臺灣博碩士論文加值系統

本研究之主要目的於探索社區民眾在鄰里中與精神疾病患者接觸之經驗，對精神疾病及其患者態度之影響，並探討影響民眾態度之相關因素，以期能找出合宜的方式，促進社區民眾以鄰里情誼對社區中的精神疾病患者提供更多的協助。
本研究為一橫斷式研究，以結構式問卷－鄰里經驗量表收集資料，個案組採立意取樣，收案對象為台北市某行政區中，曾有與精神疾病患者接觸經驗者，共收案102位；對照組以隨機分層抽樣，訪問行政區中未曾有接觸經驗之民眾，共收案107位。
研究分析以SPSS10.0版電腦軟體進行描述性分析(含次數分配、平均值（mean）、標準差（standard deviation）、百分比（﹪）)與探索性因素分析，並以LISREL8.52版電腦軟體進行驗證性因素分析，因徑分析，及結構方程模式(SEM)，檢驗因素之間的關係與人口學變項、接觸經驗對態度之影響。
研究結果顯示
（一） 因素分析結果可將社區民眾對精神疾病及其患者之態度歸納為三層面九個因素來探討:分別是對疾病之認識層面(包括疾病的歸因、醫療認知、疾病概念、精神保健概念)、對病人之態度層面(包括能力評價、接納態度、隔離限制需求、社會權利)及公眾態度層面(關懷意願)。
（二） 社區民眾對精神疾病及其患者之態度：在疾病之認識層面，疾病的歸因偏向心理社會歸因，對醫療方式、精神保健概念有正確的認識，但對疾病整體概念認識較不足；在對病人之態度層面，相信病人仍有能力，但希望限制其社會權利、隔離限制患者、接納態度偏負向；在公眾層面則一致認同應給予患者更多關懷。
（三） 態度因素間之關係，以疾病歸因與能力評價對隔離排斥或接納態度有直接且顯著的影響。
（四） 接觸經驗可増加對疾病或患者正向態度之論點，並未能在本研究中充分被支持。接觸經驗僅對疾病層面中之疾病整體概念與病人層面中之社會權利有直接影響，但對疾病歸因、醫療認知、保健概念、能力評價無直接影響，對排斥隔離、接納態度、關懷意願，則是接間影響。有接觸經驗者對疾病整體概念的認知較不足、願給與病人之社會權利較少，間接降低接納態度與關懷意願。
（五） 人口學因素與接觸經驗對各態度因素有不同程度之影響，整體而言男性、年長者、教育程度較高者，無接觸經驗者對精神疾病與其患者之態度較正向，關懷意願較高。
本研究之結果有助於暸解社區民眾對精神疾病及其患者之態度，並探討影響態度之有效因素，可提供未來相關研究的方向，並作為精神醫療專業人員為患者做出院準備、社區個案管理及衛生行政政策規劃時之參考。

The purpose of this study is to explore the experience of neighborhood living with the chronic mentally ills, evaluating community attitudes to people with mental ills, and to find the possible effective way of mutual neighborhood care for chronic mentally ills.
The study design employed a questionnaire survey. All participants were asked to complete Neighborhood Experience Scale. Structure interview were conduct with the citizen of Taipei who has the experience of contact with mental illness patient was sampling to case group (n=102), and no contact experience citizen to control group (n=105).
Data analysis was using the software SPSS 10.0 for window to perform the descriptive statistics (include mean, standard deviation and percentage) and exploratory factor analysis. To use the software LISREL 8.52 to perform the confirmatory factor analysis, path analysis, and structural equation model (SEM) for examining the relationship between attitude factor and understanding the affection of the demography and contact experience.
Result
1. The factor analysis show nine attitude factors: etiology of mental ills, treatment of mental ills, concept of mental ills, prevention of mental ills, ability evaluation, society right, acceptable attitude, exclude or isolation, and concerned desire.
2. The attitude of general public toward mental ills and patient was dividing into 3 parts: the attitude toward illness, the attitude toward patient, the public attitude. For illness view, the etiology of mental ills was favorably socio psychology cause. Most of participants had accurate knowledge about treatments and prevention of mental illness, but not enough with advance concept of mental ills. For patient view, the participant’s belief that patient still had some ability to take care himself, but asked more society restriction or isolation, and less acceptable attitude to them. For public view, almost all of the participants agreed that we should pay more concerned for the people with mental illness.
3. Etiology and ability evaluation of mental ills had direct and strong affected on the attitude of acceptable or isolation in the relationship between attitude factors.
4. The experience of contact had direct affected on factors concept of mental and society right. More contacted experience, less knowledge about advance concept of mental ills and society right.
5. The demography variables did different affect on attitude factors. Male, elder and higher education lever had more positive attitude toward people with mental illness. This study can’t adequate suggested that contact experience could increase the positive attitude.
The results of this study could understand the public attitude toward mental ills and patient, and explored the efficacious way to attitude factors. To provide related research in the future, develop local data and health administration reference of foundation.

