運用多媒體團體衛教課程改善妥瑞兒童心理社會壓力

Reduction Psycho-Social Stress in Children with Tourette Syndrome by a Multimedia Group Education Program

妥瑞症（Tourette syndrome）是一種於兒童時期出現聲音或動作抽動（tics）的長期性疾病。抽動頻率因人而異，一天數次至一分鐘數十次。突然、快速、簡短聲音或動作，造成妥瑞兒童日常生活上的困擾、引起別人異樣眼光，甚至因症狀被處罰，承受比一般兒童更多的心理社會壓力。我們發展改善妥瑞兒童心理社會壓力多媒體課程，並評估此介入在10-18 歲妥瑞兒童提升疾病知識態度與改善壓力的成效。以社會學習理論設計課程內容。採有對照組前後測的團體衛教介入。實驗組接受4 週的課程，對照組則不給予介入措施。前測（T0）、1（T1）、3（T3）個月填寫妥瑞兒童壓力量表（SICATS）及日常生活壓力量表（DLSS），以重複測量變異數分析（repeated measure ANOVA）分析兩組的差異。2009 年11 月至2010 年5 月間，實驗組22 人，對照組43 人完成試驗。實驗組的知識由T0 的63.9 分提升至T1 的84.1 分（p = .002）。討厭疾病態度，由T0 的5.08 分下降至T1 的3.64 分（p = .019）。SICATS （實驗組T0=46.95，T1=46.59，T3=43.86；與對照組T0=43.70，T1=43，T3=42.14）及DLSS（實驗組T0=26.53，T1=27.77，T3=27.77；與對照組T0=26.91，T1=27.58，T3=29.14）在兩組均無顯著差異。改善妥瑞兒童心理社會壓力多媒體團體衛教課程可提升妥瑞兒童的疾病知識，降低對疾病的討厭程度，但未看到壓力明顯下降。未來可以考量較大樣本數、更長追蹤時間、以新診斷病童為研究對象或依年齡群提供衛教不同重點，再評估此教材之成效。

Tourette syndrome (TS) is a chronic tic(s) disorder which occurs in childhood. Children with TS may have tic(s) many times per day, even many times per minute. These sudden, fast and short voices or movements affect their daily activities, and cause interaction barriers among children with TS. Anger, depression, low self-esteem will appear afterward. Children with TS are delayed to unaware their actual medical problem. Children with TS are easily mistreated or punished due to their tics. All of these increase physical, psychological and social stress for children with TS. Aims: (1) to develop an educational multimedia to reduce psycho-social stress in children with TS, and (2) to evaluate its effect on knowledge, attitude, and stress. The content of multimedia education was based on Social Learning Theory. Pre-post test group trial with control group was used. The intervention group had four-week group education with multimedia and the control group did not have any intervention. Stress index for children or Adolescents with Tourette Syndrome (SICATS) and Daily life stress scale (DLSS) was asked at baseline (T0), 1st (T1), 3rd (T3) month. Repeated measure ANOVA was used to compare the stress level between the two groups. From November 2009 to May 2010, 22 and 43 children with TS were recruited for the intervention group and control group, respectively. In the intervention group, the knowledge score about TS increased from 63.9 at T0 to 84.1 at T1 (p = .002); the attitude of dislike TS was reduced from 5.08 at T0 to 3.64 at T1 (p = .019). However, SICATS(intervention group: T0=46.95, T1=46.59, T3=43.86 vs. control group: T0=43.70, T1=43, T3=42.14) and DLSS (intervention group: T0=26.53, T1=27.77, T3=27.77 vs. control group: T0=26.91, T1=27.58, T3=29.14) did not differ significantly between the two study groups. The educational multimedia given in a group manner improve the knowledge about TS, and could reduce the dislike attitude for children with TS but not the stress level. Bigger sample size, longer follow-up, newly-diagnosed patients, age-specific contents is needed to evaluate the effect of our media education program in the future.