想更瞭解自己。 結論：綜合量性與質性研究結果發現，影音光碟類教材適用性分數較高，內容豐富完整，深受學齡期兒童吸引與喜愛。設計適用於兒童之教材，須依據兒童疾病概念、認知發展以及識讀能力，教材設計完成後，需測試教材適用性程度，並邀請兒童參閱，獲得兒童對教材的回饋意見，做最後修正，發展出適用於兒童需求之氣喘教材。Background: As the prevalence of asthma has been increasing over the years, it has been recognized as a problem having the highest prevalence and cost to children’s health worldwide. Many scholars discussed the effects of self-management programs for asthma control among school-age children. It was shown that the suitability of materials will affect the performance of asthma management and guidance. As a result, the suitability of materials has begun to receive attention in the past decade over studies abroad. However, the investigating for the suitability of materials for school-age children has never yet been done in Taiwan. Objective: The purpose of this study is to discuss the suitability of asthma materials to clinical school-age children, and whether are they learning materials which can be accepted, comprehended and expected to school-age children having asthma. Methods: A mixed methods research design combing two stage approaches was conducted. The first stage was based on questionnaire survey, in which materials of asthma in children all across the country were publicly collected, followed by inviting 5 asthma care specialists to assess the suitability of materials based on the Suitability Assessment of Materials in Taiwan. The second stage applied semi-structured interviews to collect the learning experience and feedback among 3 materials which the experts selected as the most suitable for school-age children with asthma. Results: A total of 25 pieces of asthma materials suitable to school-age children were collected. The materials consisted of 9 brochures, 11 single sheets, and 5 DVD-ROMs. The year of publication of the collected materials was from 2000 to 2010; only 6 of materials notified the data source, 14 were published by drug manufacturers and 11 were published by asthma care institutions. The brochures and DVD-ROMs had a rather integrated content, whereas the single sheets were based on a single topic. The results from the specialist assessment indicated 7 out of the 9 brochures were rated as superior material, where 2 were adequate material. Only 1 brochure was considered by the specialists to have a reading grade level suitable for 5 years of schooling level or lower, whereas the remaining materials have been considered by one or more specialists to be only suitable for 6 years of schooling level or higher; 5 out of the 11 single sheets was rated as superior material, where 6 were adequate material. All of the single sheets were considered by one or more specialists to be only suitable for 6 years of schooling level or higher; all of the 5 DVD-ROMs were rated as superior material. The relation between the basic attributes and suitability of materials were analyzed by using nonparametric statistics. Results showed that the DVD-ROMs had higher suitability scores than brochures and single sheets; the materials published by asthma care institutions had higher suitability scores than published by drug manufacturers; the materials which are more integrated and content rich resulted with a higher suitability scores; the items issued by asthma care institutions were higher than drug manufacturers; the items in DVD-ROMs were higher than those in brochures and single sheets. The results of qualitative interviews summarized two phenomena: The concept of asthma is constructed as a trilogy and escalator. The “trilogy construction in asthma concepts” includes three themes: (1) Perception of asthma, with subthemes in: Recognizing asthma symptoms from self experience, think about the relationship between asthma and chronic airway inflammation, recognize the function of a peak expiratory flow meter, imagine and experience wheezing, knowing that asthma is not contagious, and realizing the benefits of taking medication regularly; (2) Proposed questions after thinking, with subthemes in: Do I use inhalation type asthma drugs or anti-inflammatory drugs? What''s the difference between allergen and non-allergen irritants? Why do we need to rinse our mouth after inhaling drugs? What are the pharynx, bronchus and alveolar? (3) Identifying the difficulties in self care, with subthemes in: Find help for calculating the peak expiratory flow rate, and find help to confirm my drug inhaling techniques. The “escalator construction in asthma concepts” includes three themes: (1) Receive guidance from adults, with subthemes in: Tell me what is asthma, teach me about the respiratory tract, and learning to rinse one’s mouth after inhaling drugs; (2) Learning with fun, with subthemes in: Blending cartoon animations and stories into the video, combine interactive computer games with print-based education material; (3) Stay close to the children''s learning needs, with subthemes in: Pronunciation code characters are easy to read, learning operating skills while watching a video, and want to learn more about oneself. Conclusion: From the results by quantitative and qualitative research, it can be found that DVD-ROMs had a higher suitability scores, having an integrated content, and deeply appealing and liked by school-age children. The designing of materials suitable to children is required to be based on the children’s disease concept, cognitive development and reading abilities. Once the designing of the education material is finished, the suitability level of the material needs to be tested. In addition, children should be invited to collect feedback opinions of their perspectives to the education material. The final step is revising the material for developing an asthma education material suitable for school-age children