誌謝…………………………………………………………………Ⅰ
中文摘要……………………………………………………………Ⅲ
英文摘要……………………………………………………………Ⅴ

第一章 前言…………………………………………………………1
第二章 文獻查證
第一節 對精神疾病及其患者態度研究之指標及方法……… 6
第二節 社區民眾對精神疾病及其患者的態度………………… 13
第三節 影響對待態度的因素…………………………………… 20
第三章 研究方法
第一節 研究目的………………………………………………… 26
第二節 研究假設………………………………………………… 26
第三節 研究架構………………………………………………… 27
第四節 研究方法………………………………………………… 28
第五節 研究工具………………………………………………… 30
第六節 資料分析方法…………………………………………… 34
第四章 研究結果
第一節 人口學資料分析………………………………………… 38
第二節 社區民眾對精神疾病及其患者之態度………………… 40
第三節 各態度因素之間的關係………………………………… 53
第四節 接觸經驗對態度之影響………………………………… 59
第五節 人口學因素對態度之影響……………………………… 63
第五章 討論
第一節 社區民眾對精神疾病及患者之態度…………………… 68
第二節 因素間之相互關係……………………………………… 73
第三節 接觸經驗對精神疾病患者態度之影響………………… 76
第四節 人口學因素對精神疾病患者態度之影響……………… 79
第六章 結論與限制
第一節 結論……………………………………………………… 82
第二節 應用與建議……………………………………………… 84
第三節 研究限制………………………………………………… 88
第七章 參考資料………………………………………………… 90

附錄
附錄一:個性特質、飲酒看法、與鄰居生活經驗量表，參與
評量同意書…………………………………………………… 98
附錄二:里鄰經驗量表…………………………………………… 99
附錄三:個案組與對照組探索性因素分析與驗證性因素分析
流程…………………………………………………………… 103
附錄四:兩組鄰里關懷量表之百分比分佈比較………………… 116
附錄五:合併後驗證性因素分析流程…………………………… 118
附錄六:個案組各題之相關矩陣………………………………… 128
附錄七:對照組各題之相關矩陣………………………………… 130
附錄八:合併後各題之相關矩陣………………………………… 132


圖 次
圖一 社區民眾對精神疾病患者的態度研究假設架構圖… 27
圖二 假設結構模型S-null之路徑圖………………………… 53
圖三 結構模型S-r-26之路徑圖……………………………… 54
圖四 接觸經驗對各因素之影響（模型SEM-r22）……… 60
圖五 人口學變項及接觸經驗對各因素之影響（模型SEM-r59）
………………………………………………………………… 65


表 次
表一.個案組與對照組之人口學特性比較……………………… 39
表二: 對精神疾病之歸因答題百分比…………………………… 41
表三 :對精神分裂症狀之了解答題百分比……………………… 41
表四:對精神疾病醫療的相關知識答題百分比………………… 42
表五:對患者的特質能力評價答題百分比……………………… 42
表六:對患者的情緒反應答題百分比…………………………… 43
表七:願給予患者的社會權利答題百分比……………………… 43
表八:對患者的關懷態度答題百分比…………………………… 44
表九:兩組合併後之探索性因素分析結果……………………… 45
表十:兩組合併後驗證性因素分析之測量模型結果………… 46
表十一:各因素之因素分數平均值……………………………… 52
表十二:結構模型S-r-26之因素負荷量表……………………… 55
表十三:模型SEM-r22之因素負荷量表………………………… 61
表十四:模型SEM-r59之因素負荷量表………………………… 67
表十五:疾病歸因之比較………………………………………… 69

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