目標：本研究之主要目的在探討成年人耳穴貼壓及自我決定理論與體重控制相關因子間之關係，並分析其相互關係，以了解耳穴貼壓及自我決定理論對於體脂肪、腰圍、臀圍、腰臀圍比、體重及身體質量指數在治療後是否有意義之減少，進而推廣較無副作用之耳穴貼壓於體重控制，並思考未來如何提昇或維持自我動機，以達到良好之體重控制成效。方法：本研究為一交叉式隨機對照實驗，研究對象為自願參與的189位成人。隨機分成兩組，兩組之基本特性一致；在前8週，93位耳穴貼壓加基本飲食衛教之個案為實驗(先治療)組，只有基本飲食衛教之96位研究對象為對照(後治療)組，8週後兩組交換治療；並於此32週之研究期間測量其自我決定理論相關問卷量表及肥胖相關參數指標。結果：經32週之研究，兩組在治療前後其腰圍、臀圍、體重及身體質量指數皆有進步，並達統計顯著差異，但兩組之間比較，並無法顯示耳穴貼壓治療對體重控制有不一樣的療效，不過若同一組人之前8週與後8週比較，則發現耳穴貼壓治療時有顯著的成效。而自我決定理論應用於體重改善成效的預測，當感受較佳醫療人員支持、連繫感佳者或原始個人動機較偏向自主傾向者，會有較佳的勝任能力，進而能有較佳的體重控制成效；另外本研究架構模式經結構方程模式測試，模式適合度尚可接受。結論：由結果顯示，雖然兩組之間比較，並無法顯示耳穴貼壓治療對體重控制有不一樣的療效，但兩組在治療前後其腰圍、臀圍、體重及身體質量指數皆有進步，且同一組人之前8週與後8週比較，也發現耳穴貼壓治療時有顯著的成效。由於其安全無副作用，並可引導病患的自我決定動機的提昇與維持，應可當成減重的輔助方法。未來也許可延長研究時間及增加樣本數以進一步了解耳穴貼壓治療的成效及提昇自我決定理論應用模式的適合度。

Objectives: To evaluate the effects of ear points pressing at ear meridian points on obesity-related parameters( body weight, body fat, body mass index, waist, hip circumferences, and WC/HC ratio) between treatment and control groups, and we also apply the Self-Determination Theory to discuss the relationship between motivation and performance of body weight control.
Methods: The study was an cross over open-parallel randomized control trial and the sample consisted of 189 volunteers who were randomly divided into two groups and the baseline characteristics were similar. In the experimental (immediate treatment) group (n=93), ear points pressing at five ear meridian points and lifestyle education were applied, while volunteers in the control (delay treatment) group (n=96) just receive lifestyle education in the first 8 weeks. At baseline, 24th, 32nd and each week of the sixteen weeks study, the outcomes mentioned above were examined in all volunteers, and related SDT questionnaires were checked during the period of 32 weeks study.
Results: The result showed a statistically significant drop in BW, BMI, Waist circumference and Hip circumference during the 32 weeks in experimental (immediate treatment) and control (delay treatment) group, and better effect while using ear points pressing in the same group. But, no significant differences were found between the two groups. A SEM analysis showed that autonomous support, relatedness and original autonomy can get better competence and was related to positive consequences in BW control. And it was relative an adequate model to test the self determination theory.
Conclusion: Even though the result showed a statistically significant drop in BW, BMI, WC, HC during the 32 weeks treatment in experimental (immediate treatment) and control (delay treatment) groups, and better effect while using ear points pressing in the same group. But, no statistical significance change in BW related parameters were found between the two groups. Further studies are needed to detect the effect of ear points pressing and model fit of SDT application by increasing research time, and sample sizes.

