台灣大專校院健康促進計畫績優學校之校級決定因素研究

School-level determinants of superior performance in health-promoting universities and colleges in Taiwan

目標：自2012年起，台灣大專院校積極推動健康促進學校（HPS）計畫，並多數獲得政府補助，但僅少數學校被評定為績優學校。本研究旨在探討2019至2021年間，影響大專校院於HPS計畫中表現優異的校級決定因素。方法：本研究分析145所學校的資料，資料來源包括校級現況調查問卷與年度健康促進評估報告。調查問卷內容涵蓋五大面向：學校政策、學校人力組成、醫療服務量能、實證健康促進策略、菸害相關措施及無菸校園政策。評估報告則透過過程與成效指標，評估學校在菸害防制、體位管理與性教育三大領域的推動情形。表現排名前10%的學校被歸類為「績優學校」。研究先以卡方檢定與t檢定篩選具統計顯著差異的變項，再以羅吉斯迴歸進一步分析主要預測因子，最後以結構方程模型探討校級變項與績優表現間的關係。結果：績優學校在學生人數、教職員規模與補助經費上顯著高於其他學校，並在體位管理、性教育與菸害防制三個領域執行更多實證健康策略。SEM結果顯示，教職員人數可正向預測學生人數與校園健康中心規模，進而影響校護人數與戒菸服務的提供。同時，體位管理策略可進一步促進菸害防制策略的實施，並間接帶動性教育策略的推動，顯示三者間的連動性。結論：本研究指出學校資源配置、健康人力支持，以及跨領域實證策略的全面落實，是提升HPS成效的關鍵。研究結果可作為政策制訂與學校健康促進規劃的重要參考。

Objectives: Since 2012, Taiwanese universities and colleges have actively implemented health promoting school (HPS) programs, with most institutions receiving funding subsidies. However, only a small proportion have demonstrated superior performance. This study examined the school-level determinants associated with superior performance in universities and colleges participating in HPS programs from 2019 to 2021. Methods: Data from 145 universities and colleges were analyzed using the School Status Survey Questionnaire and Annual Health Promotion Evaluation Reports. The questionnaire assessed school policy, the composition of school personnel, healthcare capacity, evidence-based health promotion strategies, tobacco-related practices, and smoke-free campus policies. The reports, in turn, evaluated tobacco control, weight management, and sexuality education through process and impact assessments. Institutions ranking in the top 10% were classified as superior-performing. Chi-square tests and t-tests identified significant variables, followed by logistic regression to examine key predictors. Structural equation modeling (SEM) examined the relationships between school-level variables and superior performance. Results: Superior-performing institutions had significantly greater student enrollment, more faculty and staff, and higher subsidy funding. These schools also implemented significantly more evidence-based strategies across the domains of weight management, sexuality education, and tobacco control. SEM results revealed that faculty and staff numbers positively predicted student enrollment and campus health center size, which in turn influenced the number of campus nurses and the provision of smoking cessation services. Path analysis revealed that weight management strategies influenced tobacco control strategies, which in turn impacted sexuality education strategies, highlighting their interconnection. Conclusions: Findings highlight the importance of institutional resources, human capital, and comprehensive implementation of evidence-based strategies in driving superior HPS performance. The results provide valuable insights for policy development and institutional planning to strengthen health promotion initiatives in higher education.