發展檢核對父母的兒童發展認知、就醫態度與行為之影響

Abstract

本研究目的旨在探討發展檢核對父母的兒童發展認知、就醫態度與行為之影響。根據統計，發展遲緩兒童約佔學齡前期兒童的5-10%（蔡等，2005），而臺灣發展遲緩兒童被發現比例僅有0.6-0.8%，且國民健康局（2002）統計資料顯示，疑似發展遲緩兒童就醫率約37.9%。若以94年度出生約二十萬餘人來推估，目前臺灣地區六歲以下約有七萬二千名至九萬六千名遲緩兒童，而就醫者卻僅有2728至3683名兒童。 Glasco（2004）指出，發展遲緩兒童若能在學齡期之前診斷並接受療育，可增加自尊、就學率、生活品質、減少本身障礙程度、家庭負擔及社會成本。有鑑於此，研究者將探討發展檢核對父母的兒童發展認知、就醫態度與行為之影響，以了解發展遲緩兒童就醫率偏低之相關因素。 本研究採橫斷式研究設計。以立意取樣方式選取臺北縣托兒所及某醫學中心健兒門診之兒童及父母，以「父母對兒童發展的認知」、「就醫態度」及「就醫行為」量表進行資料收集，並以「學前兒童發展檢核表」進行檢核，於一個月後再次進行發展檢核及填寫此三份問卷。資料收集後，依據研究目的及變項性質以SPSS 13.0進行統計與分析。研究結果如下： 一、父母在兒童發展定義方面的認知得分最差，對於發展遲緩的治 療及早期療育相關知識方面的認知得分最好。 二、父母就醫態度偏正向傾向，其中以就醫的正面態度得分最高， 就醫的負面態度得分最低。 三、發展檢核前，父母就醫行為偏低，發展檢核後，就醫行為明顯 增加。 四、整體而言，父母對兒童發展的認知與就醫態度、行為無關，但 就醫態度與就醫行為之間呈現正相關。 五、通過及不通過組於發展檢核前後，其認知、態度、行為成正相 關。 六、第一次發展檢核不通過人數為28人(17.3%)，第二次發展檢核不 通過人數為12人(7.4%)，於檢核後2個月，共有9名兒童就醫。 七、發展檢核前，發展檢核「通過」組之父母對兒童發展的認知高 於「不通過」組，就醫行為及就醫態度則無差異；發展檢核 後，「通過」組及「不通過」組之兒童發展認知、就醫態度及 就醫行為則無差異。 八、發展檢核後之認知、態度及行為平均分數皆有增加情形。 根據以上研究提出以下幾點建議： 1.落實兒童發展檢核，建議由醫療院所與托兒所形成一個社區網 路，定期為兒童進行發展檢核。 2.建議幼教老師加強並宣導兒童發展檢核，以達到早期發現、早期 療育之目的。 3.政府機關應透過媒體宣導發展遲緩及早期療育之相關知識。 4.增加3-7歲兒童預防保健服務。 5.增加健兒手冊發展檢核題目。 整體而言，發展檢核確能提高父母對兒童發展的認知、就醫態度及就醫行為，更能早期發現發展遲緩兒童，並增加就醫率。期望藉由本研究可讓政府機關、醫療相關人員及幼教老師正視兒童發展檢核的重要性，以達到早期發現、早期療育之目的。

The purpose of this research is to explore about the impact of developmental screening on the parents' cognition of child development, and attitude and behavior in seeking medical care .It is estimated to be there are 5 to 10% of the children in preschool are suffering from developmental delay(Tsai,2005) ; rates of children found being with developmental delay is only 0.6-0.8% in Taiwan, and the ratio of those Children’ seeking medical care who are possibly with developmental delay is 37.9% on the basis of B.H.P. statistic in 2002. If we assume approximately200,000 infants were born in 2005, there are approximately 72,000 to 96,000 children with development delay who are under 6 years old. However, there are only 2728 to 3683 children who had been treated. Glasco（2004）contended that if those children with developmental delay were able to be identified and treated before school age, the self-esteem, schooling ratio, and life quality would increase, and the disability level, family burden, and community cost would decrease . Thus, the researcher will explore the impact of developmental screening on the parents' cognition of child development, and attitude and behavior in seeking medical care. By doing so, we hope to understand why the rate of children with Developmental delay being treated is so low. This research is a cross-sectional study. Via purposive sampling, participants are selected from some health center and kindergartens in Taipei County. Data are collected by these three questionnaires: “parents’ cognition of child development”, “attitude in seeking medical care ”, and “behaviors in seeking medical care ”. Furthermore, the children will also be screened by the “Preschool Child Developmental Screening”. After one month, they will be reassessed by the previous steps. Collected, data are analyzed and compiled statistics by SPSS 13.0 on the base of the purpose of this research and of variables. Our results and findings of this study are as follows: 1. The score is the lowest in parents’ cognition of the definition of child development, yet the score is the highest in parents’ cognition of treatment of development delay and of early treatment. 2. Parents’ attitude in seeking medical care tends to be positive. The positive attitude in seeking medical care scores highest, while the negative attitude in seeking medical care scores lowest. 3. Parents’ behaviors in seeking medical care have a tendency to be lower. After developmental screening, behaviors that seek medical treatment have apparently increased. 4. Generally speaking, parents’ cognition of child development has no correlation with attitude in seeking medical care and behavior in seeking medical care. However, there is a positive correlation attitude in seeking medical care and behavior in seeking medical care. 5. Before and after the developmental screening, cognition, attitude, and behaviors are positively related among the group passing the test and that failing the test. 6. 28 participants (17.3%) failed the first development screening at the first time, and the number of children who failed the second development screening at the second time was 12.(7.4%). Totally, there are 9 children seeking for medical treatment after 2 months counting from the date of the examination. 7. Before development screening being done, the parents’ cognition of child development whose child passed the development screening is higher than those whose child failed the test at the first time. What is more, there is no difference between attitude and behavior. After development screening being conducted, cognition of child development, attitude in medical, and behavior in medical have no difference among those who passed the development screening and those who did not. 8. After development screening being conducted, scores in cognition, attitude, and behaviors all increase. Based on the aforementioned results and findings, we propose some suggestions as follows: 1. It is essential to fulfill child development screening. We suggest hospitals and kindergarten should be the ones which are responsible for organizing a community network. And they are supposed to conduct development screening for children regularly.. 2. It is suggested that nursery teachers should promote child development screening more fully. By doing so, development delay can be identified and treated as early as possible. 3. Taiwanese government needs to promote information and knowledge pertaining to development delay via media. 4. It is recommended to enhance preventive health care services for children who are from 3~7 years old. 5. We suggest to increase the number of the questions of developmental screening in booklets of children's health. In conclusion, developmental screening can surely enhance parents’ cognition of child development, attitude in seeking medical care, and behavior in seeking medical care. What is more, through development screening, we can identify children with developmental delay earlier, improving rates of seeking medical care. Via this research, we hope Taiwanese government and the medical staff and nursery teachers can pay close attention to the significance of child development screening, so we are more capable of identifying sickness and intervening as early as possible.