目 錄

書 名 頁 ------------------------------------------------------------i
論文審定書 --------------------------------------------------------ii
誌 謝 -------------------------------------------------------------iii
中文摘要 ------------------------------------------------------------iv
英文摘要 ------------------------------------------------------------ v
目 錄 -------------------------------------------------------------vi
圖 次 ------------------------------------------------------------viii
表 次 ------------------------------------------------------------xii
附 錄 次 ---------------------------------------------------------xviii


第一章 緒論 -------------------------------------------------------1
第一節 研究背景與動機 ------------------------------------------------1
第二節 研究目的及問題 ------------------------------------------------4

第二章 文獻探討 ---------------------------------------------------6
第一節 肥胖定義 ---------------------------------------------------------6
第二節 肥胖病因及醫療、健康相關議題 ---------------------------7
第三節 肥胖的治療與研究假設 ---------------------------------------8

第三章 理論探討 --------------------------------------------------------18
第一節 自我決定理論 -------------------------------------------------18


第二節 自我決定理論在醫療、健康相關議題之研究與研究假
設 ----------------------------------------------------------------25

第四章 研究設計與方法 ----------------------------------------------35
第一節 研究架構 --------------------------------------------------------35
第二節 研究設計 --------------------------------------------------------37
第三節 研究樣本 --------------------------------------------------------40
第四節 資料收集、變項操作型定義與測量工具 -----------------41
第五節 分析方法 --------------------------------------------------------43

第五章 研究結果 -------------------------------------------------------52
第一節 耳穴貼壓對於體脂肪、腰圍、臀圍、體重及身體質量
指數之治療成效探討 ----------------------------------------52
第二節 自我決定理論與體重相關參數控制成效之探討 --------60

第六章 結論與建議 --------------------------------------------------128
第一節 討論 -------------------------------------------------------------128
第二節 結論與建議 ----------------------------------------------------133
第三節 研究限制 -------------------------------------------------------134

參考文獻 -------------------------------------------------------------------136

圖 次

圖3-1 病患動機、行為與健康的自我決定模式 --------------------30
圖4-1 耳穴貼壓治療與體重控制成效探討之研究架構 ----------35
圖4-2 自我決定理論與體重控制成效探討之研究架構 ----------36
圖4-3 研究流程 -----------------------------------------------------------38
圖4-4 耳穴治療圖 --------------------------------------------------------39
圖4-5 測量模式自主調節動機(TSRQ)之驗證性因素分析 -------46
圖4-6 測量模式原始自主動機(GCOS)之驗證性因素分析 -------46
圖4-7 研究架構模式徑路圖 --------------------------------------------46
圖4-8 自主調節動機(TSRQ)與體重成效變化之成長曲線模式徑路圖 --------------------------------------------------------------------50
圖4-9 勝任能力(PCS)與體重成效變化之成長曲線模式徑路圖-------------------------------------------------------------------------51
圖4-10 自主決定模式與體重成效變化之成長曲線模式徑路圖-------------------------------------------------------------------------51
圖5-1 8週後病患動機、行為與健康自我決定模式之體重成效預
測與模式適合度 ---------------------------------------------------93
圖5-2 16週後病患動機、行為與健康自我決定模式之體重成效
預測與模式適合度 -----------------------------------------------94
圖5-3 8至16週病患動機、行為與健康自我決定模式之體重成
效預測與模式適合度 --------------------------------------------95


圖5-4 16至24週病患動機、行為與健康自我決定模式之體重成
效預測與模式適合度 --------------------------------------------96
圖5-5 16至32週病患動機、行為與健康自我決定模式之體重成
效預測與模式適合度 ---------------------------------------------97
圖5-6 8週後病患動機、行為與健康自我決定模式之身體質量指
數成效預測與模式適合度 --------------------------------------98
圖5-7 16週後病患動機、行為與健康自我決定模式之身體質量
指數成效預測與模式適合度 -----------------------------------99
圖5-8 8至16週病患動機、行為與健康自我決定模式之身體質
量指數成效預測與模式適合度 -------------------------------100
圖5-9 16至24週病患動機、行為與健康自我決定模式之身體質
量指數成效預測與模式適合度 ------------------------------101
圖5-10 16至32週病患動機、行為與健康自我決定模式之身體
質量指數成效預測與模式適合度 --------------------------102
圖5-11 8週後病患動機、行為與健康自我決定模式之體脂肪比
例成效預測與模式適合度 -----------------------------------103
圖5-12 16週後病患動機、行為與健康自我決定模式之體脂肪
比例成效預測與模式適合度 --------------------------------104
圖5-13 8至16週病患動機、行為與健康自我決定模式之體脂
肪比例成效預測與模式適合度 -----------------------------105
圖5-14 16至24週病患動機、行為與健康自我決定模式之體脂
肪比例成效預測與模式適合度 -----------------------------106



