社區長者健康促進方案成效評估工具的發展

The Development of an Outcome Measure of Health-Promotion Program for Community-Dwelling Elderly

因應高齡健康照護需求，各國積極推展社區長者健康促進方案，然較缺乏簡易量測社區長者在多元健康面向變化的評估工具。本研究發展評量社區長者健康促進方案之成效評估工具（簡稱方案成效評估），初版共五面向（認知、肌力／體能、生活功能、營養口牙、和心理社會） 34 題。研究目的為篩選題項，形成正式版本，並臉證其心理計量特性。研究對象採方便取樣，招募來源為長者健原促進或預防及廷緩失能方案之社區執行單位，招募65 歲以上不同健康表現（排除重度失能／ 失智）之受試者，接受方案成效評估和高齡者衰弱量表（Kihon Checklist，簡稱衰弱量表） 。另隨機選定受試者完成2 週後的再測，及完成12週方案後的後測。結果完成前測者共137 位長者（健原61 名、衰弱者32 位，失智者44 位），平均年齡76.63±7.50 歲。完成再測者87 位，完成前後測者共57 位。選題後每面向為4 題，共20 題，內部一致性良好(McDonald 's ω=0.811) ，再測信度(ICC=0.912)；眾合效度結果為與衰弱量表相關性呈中度(Pearson's r=0.698); 區辨效度顯示可顯著區辨健康、衰弱及失智者；反應性顯示介入前後之總分、肌力、認知丶心理社會次量表均達顯署差異(p<0.001) 。結論：方案成效評估工具題項精簡丶信／效度佳，能反應方案介入前後變化，適用於評量多元健康面向及不同長者族群健康促進方案成效。

In response to the elders' health care needs, many countries actively promote community health promotion programs for older people. However, there is a lack of simple and community-friendly assessment tools to measure the changes in multiple health domains after participating in the program. The health-promotion program outcome measure was designed to evaluate the effectiveness of health promotion programs for community-dwelling elderly. The first version of this instrument consists of 34 items in five domains ( cognition, physical, activities of daily living, nutrition and oral function, and psychosocial function). This study aimed to develop a reliable and valid outcome measure through item selection to form a final version and examine the psychometric properties. This study used a convenient sampling to recruit subjects over 65 participating in community health promotion or disability prevention programs and with a wide range of health statuses ( except for severe disability/dementia). They were assessed with the health-promotion program outcome measure and the elderly frailty scale (Kihon Checklist). In addition, we randomly selected subjects to complete the re-test approximately two weeks after the first assessment and the post-test after finishing the 12-week programs. A total of 137 elders (61 healthy, 32 frail, and 44 demented) completed the pre-test, with an average age of 76.63±7.50 years. Additionally, 87 subjects completed the re-test, and 57 completed the post-test. After the item selection, the final version of the health-promotion program outcome measure incorporated five subscales with a total of 20 items (4 for each subscale). The outcome measure had good internal consistency (McDonald's m=0.811) and test-retest reliability (ICC=0.912). The convergent validity indicated a moderate correlation between the outcome measure and the Kihon Checklist (Pearson's r = 0.698); the discriminant validity showed satisfactory discrimination among the healthy, the frail, and the dementia. Small to medium magnitude intervention effects were captured by the outcome measure, with significant improvement in the total score, and the subscale scores of physical, cognition, and psychosocial function (p<0.001). Conclusion: The 20-item health-promotion program outcome measure is concise and has good reliability/validity. It is suitable for assessing the effectiveness of health promotion programs targeting different elderly populations.