國民健康署針對孕婦預防保健服務，從民國84年結合健保特約醫院開辦實施10次產前檢查。10次產前檢查中包含1次超音波檢查及2次的產前衛教評估及指導，民國110年7月更將原有的10次產前檢查增加到14次。孕婦預防保健主要目的是希望藉由產前檢查及產前衛教指導保障母嬰健康。過去的研究當中，較少探討這些資訊的提供對孕婦孕期身心健康適應的影響，故本研究欲探討初次懷孕婦女在第一孕期接受重新統整規劃並運用多媒體素材所設計出的產檢「產前衛教地圖」之介入方案措施下孕婦在懷孕過程中是否可以提升產前衛教內容認知情形並且改善孕期焦慮情形、輔助孕婦孕期身心健康的適應、提升母乳哺餵及親子同室意願。
本研究採類實驗性研究設計，方便取樣方式，研究對象共114位，為第一孕期初產婦，以南部某醫學中心收案為實驗組(N=73)，使用「產前衛教地圖」執行產前衛教，以南部某教學醫院收案為對照組(N=41)，採一般常規產前衛教照護。兩組研究對象分別在懷孕8-12週接受介入方案及一般常規衛教前進行前測、懷孕15-17週進行後測。實驗組進行第一孕期衛教內容認知測量、視覺類比焦慮量表及台灣懷孕婦女身心健康適應問卷；對照組進行視覺類比焦慮量表及台灣懷孕婦女身心健康適應問卷。資料分析採描述性統計、配對樣本t檢定、獨立樣本t檢定及卡方檢定等推論性統計。
研究結果顯示實驗組在介入措施後孕婦在衛教內容認知平均分數由84.1±10.4分提升至98.4±4.1分，且有顯著的差異(p=<0.001)；孕期焦慮分數由4.9±2.7分減少為4.2±2.3分，有顯著差異(p=0.003)，然而在孕婦身心健康適應得分、親子同室及母乳哺餵意願均無顯著差異。對照組孕婦接受一般常規照護後前後孕婦身心健康適應情形、孕期焦慮情形以及親子同室及母乳哺餵意願均無顯著差異。實驗組及對照組在介入措施後與孕婦身心健康適應情形、孕期焦慮情形以及親子同室及母乳哺餵意願均無顯著差異。
本研究使用「產前衛教地圖」可有系統的將每個孕期所需要知道的相關產前資訊整理在一個方便使用的平台，提供孕婦容易了解孕期重要衛教資訊、理解生澀的專業衛教內容、以及技能操作，提升孕婦孕前的衛教內容認知及降低孕期的焦慮，但與是否比傳統的衛教較為有效，因本研究樣本數略不足，有待進一步探討。

Background: For the preventive health care service of pregnant women, the National Health Service has launched and implemented 10 prenatal checkups since 1984 in the designated hospital for combined with national health insurance. The 10 prenatal checkups included one ultrasound examination and two prenatal health education assessments and guidance. In July 2011, the original 10 prenatal checkups were increased to 14. The main purpose of preventive health care for pregnant women is to protect the health of mothers and babies through prenatal examinations and prenatal education. Few studies have explored the impact of the provision of such information on pregnant women's physical and mental health adaptation and medical decision-making during pregnancy. Therefore, this study aimed to explore the effect of the reorganized intervention plan of the " Prenatal Health Education Map " designed with multimedia materials on cognizant prenatal health education, anxiety, physical and mental health adaptation, and In the first trimester of primipara breastfeeding and parent-child roommate willingness.
Method: This study adopted a quasi-experimental design and a convenient sampling method. A total of 114 research subjects. Subjects are primiparous women in the first trimester. Subjects had the prenatal check in the medical center were included in the experimental group (N=73), receiving the intervention of " Prenatal Health Education Map " Subjects had the prenatal check in a teaching hospital were treated as the control group (N=41), receiving general routine antenatal health care. All the subjects carried out the pre-test in the first visit at 8-12 weeks gestation, and post-test at 15-17 weeks gestation. The experimental group carried out cognitive measurement of the health education content, visual analogy anxiety scale, and physical and mental health adaptation questionnaire for pregnant women in Taiwan; The control group took the visual analogy anxiety scale and the physical and mental health adaptation questionnaire for Pregnant Women in Taiwan. Descriptive statistics, independent samples, and paired t-test, chi-square test, were applied for analysis.
