2015-08-012024-05-18https://scholars.lib.ntu.edu.tw/handle/123456789/710037摘要：背景及目的氣喘是一個複雜多重因素疾病，許多證據指出環境及生活型態是影響氣喘表觀遺傳的因素。過去20年來，兒童同時發生氣喘及肥胖的健康問題，已為全球性的關注議題，需要有效措施來降低醫療及社會成本。近年來，行動醫療科技已廣為運用來預防及處置健康問題，智慧型手機的便捷及個別性的措施，將有效地改變健康行為。鑑此，本研究目的在於：(1)發展符合年紀及個別化的KidsHealth智慧型手機APPS措施計畫，以調整氣喘學童的健康生活型態；(2)評值智慧型手機措施計畫之可行性及可近性；(3)評值智慧型手機於改善氣喘學童的健康行為及健康狀況。研究方法本研究將進行三年計畫，研究對象將選自台北市國民小學，有過重、肥胖及不健康生活型態風險的9-12歲學童，在其家長或法定代理人同意後進行試驗。第一年藉由調查及德爾菲法來發展KidsHealth智慧型手機措施計畫及執行初步測試。第二年將選取30對兒童及其父母，進行隨機雙組比較研究，評價措施可行性及修正為後續的試驗使用。第三年將進行隨機對照試驗研究，於氣喘及非氣喘兒童的學校及居家照護情境，來評價智慧型手機措施之成效。成效指標包括：(1)健康生活行為：食物及飲料攝取、身體活動、靜態行為及睡眠型態，(2)健康狀態：氣喘症狀況控制、疾病進展、返急診頻率、學校請假日數， (3)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第一次基礎測量(T1)，及後續間隔3個月的四次追蹤(T2-T5)。隨機對照試驗研究之樣本數由檢力分析及10%流失率來估算，預計將徵募220位符合納入條件的氣喘學童。重複量測變異數分析、意圖治療分析法(ITT)、廣義估計方程式(GEE)等將運用為資料分析方法。預期成效本研究之隨機對照試驗，將運用智慧型手機平台提供氣喘兒童的互動回饋，而產生健康行為的改變。研究方案的發展及執行，企能夠提供發展其他慢性疾病兒童e-健康照護計畫之參考。<br> Abstract: Background and PurposeAsthma is a complex multifactorial disease, increasing evidence shows that environmental and lifestyle factors may modify epigenetic mechanism of asthma development. The concurrence increase of both obesity and asthma among children has been noticed worldwide during the past two decades, there is a need to an effective intervention to reduce the obesity-related medical and social cost. As mobile health technology has been widely applied in the prevention and management of health problem, smart phone applications offer a potentially powerful approach for behavioral change through delivering convenient, individual tailored intervention. Purposes of this study are three-fold: (1) to develop an age-appropriate tailored KidsHealth Smart Phone Intervention (SPI) to modify the healthy lifestyles for asthma children with obesity risks; (2) to evaluate the feasibility and accessibility of interventions delivered by Smart Phone technology; (3) to evaluate the effectiveness of the Smart Phone applications in improving the healthy behaviors and outcomes for school-age children with asthma.MethodsThis study will consist of three-year program. Research subjects will be recruited in selected elementary schools in Taipei. Children aged 9-12 of body mass index (BMI) more than 85th percentile and at risks of unhealthy life styles, with permission of parents or legal guardian are eligible to participate in the study. In the first year, we will conduct a Delphi method to develop the Smart Phone Intervention platform, and then conduct a preliminary testing on children. In the second year, we plan to apply a randomized two-group comparative design to evaluate the feasibility of the SPI program and revise for applications on the further trials. In the third year, we will conduct a randomized controlled pilot study on children with asthma and non-asthma at school and home settings to evaluate the effectiveness of the Smart Phone applications 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 at 12-month follow-up (T2-T5). Outcome measures include healthy lifestyle behaviors: food and beverage intake, physical activity, sedentary behaviors and adequate sleep. The health outcomes are health status (asthma symptom control and disease progression), frequency of ER visit, days of school absence and body composition measured by body mass index, waist circumferences, and body fat. Sample size is estimated by power analysis and dropout rate, the eligible sample size of the intervention group will be 30 and 220 in the phase II and phase III study. Repeated ANOVA, Intention to Treat (ITT), and generalized estimating equation (GEE) will be conducted for the statistical analysis.Expected outcomesThis randomized controlled pilot study of 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 children with other chronic health conditions to foster their healthy lifestyle behaviors and health outcomes.智慧型手機氣喘健康生活型態氣喘症狀控制隨機對照試驗研究smart phone applicationsasthmahealthy lifestylesasthma symptom controlrandomized controlled pilot study