| 摘要: | 由於我國人口老化快速、慢性病盛行率逐年增加，為有效促進全民健康、降低社會與醫療成本，職場健康促進已是我國刻不容緩的工作。本研究基於原始研究設計：「假設健康促進介入能改變員工健康行為，進而塑造集體健康風氣與職場健康文化」之概念，在我國職場尚未導入健康教練介入方案下，進行以下兩部分研究：第一部分係發展我國職場適用的「職場健康文化量表」，並探討其與職場健康促進推動工作、職場員工之健康生活習慣與個人健康狀況之關聯性；第二部分研究則從醫療臨床場域導入健康教練，探討其成效以及未來推展至職場之可行性。
在第一部分研究中，問卷之發展共收集2,431個有效樣本，來自六家規模不一、健康促進推動程度不等之企業，發展出一份信效度良好的職場健康文化量表(共計25題)。其後，再自27家職場進行問卷調查，共計1,732個有效樣本，發現職場健康促進推動程度確實顯著與健康文化有關，且健康文化亦與員工健康生活習慣如運動習慣、蔬果攝取等有關，也與員工健康狀況如自評健康、慢性病個數、BMI等有關，健康文化程度越好，員工健康生活習慣與健康狀況亦越佳。
在第二部份研究中，於某醫學中心內分泌新陳代謝科進行糖尿病健康教練之測試，分為兩年期。第一年期以準試驗設計之方式進行前驅研究，收取共計116個有效樣本，發現在六個月的介入中，能確實使介入組參與者的糖化血色素降低平均0.64%，且顯著優於對照組，並顯著改善自我效能與運動習慣。第二年期的試驗則進一步基於前驅測試之經驗，設計嚴謹的隨機對照試驗，收取114個有效樣本，並發現在六個月的介入中，能顯著使介入組參與者降低其每日熱量以及水果、肉類與油脂類的攝取量，同時增加蔬菜攝取量，並顯著改善其糖化血色素達0.68%，顯著優於對照組。此外，在本研究期間，受到COVID-19全球大流行之影響，因此第二年期試驗中，亦分析疫情對本試驗的可能影響，發現有教練輔導之介入組，能因為有設定明確的行為目標，而使健康行為較不受疫情相關的防疫政策等環境因素影響。
因此，本系列研究證實健康文化確實與職場健康促進有關，而我國亦能於醫院臨床提供實際的健康教練行為輔導，本研究測試之結果將有助於未來進一步測試是否能基於現行的員工健康檢查與後續服務之方式，由醫院端提供健康教練輔導，從而改善職場員工之健康生活習慣，進而塑造出健康文化之研究。
With the rapidly aging population and the increasing prevalence of chronic diseases in Taiwan, to promote national health and reduce social and medical costs effectively, workplace health promotion has become an urgent task. This study is based on the original research design: "Health promotion intervention can improve employees' health behaviors, thereby shaping collective employee health ethos and workplace health culture." The research is conducted in two parts in the absence of health coaching intervention programs in the workplace in Taiwan. The first part of this study is to develop a "Workplace Health Culture Scale" applicable to the workplace here in Taiwan, and to explore its correlation with workplace health promotion, employees' healthy lifestyle, and personal health status. The second part of the study is the introduction of health coaching from the clinical field to explore its effectiveness and the feasibility of extending it to the workplace in the future.
In the first part of the research, 2,431 participants from six companies were recruited in the development of the 25-item workplace health culture scale with sufficient reliability and validity questionnaire. Then, the questionnaire survey was conducted in 27 workplaces, rendering a total of 1,732 samples, and it is found that the workplace health promotion performance is significantly related to health culture, which in turn is also related to employees' healthy lifestyle such as physical activity and consumption of fruit and vegetables. The health culture is also significantly related to employees’ health such as self-rated health, chronic diseases, and BMI. In other words, the better the health culture, the better the employees' healthy lifestyle and health status.
In the second part of the research, a two-year study of the diabetes health coach test was conducted in the department of endocrinology and metabolism of a medical center. In the first year, a quasi-experimental study was conducted, and a total of 116 samples were collected. It is found that during the six-month intervention, the hemoglobin A1c of the participants in the intervention group was reduced by an average of 0.64%, which was significantly better than the control group. The intervention group also notably displayed improvement in their self-efficacy and physical activity. In the second year, a rigorous randomized controlled trial was carried out with 114 samples collected. It is found that in the six-month intervention, the participants in the intervention group had a significant reduction in their daily calorie intake, fruits, meat, and oils, increased in the intake of vegetables, and significantly improved the hemoglobin A1c by 0.68%. In addition, since the study was done during the COVID-19 pandemic, possible impact on the second-year trial was also analyzed. It is found that health behaviors of the participants in the intervention group were less affected by environmental influences such as epidemic-related policies.
Therefore, this study has confirmed that health culture is notably related to workplace health promotion, and health coaching is applicable in hospitals in Taiwan. The results of this study will benefit further studies on whether health coaching provided by hospitals can aid the current system of employee health screening and post-screening services to improve the healthy lifestyles of employees and create a healthy culture. |