Results: The results of the study showed that in the experimental group, the average cognition score of pregnant women in health education content increased from 84.1±10.4 points to 98.4±4.1 points after the intervention, and the difference was significant (p=<0.001); Anxiety score during pregnancy decreased from 4.9±2.7 to 4.2±2.3 was also significant (p=0.003), However, there was no significant difference in maternal physical and mental health adaptation score, parent-child rooming-in, and breastfeeding willingness. Comparing the experiment and control groups, there was no significant differences among all outcome parameters.
Conclusion: The " Prenatal Health Education Map " systematically organizes the relevant prenatal information that needs to be known during each pregnancy on a convenient platform. It is convenient for pregnant women to understand necessary health information and technology without difficult medical technology during pregnancy, However, this intervention is better than regular health education required further exploration with larger sample size.

王瓊琦、鄭雅如、許玫琪（2020）．提升24小時親子同室率和改善純母乳哺餵之研究-以母嬰親善醫院為例．健康促進研究與實務，3(2)，1-10。
王子芳、江曉菁（2018）．妊娠期婦女及其家庭成員的心理反應．於高美玲總校閱，實用產科護理學(八版，172-198頁)．華杏。
王子芳、方郁文（2018）．妊娠期母體的生理變化．於高美玲總校閱，實用產科護理學(八版，152-170頁)．華杏。
王秀梅、陳惠敏、徐秋玉、張慧先（2007）．音樂治療對於子宮全切除婦女焦慮程度改善之影響．長庚護理，18(1)，11-20。
史美瑤（2014）．混成學習(Blended/Hybrid Learning)的挑戰與設計．評鑑雙月刊，50，34-36。
李靜芳、林顯明、孫吉珍、谷幼雄（2009）．婦女於不同孕期之症狀困擾研究．亞東學報(29)，207-215。doi.org/10.30167/joit.200906.0024
李月萍、陳玉敏（2007）．適應之概念分析．長庚護理18(3)，352-358。
呂文娟、徐曼瑩、蔡依帆、楊文理、高木榮、李俊秀（2017）．護理新人的管路照護模組課程之混成式學習成效．北市醫學雜誌14(3)，315-323。
林玉雯、黃台珠、劉嘉茹（2010）．課室學習專注力之研究－量表發展與分析應用．科學教育學刊，18(2)，107-129。
林軍廷、周汎澔（2008）．不同孕次婦女之孕期心理社會適應的比較．護理雜誌，55(6)，28-36。
林麗珠、李從業、郭素珍、穆佩芬、許洪坤（2004）．產婦接受母嬰同室護理的生活經驗．護理雜誌，51(1)，35-44。
周雨樺（2014）．妊娠期婦女的生理及心理變化．於余玉眉總校閱，產 科護理學(七版，85-127頁)．新文京。
周汎澔（2013）．孕期噁心嘔吐之症狀經驗評估與護理處置．護理雜誌，60(6)，5-10。
胡連珍、曾雅玲（2018）．翻轉教室模式對產後哺餵母乳之成效-前驅性研究．澄清醫學管理雜誌，14(4)，44-52。
胡連珍、曾雅玲（2015）．支持策略對哺餵母乳之成效-系統性文獻回顧．澄清醫學管理雜誌，11(1)，56-63。
岳端品、陳柚綾、陳淑齡（2010）．適應概念的分析．弘光學報(61)，40-48。
郝永崴（2010）．翻轉教室：談學生看法．教育脈動，(1)，34-52。
徐禎美、陳彰惠（2008）．孕期憂鬱的盛行率和預測因子．實證護理，4（2），149-156。
徐莞雲、陳筱瑀（2008）．焦慮的概念分析．志為護理-慈濟護理雜誌，7（3），65-70。
陳俊榕（2019）．醫療上之知情拒絕權．高大法學論叢，14(2)，69-108。
陳淑溫（2018）．共享決策在產科臨床上的應用．台灣醫學，22(5)，560-566。
陳芷如（2017）．應用混成式學習於成人學習之實證經驗．數位與開放學習期刊，(7)，50-67。
陳昭惠、徐桂芳、陳得源（2015）．臨床教學：從成人學習理論到實際運用．中榮醫教（18），29-32。
