比較問題與主題導向學習在中年婦女體重自我控制之成效
Comparison of effects of self weight-control in mid-aged women with Problem-based learning and

Subject-based learning.

高毓秀博士

曹麗英博士

中年婦女因為更年期賀爾蒙改變、代謝率降低、飲食型態及體能活動減少等因素，造成體重增加、身體組成及脂肪組織分佈改變等危害健康的情形；在台灣，45~64歲女性的肥胖盛行率高達41.6 %，本研究目的為：比較問題導向學習（Problem-based learning, PBL）與傳統主題導向學習（Subject-based learning, SBL）兩種不同教育介入方式，在社區中年婦女體重控制班之成效。

 本研究為類實驗設計，以方便取樣，於民國97年3月至8月在台北縣開辦體重控制班，招收40~64歲、體重過重之婦女，兩組皆進行八週、每週一小時的教育介入；實驗組共30人，以問題導向學習；比較組共34人，以主題導向學習，工具包括體位測量及體重自我控制能力問卷。

資料以SPSS Window 13.0版套裝統計軟體建檔，並以卡方檢定、配對樣本t檢定、獨立樣本t檢定等進行分析。結果顯示：PBL及SBL皆能使研究對象身體質量指數、體脂肪及腰圍達顯著進步；在體重自我控制能力方面，兩組的體重控制知識、體重控制行為及問題解決能力皆較介入前達顯著進步，但比較兩組間，後測與前測差異時，則發現實驗組的腰圍（t = 2.386、p = 0.022）及問題解決能力（t = - 2.478、p = 0.016）顯著優於比較組，尤其比較兩組間後測時，實驗組界定問題原因（t = - 3.315、p = 0.002）、提出解決方法（t = - 2.202、p = 0.031）及預防問題發生t = - 2.336、p = 0.023）顯著優於比較組。 

因此，建議未來體重控制班除傳統SBL以外，亦可善用PBL的教學策略，指引學員去發覺問題、界定問題原因與提出解決對策，並且結合機構或網路多元化的進行體重控制班，讓更多民眾參與，以及增加追蹤時間，了解教育介入之延宕成效。

關鍵詞：問題導向學習、主題導向學習、體重控制、中年婦女。

Mid-aged women have increased body weight due to decreased levels of endogenous estrogen, metabolic rate, changing eating style and lack off physical activity during menopause. This also leads to changes in body composition, fat distribution, and even health hazards in this age group. In Taiwan, the obesity prevalence in 45~64 years old women is 41.6 %, the purpose of this study was to compare the effects of problem-based learning (PBL) and subject-based learning (SBL) in community weight control programs.

This study used quasi-experimental design and convenient sampling. The subjects were overweight women ranging from 40~64 years old. Education intervention was 1 hour per week for 8 weeks during March to August 2008 in Taipei County. Thirty women in the experimental group used PBL and thirty-four women in the comparison group used SBL. The instruments used in this study were body measurements and a self weight control questionnaire.

Data analysis by SPSS Window 13.0 included chi-square, pair-t and independent-t tests. The results showed that women in PBL and SBL groups all significantly decreased body mass index, body fat and waist width after intervention, and they also achieved significantly better results in self weight control knowledge, attitude and problem solving. When comparing the pre and post test differences between groups, the women in PBL groups obtained significantly better problem solving ability ( t = - 2.478、p = 0.016) and waist width ( t = 2.386、p = 0.022) than SBL groups, especially in cause identification ( t = - 3.315、p = 0.002) , solution ( t = - 2.202、p = 0.031) and prevention ( t = - 2.336、p = 0.023) when comparing the post-test scores between groups.

 Therefore, apart from the traditional SBL method, we suggest utilizing PBL in weight control programs, and institution-based or multimedia-based methods could be used in the future. Furthermore, we suggest that longitudinal studies should be conducted to evaluate long-term effects.

Key words：problem-based learning、subject-based learning、weight control、

Mid-aged women.