圖5-15 16至32週病患動機、行為與健康自我決定模式之體脂
肪比例成效預測與模式適合度 -----------------------------107
圖5-16 8週後病患動機、行為與健康自我決定模式之腰圍成效
預測與模式適合度 --------------------------------------------108
圖5-17 16週後病患動機、行為與健康自我決定模式之腰圍成效
預測與模式適合度 --------------------------------------------109
圖5-18 8至16週病患動機、行為與健康自我決定模式之腰圍成
效預測與模式適合度 -----------------------------------------110
圖5-19 16至24週病患動機、行為與健康自我決定模式之腰圍
成效預測與模式適合度 ---------------------------------------111
圖5-20 16至32週病患動機、行為與健康自我決定模式之腰圍
成效預測與模式適合度 --------------------------------------112
圖5-21 8週後病患動機、行為與健康自我決定模式之臀圍成效
預測與模式適合度 --------------------------------------------113
圖5-22 16週後病患動機、行為與健康自我決定模式之臀圍成
效預測與模式適合度 -----------------------------------------114
圖5-23 8至16週病患動機、行為與健康自我決定模式之臀圍
成效預測與模式適合度 ---------------------------------------115
圖5-24 16至24週病患動機、行為與健康自我決定模式之臀圍
成效預測與模式適合度 --------------------------------------116
圖5-25 16至32週病患動機、行為與健康自我決定模式之臀圍
成效預測與模式適合度 ---------------------------------------117
圖5-26 8週後病患動機、行為與健康自我決定模式之腰臀圍比
成效預測與模式適合度 --------------------------------------118


圖5-27 16週後病患動機、行為與健康自我決定模式之腰臀圍
比成效預測與模式適合度 ------------------------------------119
圖5-28 8至16週病患動機、行為與健康自我決定模式之腰臀圍
比成效預測與模式適合度 -----------------------------------120
圖5-29 16至24週病患動機、行為與健康自我決定模式之腰臀
圍比成效預測與模式適合度 --------------------------------121
圖5-30 16至32週病患動機、行為與健康自我決定模式之腰臀
圍比成效預測與模式適合度 --------------------------------122
圖5-31 體重之成長曲線模式與模式適合度 -----------------------123
圖5-32 身體質量指數之成長曲線模式與模式適合度 -----------124
圖5-33 體脂肪比例之成長曲線模式與模式適合度 --------------124
圖5-34 腰圍之成長曲線模式與模式適合度 -----------------------125
圖5-35 臀圍之成長曲線模式與模式適合度 -----------------------125
圖5-36 腰臀圍比之成長曲線模式與模式適合度 -----------------126
圖5-37 自主(調節)動機之成長曲線模式與模式適合度 ---------126
圖5-38 勝任能力之成長曲線模式與模式適合度 -----------------127
圖5-39 原始動機、自主支持、自主(調節)動機、勝任能力、連
繫感及體重之成長曲線模式分析與模式適合度 --------127