梁慧敏、高美玲、陳治平、劉介宇（2019）．入院待產時機教育課程於孕婦焦慮、不確定感生產控制感及待產結果之成效．護理雜誌， 66(2)，36-47。
黃惠滿、鄭夙芬（2018）．翻轉教室教學策略於護理教育課程之應用．護理雜誌，65(6)，5-12。https://doi.org/10.6224/jn.201812_65(6).02
黃政傑（2014）．翻轉教室的理念、問題與展望．台灣教育評論月刊，3(12)，161-186。
翁敏雪、李從業、李文宗（2003）．產前錄影帶衛教介入措施對產婦分娩自我控制成效之探討．新台北護理期刊，5(2)，49-58。
張淑娟、林玉華、周汎澔（2010）．職業婦女孕期適應之相關性研究．健康生活與成功老化學刊，1（2），55-72。
施麗雯（2015）．台灣的道德先鋒：焦慮、產檢選擇與責任的矛盾．科技、醫療與社會，21，77-134。
郭碧照、李麗珠、王郁茗、李淑杏（2003）．產前教育模式對生殖科技懷孕婦女安適感成效之探討．中山醫學雜誌，14（1），89-98。
國民健康署（2020年，7月10日）．107年健康促進年報。https://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=268&pid=12886
國民健康署（2019年，9月25日）．哺餵母乳，守護寶寶健康!有母嬰親善醫療院所真好。https://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=1136&pid=3102
國民健康署（2017年，1月4日）．孕婦產前健康照護衛教指導服務補 助方案。https://www.hpa.gov.tw/Pages/List.aspx?nodeid=195
楊雅婷、陳奕樺（2013）．課室專注力量表之建構．教育研究與發展期刊，9(4)，1-28。
蔡瑞君（2015）．翻轉教室之過去、現在與未來．教育脈動，(1)，21-31。
蔡菊蘭、陳淑溫（2004）．妊娠期婦女的護理．於鍾聿琳總校閱，簡明產科護理(五版，113-194頁)．華杏。
劉慧珠（2021）．以創新學習技法融入文創教學之實踐與評估．藝見學刊，21，33-49。
劉彥君、陳燕諭（2020）．台灣懷孕婦女身心健康適應問卷之發展研究．教育心理學報，51(4)，531-560。
饒秀玲、林麗鳳（2009）．社區民眾的高血壓自我保健衛生教育之方案設計－成人教育理論之應用．澄清醫護管理雜誌，5(4)，39-52。
謝姿宜（2015）．服務主導邏輯觀點之價值共創：孕產婦醫療照護之實證研究（碩士論文，國立成功大學），http://dx.doi.org/10.6844/NCKU.2015.00446. doi:10.6844/NCKU.2015.00446
顏崇凱（2015）．混成式學習教學實驗研究．台灣教育評論月刊，4(7)，141-144。
蕭若蘭、游曉貞、陳威志、林麗珠（2017）．應用網路教學平台及多媒體動畫教材對初產婦生產教育的成效．助產雜誌，(59)，12-22。
Aksoy Derya, Y., Altiparmak, S., AkÇa, E., GÖkbulut, N., & Yilmaz, A. N. (2021). Pregnancy and birth planning during COVID-19: The effects of tele-education offered to pregnant women on prenatal distress and pregnancy-related anxiety. Midwifery, 92, 102877. https://doi.org/10.1016/j.midw.2020.102877
American College of Obstetricians and Gynecologists. (2018). group prenatal care. ACOG Committee Opinion, 131(3), 104-108. https://doi.org/10.1097/aog.0000000000002529
Afshar, Y., Mei, J. Y., Gregory, K. D., Kilpatrick, S. J., & Esakoff, T. F. (2018). Birth plans-impact on mode of delivery, obstetrical interventions, and birth experience satisfaction: A prospective cohort study. Birth, 45(1), 43-49. https://doi.org/10.1111/birt.12320
Bjelica, A., Cetkovic, N., Trninic-Pjevic, A., & Mladenovic-Segedi, L. (2018). The phenomenon of pregnancy - a psychological view. Ginekologia Polska, 89(2), 102-106. https://doi.org/10.5603/GP.a2018.0017
Caruth, G. (2014). Learning how to learn: A six point model for increasing student engagement. Participatory Educational Research, 1(2), 1-12.
