「智慧生活家」方案之評值與修正－－臺灣糖尿病預防計畫之經驗

The Evaluation and Revision of “the LOHAS Executants for People Who Have Prediabetes”: The Experience of the Diabetes Prevention Program in Taiwan

糖尿病是台灣十大死因的第四位。過去研究證明健康的生活型態能減少58％糖尿病高危險群罹患第二型糖尿病。本文以參與糖尿病預防計畫－－「智慧生活家」方案的217名第二型糖尿病高危險群及提供服務之19名公共衛生護理人員及相關教材為對象。以CIPP (context, input, process, and product)評值模式，多元地評值方案的執行者、接受者、及方案內容。結果如下，背景(context)：此方案之個案管理師，資深有經驗，但需加強諮詢的概念及演練。需要進行飲食及身體活動諮詢的個案管理師，近一半本身的身體活動和高纖攝取行為並不積極。個案以女性為主，增加身體活動量方面最需要協助。輸入(input)：研究者與個案管理師共同修正教材，包括行政作業手冊、配適寶典、貼心秘笈、個案管理師手冊、核心課程、及進步的軌跡手冊。過程(process)：在鼓勵個案參與諮詢、記錄、及追蹤方面，個案管理師做得最好；解決個案個別的困難挑戰較大；需提昇個案管理師的成就感。成果(product)：個案管理六個月後，個案中等費力以上身體活動增加到平均每週250分鐘；體重平均減少了3.1％。在多面向、持續評值及修正後，此方案成為更適合臺灣本土的糖尿病預防計劃，值得推廣。

The diabetes was the fourth of leading causes of the death in Taiwan. The Diabetes Prevention Program promoting health lifestyle modification effectively prevented 58% occurrence of type 2 diabetes. Investigators used CIPP (context, input, process, and product) model to evaluate and revise this program to develop a culture sensitive program. The samples were 217 prediabetes clients and 19 public health nurses. The results were the following. Context: the case managers needed to empower and practice on consultations. Almost half of the case managers’ physical activity and high fiber intake behaviors were on the contemplation stage. Most cases needed consultations that focused on more physical activity behaviors. Input: investigators and case managers revised the materials of the native Diabetes Prevention Program for people who have prediabetes which includes administrative guides, case manager handbooks, etc. Process: encouraging cases participation, recording and tracking were well done by case managers. Challenges were problem solving and increasing the case managers’ sense of achievement. Product: after six months, cases had more moderate physical activity (250 minutes/week) and weight reduction (3.1%). Through continuative evaluation and revision by investigators, clients and cases managers, the culture-sensitive Diabetes Prevention Program will be suitable for decreasing the incidence of type 2 diabetes in Taiwan.