幼教人員執行學齡前幼童視力篩檢效度之相關研究~以苗栗縣三市鎮為例
The Validity of Vision Screening Among Teachers of Preschoolers in Miaoli County.
中文摘要
論文名稱：幼教人員執行學齡前幼童視力篩檢效度之相關研究：
以苗栗縣三市鎮為例
研究所名稱：臺北醫學大學護理學研究所 研究生姓名：張美枝
畢業時間：九十二學年度第二學期
指導教授：陳靜敏 臺北醫學大學護理學研究所副教授
斜、弱視及近視為我國學齡前幼童視力障礙的主要因素，其診治必須即早開始。
為維護我國幼童之視力，衛生署自 1995 年始陸續推展學齡前斜弱視篩檢計劃，
至 2001 年篩檢率已達該年齡層之 90%以上，但計劃推動迄今，其篩檢之效度如 何尚未有具體之檢測研究報告。本研究目的即為瞭解幼教人員執行學齡前幼童視 力篩檢效度之情況，並進一步探討影響篩檢效度的相關因素。
本研究採橫斷式研究設計。研究對象為苗栗縣之苗栗市、竹南鎮及頭份鎮轄內托 兒所幼稚園之幼教人員 75 位。篩檢工具包括「幼童視力保健與篩檢認知調查問 卷表」、「幼教人員視力篩檢行為檢核表」、「幼童視力篩檢紀錄表」及「轉介複檢 記錄回應單」，此外還包括量尺、光度測定器、E 視力表及 NTU 亂點立體感圖。
篩檢對象為就讀於上述市鎮轄內幼托園所中之 1999 年以前出生之幼童 3547 位。
經篩檢未通過個案為個案組，另外在每一位未通過個案之下一位通過個案為對照 組，安排由統一診斷標準之眼科專科醫師複查，個案家屬及醫師皆不知其初步篩 檢結果。最後將問卷、檢核表、篩檢及複診結果資料皆輸入電腦 SPSS11.0 套裝 軟體以 ANOVA、T-test、Pearson Correlation、 Linear Regression、Multiple Regression 等統計方法進行分析。
統計分析結果發現整體篩檢的敏感度為 91.5%，特異度為 76.8 %，陽性預測度為 74.1%，陰性預測度為 92.5%，整體篩檢之準確度為 82.97%。幼教人員的年齡與 其篩檢的準確度有顯著相關；工作年資顯著會影響其篩檢的敏感度；學歷與其篩 檢的敏感度與陰性預測度亦有顯著關係。而幼教人員對視力保健與篩檢的認知正 確率得分為 67.42%（SD=15.6%），對視力篩檢的態度分平均為 3.21（SD=0.27），
篩檢行為正確率則為 82.22%（SD=10.22%）；而幼教人員對視力保健與篩檢的認 知與其篩檢的特異度、準確度與陽性預測度呈統計上顯著正相關；執行篩檢的態 度與其特異度亦呈正相關；執行篩檢的行為與其篩檢的敏感度、特異度、陽性預 測度、陰性預測度、準確度皆呈統計上顯著正相關。而進一步以複迴歸分析發現，
敏感度的主要預測因子為學歷與篩檢的行為；特異度的主要預測因子為篩檢的行 為；陽性預測度的主要預測因子為篩檢的行為；幼教人員的學歷與篩檢的行為則 為陰性預測度的主要預測因子；而篩檢準確度的主要預測因子為幼教人員的年 齡、認知及篩檢的行為。
依本研究之結果可提供相關單位培訓幼童視力篩檢人員及公衛護士在篩檢工作 前研習訓練計劃之課程內容以及督導實際執行篩檢工作之改進依據，進而提供相 關政策制定者針對幼童視力保健與篩檢相關策略修正之參考，以提昇篩檢品質及 效度，並即早落實幼童視力篩檢工作於社區，讓有視力問題之幼童能及早獲得診 治。
關鍵詞：效度、 視力篩檢、學齡前幼童
英文摘要 Abstract
Title of Thesis:The Validity of Vision Screening Among Teachers of Preschoolers in Miaoli County
Institution:Graduate Institute of Nursing, Taipei Medical University Author name: Mei-Chi Chang
Thesis directed by: Ching-Min Chen, RN, DNS, Associate Professor
Strabismus, amblyopia and myopia are the major visual problems in preschool children in our country. The treatments for these problems should begin as early as possible, hence, the Department of Health has promoted the visual screening program among preschool children since 1995 to train preschool teachers to conduct the vision screening. By 2001, the screened rate has reached 90%.
However there is not yet any specific study on the validity of it. The research purposes were to describe the validity of vision screening among teachers of preschoolers, and to explore the related factors that affect the validity of the vision screening.
The cross-sectional design was used. 75 teachers and 3547children were recruited from kindergartens in Miaoli County. Research instruments included “Child Vision Care and Screening Questionnaire”, “Vision Screening Checklist for Preschool teachers”, “Child Vision Record” and “Referral List”, as well as measuring tapes, photometric testers, E visual acuity test charts and NTU Random-dot stereogram.
All collected data were analyzed using SPSS 11.0；and ANOVA, T-test, Pearson Correlation, Linear Regression, Multiple Regression were used for data analysis.
The overall sensitivity of the screening was 91.5%，specificity was 76.8%，positive predictive value（PPV） was 74.1%，negative predictive value（NPV）was 92.5%, and the overall screening validity was 82.97%. The validity was negatively related to age of the preschool teachers. The sensitivity was correlated with the work seniority and educational background of the preschool teachers. The NPV was also related to the educational background. In average the knowledge, attitude, and behavior, toward vision care and screening were 67.42%（SD=15.6%）, 3.21
（SD=0.27）, 82.22%（SD=10.22%）according. The knowledge of vision acre &
screening had a positive correlation with the specificity, validity and PPV of the screening among preschool teachers. The attitude of it also had a positive
correlation with the screening specificity. Sensitivity, specificity, PPV and NPV of the screening were all positively associated whith the accuracy of screening behavior.
The multiple regression analyses also found that the main predicting factor of sensitivity was educational background and the behavior. The specificity was only predicted by the accuracy of behavior. The main predicting factor of PPV of the screening was the behavior. Both the educational background and the behavior of preschool teachers were the main predicting factors for NPV. Age, knowledge, and behavior of preschool teachers were main predicting factors for the validity of screening.
Findings of this study will help public health nurses to revise suitable training program and supervision plan for the preschool teachers before they can correctly conduct the vision screening. Recommendations can be made to stakeholders to make policy adjustment to promote high quality preschool children vision screening and to really implement the valid vision screening projects in communities. Finally, visual problems of children can be detected and treated as early as possible.
Keywords: validity, vision screening, preschool children.