Chou, F. H., Avant, K. C., Kuo, S. H., & Cheng, H. F. (2005). Assessing the psychometric and language equivalency of the chinese versions of the index of nausea, vomiting and retching, and the prenatal self-evaluation questionnaire. Kaohsiung Journal of Medical Sciences, 21(7), 314-321. https://doi.org/10.1016/s1607-551x(09)70127-5
Gift, A. G. (1989). Visual analogue scales: measurement of subjective pheno mena. Nursing Research. 38(5), 286-288.
Hong, K., Hwang, H., Han, H., Chae, J., Choi, J., Jeong, Y., Lee, J., & Lee, K. J. (2021). Perspectives on antenatal education associated with pregnancy outcomes: Systematic review and meta-analysis. Women Birth, 34(3), 219-230. https://doi.org/10.1016/j.wombi.2020.04.002
Hassanzadeh, R., Abbas-Alizadeh, F., Meedya, S., Mohammad-Alizadeh-Charandabi, S., & Mirghafourvand, M. (2020). Fear of childbirth, anxiety and depression in three groups of primiparous pregnant women not attending, irregularly attending and regularly attending childbirth preparation classes. BMC Womens Health, 20(1), 180-188. https://doi.org/10.1186/s12905-020-01048-9
Han, E., & Klein, K. C. (2019). Pre-class learning methods for flipped classrooms. American Journal of Pharmaceutical Education, 83(1), 40-49. https://doi.org/10.5688/ajpe6922
Kim, H. K., Kim, H. K., Kim, M., & Park, S. (2021). Development and evaluation of prenatal education for environmental health behavior using cartoon comics. Journal of Korean Academy of Nursing, 51(4), 478-488. https://doi.org/10.4040/jkan.21083
Kacperczyk-Bartnik, J., Bartnik, P., Symonides, A., Sroka-Ostrowska, N., Dobrowolska-Redo, A., & Romejko-Wolniewicz, E. (2019). Association between antenatal classes attendance and perceived fear and pain during labour. Taiwanese Journal of Obstetrice and Gynecology, 58(4), 492-496. https://doi.org/10.1016/j.tjog.2019.05.011
Knowles, M. S., Holton, E. F., & Swanson, R. A. (2005). The Adult Learner(9 th ed.).Routledge.
Liu, Q., Peng, W., Zhang, F., Hu, R., Li, Y., & Yan, W. (2016). The effectiveness of blended learning in health professions: Systematic review and meta-analysis. Journal of medical Internet research, 18(1), 1-19.
Lin, C. T., Cheng, C. P., Kuo, S. H., & Chou, F. H. (2009). Development of a chinese short form of the prenatal self-evaluation questionnaire. Journal of Clinical Nursing, 18(5), 659-666. doi:10.1111/j.1365-2702.2007.02201.x
Lederman, R. P. (1984). Anxiety and conflict in pregnancy: Relationship to maternal health status. Annual Review of Nursing Research, 2, 27-61.
Megregian, M., & Nieuwenhuijze, M. (2018). Choosing to decline: finding common ground through the perspective of shared decision making. J Midwifery Womens Health, 63(3), 340-346. doi:10.1111/jmwh.12747
Moffett, J. (2015). Twelve tips for "Flipping" the classroom. Medical Teacher, 37(4), 331-336. https://doi.org/10.3109/0142159x.2014.943710
Merriam, S. B. (2011). Third Update on Adult Learning Theory: New Directions for Adult and Continuing Education (3 rd ed.). John Wiley & Sons.
Montgomery, A. A. (2004). The DiAMOND trial protocol: A randomised controlled trial of two decision AIDS for mode of delivery among women with a previous caesarean section. BioMed Central Pregnancy Childbirth, 4(1), 25-32. doi:10.1186/1471-2393-4-25
Nieuwenhuijze, M. J., Korstjens, I., de Jonge, A., de Vries, R., & Lagro-Janssen, A. (2014). On speaking terms: A delphi study on shared decision-making in maternity care. BioMed Central Pregnancy Childbirth, 14, 223-234. doi:10.1186/1471-2393-14-223
O'Brien, D., Casey, M., & Butler, M. M. (2018). Women's experiences of exercising informed choices as expressed through their sense of self and relationships with others in ireland: A participatory action research study. Midwifery, 65, 58-66. Retrieved from http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L625613055
O'Brien, D., Butler, M. M., & Casey, M. (2017). A participatory action research study exploring women's understandings of the concept of Informed choice during pregnancy and childbirth in ireland. Midwifery, 46, 1-7. Retrieved from http://www.sciencedirect.com/science/article/pii/S0266613817300050. doi:https://doi.org/10.1016/j.midw.2017.01.002
Parry, K. C., Tully, K. P., Hopper, L. N., Schildkamp, P. E., & Labbok, M. H. (2019). Evaluation of Ready, Set, BABY: A Prenatal Breastfeeding Education and Counseling Approach. Birth, 46(1), 113-120. https://doi.org/10.1111/birt.12393
Persky, A. M., & McLaughlin, J. E. (2017). The flipped classroom–from theory to practice in health professional education. American Journal of Pharmaceutical Education, 81(6), 1-11.
