父母及兒童健康識能與兒童肥胖相關性之多重路徑分析

Abstract

目的:兒童期肥胖是全球普遍面臨的問題，它與成人期肥胖及慢性疾病有顯著關聯。預防或介入兒童肥胖是一項重要的公共衛生課題。提升個體的健康識能被視為其中的主要策略之一，然而目前尚缺乏明確的解釋，說明家長和兒童的個人健康識能如何通過特定的中介變項影響兒童的肥胖狀態。本研究旨在探討家長和兒童的健康識能如何影響兒童的肥胖狀態。 方法:本橫斷面研究調查新竹縣10-11歲的兒童及其父母。透過多階段人口比例抽樣方法，在新竹縣的30所學校中選擇3620名兒童與其父母。使用匿名的結構性問卷對兒童、父親和母親分別進行調查，問卷涵蓋了家庭社經地位、個人體重、父母和兒童的健康識能、父母的飲食行為和照護態度，以及兒童的自我照護行為。同時通過驗證性因素分析建立中文版青少年健康識能量表的信效度，並利用此工具進行兒童健康識能的測量。研究利用結構方程模型作為分析工具，進行家長和兒童健康識能與兒童身體質量指數z-score關聯性的結構方程模式路徑分析。 結果: 共回收2868份問卷，其中有效問卷為2123份。本研究建立了中文版青少年健康識能量表的信效度。研究發現，兒童的健康識能對其身體質量指數z-score無直接相關效果，但會經由兒童情緒性飲食行為的中介而有間接相關效果，總相關效果的標準化係數為-0.025（95%信賴區間：-0.050至 -0.006，p-value = 0.005）；父親的健康識能是經由兒童健康識能及兒童情緒性飲食行為作為中介，總相關效果的標準化係數為-0.003（95%信賴區間：-0.007至-0.001，p-value =0.003）。母親的健康識能則是藉由母親自身的飲食行為與照護態度影響兒童，產生中介作用與兒童體重有間接相關，總相關效果的標準化係數為-0.010（95%信賴區間：-0.016至-0.005，p-value =0.001）。 結論: 家長的健康識能與兒童身體質量指數z-score呈顯著負相關性。家長的飲食行為與照護態度會產生中介作用，父親與母親的中介路徑大不相同。兒童自身的健康識能和自我照護行為與其兒童身體質量指數z-score密切相關，特別是兒童的情緒性飲食行為與體重之間存在關聯。

Purpose: Childhood obesity is a prevalent global issue, significantly associated with adult obesity and chronic diseases. Preventing or intervening in childhood obesity is a critical public health challenge. Enhancing individual health literacy is considered one of the main strategies; however, there is a lack of clear explanation on how parental and child health literacy affects childhood obesity through specific mediating variables. This study aims to explore how parental and child health literacy influences childhood obesity. Methods: This cross-sectional study surveyed children aged 10-11 and their parents in Hsinchu County. Using a multistage proportional sampling method, 3,620 children and their parents from 30 schools in Hsinchu County were selected. An anonymous structured questionnaire was administered to children, fathers, and mothers, covering family socioeconomic status, individual weight, parental and child health literacy, parental dietary behaviors and caregiving attitudes, and children’s self-care behaviors. The validity and reliability of the Chinese version of the Adolescent Health Literacy Scale were established through confirmatory factor analysis, and this tool was used to measure children’s health literacy. Structural equation modeling (SEM) was employed to analyze the associations between parental and child health literacy and children’s body mass index (BMI) z-score. Results: A total of 2,868 questionnaires were returned, with 2,123 valid responses. The study established the reliability and validity of the Chinese version of the Adolescent Health Literacy Scale. The findings indicated that children’s health literacy had no direct effect on their BMI z-score, but it had an indirect effect mediated by children’s emotional eating behaviors, with a total standardized effect size of -0.025 (95% CI: -0.050 to -0.006, p-value = 0.005). Fathers’ health literacy had an indirect effect mediated by children’s health literacy and emotional eating behaviors, with a total standardized effect size of -0.003 (95% CI: -0.007 to -0.001, p-value = 0.003). Mothers’ health literacy indirectly influenced children’s weight through their own dietary behaviors and caregiving attitudes, with a total standardized effect size of -0.010 (95% CI: -0.016 to -0.005, p-value = 0.001). Conclusion: Parental health literacy is significantly negatively associated with children’s BMI z-score. Parental dietary behaviors and caregiving attitudes play a mediating role, with distinct pathways for fathers and mothers. Children’s own health literacy and self-care behaviors are closely related to their BMI z-score, particularly the association between children’s emotional eating behaviors and weight.