表 次

表2-1 不同領域的文獻證據力分級 ---------------------------------151
表2-2 相關針炙減重之隨機對照試驗研究文獻摘要匯整 --------15
表3-1 動機型態及調節類型的自我決定連續帶 --------------------23
表3-2 自我決定理論在醫療、健康相關議題之文獻摘要匯整-------------------------------------------------------------------------33
表4-1 結構方程式模型各種契合度指標之理想建議值 -----------49
表5-1 耳穴貼壓實驗(先治療)組與對照(後治療)組之基本特徵比
較 ----------------------------------------------------------------------53
表5-2 耳穴貼壓實驗(先治療)組與對照(後治療)組之治療前後相
關肥胖參數成效比較 --------------------------------------------54
表5-3 耳穴貼壓實驗(先治療)組與對照(後治療)組之相關肥胖參
數成效比較 ---------------------------------------------------------57
表5-4 耳穴貼壓實驗(先治療)組與對照(後治療)組之治療前8 週
與後8週相關肥胖參數成效比較 -----------------------------59
表5-5 相關自我決定理論問卷 (GCOS、HCCQ、TSRQ、PCS、
BPNS-R) 之信度 ---------------------------------------------------61
表5-6 個人基本特性與體重之相關性分析 --------------------------63
表5-7 個人基本特性與身體質量指數 (BMI) 之相關性分析
-------------------------------------------------------------------------63
表5-8 個人基本特性與體脂肪比例 (BF) 之相關性分析 ----------64
表5-9 個人基本特性與腰圍之相關性分析 --------------------------64
表5-10 個人基本特性與臀圍之相關性分析 -------------------------65
表5-11 個人基本特性與腰臀圍比 (WHC) 之相關性分析 --------65



表5-12 原始動機、連繫感、勝任能力、自主支持、自主調節
動機之相關性分析 ----------------------------------------------66
表5-13 體重(第8週)與相關因子之多變項層級逐步迴歸分析-------------------------------------------------------------------------66
表5-14 體重(第16週)與相關因子之多變項層級逐步迴歸分析
-------------------------------------------------------------------------67
表5-15 體重(第24週)與相關因子之多變項層級逐步迴歸分析
-------------------------------------------------------------------------68
表5-16 體重(第32週)與相關因子之多變項層級逐步迴歸分析
-------------------------------------------------------------------------69
表5-17 身體質量指數 (BMI) (第8週)與相關因子之多變項層級
逐步迴歸分析 ----------------------------------------------------70
表5-18 身體質量指數 (BMI) (第16週)與相關因子之多變項層級 逐步迴歸分析 ----------------------------------------------------71
表5-19 體質量指數 (BMI) (第24週)與相關因子之多變項層級逐
步迴歸分析 -------------------------------------------------------72
表5-20 身體質量指數 (BMI) (第32週)與相關因子之多變項層級
逐步迴歸分析 ----------------------------------------------------73
表5-21 體脂肪比例 (BF) (第8週)與相關因子之多變項層級逐步
迴歸分析 ----------------------------------------------------------74
表5-22 體脂肪比例 (BF) (第16週)與相關因子之多變項層級逐
步迴歸分析 -------------------------------------------------------75
表5-23 體脂肪比例 (BF) (第24週)與相關因子之多變項層級逐
步迴歸分析 -------------------------------------------------------76


表5-24 體脂肪比例 (BF) (第32週)與相關因子之多變項層級逐
步迴歸分析 -------------------------------------------------------77
表5-25 腰圍(第8週)與相關因子之多變項層級逐步迴歸分析
-----------------------------------------------------------------------78
表5-26 腰圍(第16週)與相關因子之多變項層級逐步迴歸分析
-----------------------------------------------------------------------79
表5-27 腰圍(第24週)與相關因子之多變項層級逐步迴歸分析
-----------------------------------------------------------------------80
表5-28 腰圍(第32週)與相關因子之多變項層級逐步迴歸分析
-----------------------------------------------------------------------81
表5-29 臀圍(第8週)與相關因子之多變項層級逐步迴歸分析
-----------------------------------------------------------------------82
表5-30 臀圍(第16週)與相關因子之多變項層級逐步迴歸分析
-----------------------------------------------------------------------83
表5-31 臀圍(第24週)與相關因子之多變項層級逐步迴歸分析
-----------------------------------------------------------------------84
表5-32 臀圍(第32週)與相關因子之多變項層級逐步迴歸分析
-----------------------------------------------------------------------85
表5-33 腰臀圍比(第8週)與相關因子之多變項層級逐步迴歸
分析 ----------------------------------------------------------------86
表5-34 腰臀圍比(第16週)與相關因子之多變項層級逐步迴歸
分析 ----------------------------------------------------------------87
表5-35 腰臀圍比(第24週)與相關因子之多變項層級逐步迴歸
分析 ----------------------------------------------------------------88