Papadakos, C. T., Papadakos, J., Catton, P., Houston, P., McKernan, P., & Jusko Friedman, A. (2014). From theory to pamphlet: The 3Ws and an H process for the development of meaningful patient education resources. Journal of Cancer Education, 29(2), 304-310. https://doi.org/10.1007/s13187-013-0600-z
Ricchi, A., La Corte, S., Molinazzi, M. T., Messina, M. P., Banchelli, F., & Neri, I. (2020). Study of childbirth education classes and evaluation of their effectiveness. Clinica Terapeutica, 170(1), 78-86. https://doi.org/10.7417/ct.2020.2193
Ragusa, R., Giorgianni, G., Marranzano, M., Cacciola, S., La Rosa, V. L., Giarratana, A., Altadonna, V., & Guardabasso, V. (2020). Breastfeeding in hospitals: Factors influencing maternal choice in italy. International Journal of Environmental Research and Public Health, 17(10), 35-75. https://doi.org/10.3390/ijerph17103575
Rowe, M., Frantz, J., & Bozalek, V. (2012). The role of blended learning in the clinical education of healthcare students: A systematic review. Medical Teacher, 34(4), 216-221.
Rubin, R. (1976). Maternal tasks in pregnancy. Journal of Advanced Nursing, 1(5), 367-376.
Sanchez, L. M., & Cooknell, L. E. (2017). The power of 3: using adult learning principles to facilitate patient education. The Peer-Reviewed Journal of Clinical Excellence, 47(2), 17-19.
Stark, M. A. (1997). Psychosocial adjustment during pregnancy: The experi ence of mature gravidas. Journal of Obstetric Gynecologic Neonatal Nursing, 26(2), 206-211. doi:10.1111/j.1552-6909.1997.tb02134.x
Teixeira, C., Figueiredo, B., Conde, A., Pacheco, A., & Costa, R. (2009). Anxiety and depression during pregnancy in women and men. Journal of Affective Disorders, 119(1-3), 142-148.
Wang, M. M., Loh, E. W., Chou, J. F., Sung, P. M., Chou, Y. Y., Lin, Y. K., Chen, S. F., & Tam, K. W. (2021). Influence of shared decision making on decisional conflict and regret in postpartum mother-infant care: A randomized controlled trial. Value Health, 24(9), 1335-1342. https://doi.org/10.1016/j.jval.2021.03.011
World Health Organization. (2018). WHO and UNICEF issue new guidance to promote breastfeeding in health facilites globally. https://www.who.int/news/item/11-04-2018-who-and-unicef-issue-new-guidance-to-promote-breastfeeding-in-health-facilities-globally
Wilson, K., & Korn, J. H. (2007). Attention during lectures: beyond ten minutes. Teaching of Psychology, 34(2), 85-89.
Webster, J., Linnane, J. W., Dibley, L. M., Hinson, J. K., Starrenburg, S. E., & Roberts, J. A. (2000). Measuring social support in pregnancy: Can it be simple and meaningful? Birth Issues in Perinatal Care, 27(2), 97-101. doi:10.1046/j.1523-536x.2000.00097.x
Yesilcinar, I., & Guvenc, G. (2021). Counselling and education for prenatal screening and diagnostic tests for pregnant women: Randomized controlled trial. International Journal of Nursing Practice, 27(5), 130-134. https://doi.org/10.1111/ijn.13000
Yikar, S. K., & Nazik, E. (2019). Effects of prenatal education on complaints during pregnancy and on quality of life. Patient Education Counseling, 102(1), 119-125.