摘要：家庭是兒童健康行為養成的重要關鍵，以家庭為基礎的健康促進及生活型態，有助於兒童健康成長及減少成年期慢性疾病的發展。近年來e化健康醫療科技，已廣為運用於預防及處置健康問題，證據顯示智慧型手機應用程式可有效地改變健康行為。在台灣尚未有智慧型手機應用程式於改善父母及兒童與健康生活型態之研究，本研究旨在於：(1)發展以家庭為基礎的兒童健康智慧型手機應用程式措施計畫(Kidshealth Smartphone Apps Intervention, KSAI)；(2)驗證KSAI之臨床可行性及推廣普及性；(3)評值KSAI於改善氣喘學童的健康生活行為及健康狀況之效用。研究方法本研究乃延續目前進行中的Kidsheath Apps研究，將再進行三年期二階段計畫，於大台北地區國民小學及北部某醫學中心，選取年齡介於9-12歲之學童，在其家長或法定代理人同意後納入研究。KSAI措施將包括八週系列性的活動，運用智慧型飲食系統(NTU DRS)、h2U健康手錶監測學童活動(physical activity)與睡眠型態 (sleep pattern)。透過親子自我檢視評估、居家訪視及線上溝通回饋等互動，以達成親子學習健康吃、多活動、好睡眠的健康生活型態。第一階段研究將運用混合研究法(mixed methods research)，預定選取60對兒童及其父母，於接受KSAI後進行為期一年的追蹤研究，以改善KSAI措施內容及修正措施步驟為後續的臨床試驗使用。第二階段將採隨機對照試驗研究(randomized controlled trials)，運用KSAI措施於氣喘兒童的居家照護情境，來評價KSAI措施之成效(effectiveness)。第二階段樣本數由檢力分析及10%流失率來估算，預計將徵募220對符合納入條件的兒童及其父母。成效評量指標包括：(1)健康生活行為：飲食、身體活動、靜態行為及睡眠，(2)健康狀態：身體組成分析(身體質量指數、腰圍及身體脂肪)。成效評量時間為隨機分派後的基礎測量(T1)及為期21個月的四次追蹤(T2-T5)。質性主題分析(thematic analysis)、重複性測量變異數分析(repeated measure ANOVA)、意向分析(intention-to-treat, ITT)及廣義估計方程式(generalized estimating equation, GEE)將運用於資料分析。預期結果本研究之智慧型手機平台提供兒童與家庭的互動回饋，希望強化父母與孩童的健康生活型態，由改善家庭健康而降低醫療及社會的經濟成本。研究方案的發展及執行，企能夠提供為健康及生病兒童e-健康發展計畫之參考。
Abstract: Background and purpose:Family is a primary agent in the promotion of healthy behaviors for children, family-based health promotion and lifestyle modification will be beneficial to live healthily in childhood and prevent from chronic conditiond in adulthood. As e-health technology has been widely applied to prevent and manage of health problems. Evidences showed that smart phone applications offer a potentially powerful approach for behavioral change. Research on the smart phone application to modify healthy lifestyles for Taiwanese2parents and children has not explored yet, this research aims to: (1) develop a family-based Kidshealth Smart phone Apps Intervention (KSAI); (2) validate the clinical feasibility and generalization of KSAI ; (3) evaluate the effectiveness of the KSAI in improving the healthy behaviors and outcomes for school-age children with asthma.MethodsThis 3-year study is an extension of current Kidshealth Apps study, will consist of two-phase programs. Research subjects will be recruited from the selected elementary schools and a university hospital in Taipei. Children aged 9-12, with permission of parents or legal guardian are eligible to participate in the study. The 8-week KSAI will be conducted by parent-child self-assessments, home visits, on-line discussion and feedbacks. Components consists of healthy eating, regular physical activity, decrease sedentary behaviors and preserve good sleep quality, which will be conducted by NTU DRS smart eating system, h2U smart watch to monitor physical activity and sleep quality.In the first phase, we will conduct a 1-year longitudinal follow-up on 60 pairs of parents and children, with mixed methods design to evaluate the feasibility and generalization of KSAI. In the second phase, we will conduct randomized controlled trials (RCT) to evaluate the effectiveness of the KSAI in improving the healthy behaviors and health outcomes. Data of the outcome measures are collected at the time of randomization (T1) and further 4 waves (T2-T5) in the further 21 months of follow-up. Outcome measures include healthy lifestyle behaviors: food and beverage intake, physical activity, sedentary behaviors and adequate sleep. The health outcomes are body composition measured by body composition analysis of body mass index, waist circumferences, and body fat. Sample size is estimated by power analysis and percentage of dropout rate, the eligible sample size will be 220 in the phase II study. Data analysis will be conducted by qualitative thematic analysis, repeated measure ANOVA, intention-to-treat ( ITT) and generalized estimating equation (GEE).Expected outcomesThis KSAI smart phone platform can provide dynamic feedback to the school-age asthma children to deliver healthy behavior change, the program development and implementation can be a reference for the e-Health action plan for healthy and sick children to foster their healthy lifestyle behaviors and health outcomes.