表5-36 腰臀圍比(第32週)與相關因子之多變項層級逐步迴歸
分析 -----------------------------------------------------------------89
表5-37 8週後病患動機、行為與健康自我決定模式之體重成效
預測 ----------------------------------------------------------------93
表5-38 16週後病患動機、行為與健康自我決定模式之體重成效
預測 ----------------------------------------------------------------94
表5-39 8至16週病患動機、行為與健康自我決定模式之體重成
效預測 -------------------------------------------------------------95
表5-40 16至24週病患動機、行為與健康自我決定模式之體重
成效預測 ----------------------------------------------------------96
表5-41 16至32週病患動機、行為與健康自我決定模式之體重
成效預測 ----------------------------------------------------------97
表5-42 8週後病患動機、行為與健康自我決定模式之身體質量
指數成效預測 ----------------------------------------------------98
表5-43 16週後病患動機、行為與健康自我決定模式之身體質量
指數成效預測 ----------------------------------------------------99
表5-44 8至16週病患動機、行為與健康自我決定模式之身體質
量指數成效預測 -----------------------------------------------100
表5-45 16至24週病患動機、行為與健康自我決定模式之身體
質量指數成效預測 ---------------------------------------------101
表5-46 16至32週病患動機、行為與健康自我決定模式之身體
質量指數成效預測 ---------------------------------------------102
表5-47 8週後病患動機、行為與健康自我決定模式之體脂肪比
例成效預測 -----------------------------------------------------103


表5-48 16週後病患動機、行為與健康自我決定模式之體脂肪比
例成效預測 -----------------------------------------------------104
表5-49 8至16週病患動機、行為與健康自我決定模式之體脂肪
比例成效預測 --------------------------------------------------105
表5-50 16至24週病患動機、行為與健康自我決定模式之體脂
肪比例成效預測 -----------------------------------------------106
表5-51 16至32週病患動機、行為與健康自我決定模式之體脂
肪比例成效預測 -----------------------------------------------107
表5-52 8週後病患動機、行為與健康自我決定模式之腰圍成效
預測 --------------------------------------------------------------108
表5-53 16週後病患動機、行為與健康自我決定模式之腰圍成
效預測 -----------------------------------------------------------109
表5-54 8至16週病患動機、行為與健康自我決定模式之腰圍
成效預測 --------------------------------------------------------110
表5-55 16至24週病患動機、行為與健康自我決定模式之腰圍
成效預測 --------------------------------------------------------111
表5-56 16至32週病患動機、行為與健康自我決定模式之腰圍
成效預測 --------------------------------------------------------112
表5-57 8週後病患動機、行為與健康自我決定模式之臀圍成效
預測 --------------------------------------------------------------113
表5-58 16週後病患動機、行為與健康自我決定模式之臀圍成
效預測 -----------------------------------------------------------114
表5-59 8至16週病患動機、行為與健康自我決定模式之臀圍
成效預測 --------------------------------------------------------115


表5-60 16至24週病患動機、行為與健康自我決定模式之臀圍
成效預測 --------------------------------------------------------116
表5-61 16至32週病患動機、行為與健康自我決定模式之臀圍
成效預測度 -----------------------------------------------------117
表5-62 8週後病患動機、行為與健康自我決定模式之腰臀圍比
成效預測 --------------------------------------------------------118
表5-63 16週後病患動機、行為與健康自我決定模式之腰臀圍
比成效預測 -----------------------------------------------------119
表5-64 8至16週病患動機、行為與健康自我決定模式之腰臀
圍比成效預測 --------------------------------------------------120
表5-65 16至24週病患動機、行為與健康自我決定模式之腰臀
圍比成效預測 ---------------------------------------------------121
表5-66 16至32週病患動機、行為與健康自我決定模式之腰臀
圍比成效預測 --------------------------------------------------122


附 錄 次

附錄一 實證研究的證據力分級與說明 -----------------------------150
附錄二 減重檢查記錄單 -----------------------------------------------152
附錄三 人體試驗計畫試驗者同意書 --------------------------------153
附錄四 問卷使用同意函 -----------------------------------------------155
附錄五 自我決定理論相關中文問卷 --------------------------------157

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