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研究生:蔡瑜珍
研究生(外文):Yue-Chen Tsai
論文名稱:社區意識與整體環境維護的登革熱防治觀點一個針對高雄市的社區比較研究
論文名稱(外文):Dengue Prevention from the viewpoint of sense of community and overall environmental health---A community-based comparative study in Kaohsiung city
指導教授:丁志音丁志音引用關係
學位類別:碩士
校院名稱:國立臺灣大學
系所名稱:衛生政策與管理研究所
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2004
畢業學年度:92
語文別:中文
論文頁數:87
中文關鍵詞:登革熱防治整體環境維護登革熱社區動員
外文關鍵詞:Denguecommunity participationdengue controloverall environmental health
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摘要
登革熱防治工作逐漸朝向以社區為基礎(community-based)的防治方向發展,經由動員社區義工的方式來幫助政府共同防治登革熱。雖然探討社區介入成效的相關研究不少,惟其介入效果的持久性一直備受質疑,介入計畫始終未能引發真正社區動員的主要原因為,登革熱議題一項不被視為重要的社區議題,且透過知識宣導及孳生源稽查等介入方式,不易引發民眾的共鳴。

本研究以里長、里幹事訪談以及家戶面訪的方式進行社區整體狀態的資料收集,訪問了分屬於高中低三組不同盛行程度社區6個里的里長與里幹事,以及598位社區民眾。希望經由比較不同登革熱盛行程度社區的特質,來探討社區意識的提升以及整體環境的維護,與登革熱防治的關係。

本研究結果顯示:(1) 社區意識與登革熱盛行程度之間存在著關聯性。低登革熱盛行程度之社區其登革熱的相關認知雖較為薄弱,然其社區意識與社區組織活絡程度,明顯優於高盛行程度之社區,且較傾向於將清除家戶以外孳生源的工作責任歸屬於社區居民或鄰里長。 (2)民眾對於維護住家附近環境整潔以及清除家戶以外孳生源的態度有很大的差異。多數民眾(67.1%)認為維護居住環境整潔是居民的責任,但是清除戶外孳生源則僅有14.4%的受訪者認為是居民的責任。顯示倡導維護住家附近環境整潔,會比宣導清除孳生源更容易引發民眾的共鳴。

根據以上的研究結果,本研究因此建議疾病防治應該進入一種更新更廣的思維模式,以登革熱來說,防治並不能僅靠灌輸民眾登革熱的相關認知,或經由斷斷續續的社區介入方案來達成,我們必須跳脫防治單一疾病的思考模式,學習以社區居民的需求來思考問題,才能引發真正的社區動員。執行策略有二:(1)把登革熱防治重新包裝成維護並改善住家環境整潔或釦颾e易引發共鳴,(2)成立社區環境維護組織來提升社區意識,進而促進社區動員。藉由這些非針對單一疾病的策略性觀點,來改善過去社區介入方案的缺陷,鞏固社區動員的持久性,或野i為以社區為基礎的登革熱防治工作開啟另一扇窗。
Abstract
Community-based programs focused on the cooperation between government and community members have lately become a widely recognized strategy in dengue prevention and control. Unfortunately the effectiveness and sustainability of these programs have been questioned seriously. In most of the cases, dengue control was not considered by the community citizens as a major health issue. Moreover, conventional intervention strategies such as health education and campaign or container cleaning may not be able to incite and motivate community members to participate.

The present research is a comparative community study. Six communities were selected from areas with low, median, and high dengue prevalence rates. Data were collected by in-depth interviewing with community leaders and face-to-face interviewing with community residents from 598 households. Thus both qualitative and quantitative data were integrated to examine community characteristics, dengue-related knowledge, attitudes, and behavioral intentions, and overall outlook on community environmental health in relation to dengue prevalence.

The major findings are; (1) Sense of community is strongly correlated with dengue prevalence. Participants came from low prevalence communities, although having poorer dengue knowledge had stronger sense of community, as well as a more actively participating in community activities. Moreover, they also tended to consider the outdoor breeding source cleansing as the community’s rather than the government’s responsibility. (2) A substantial difference was found between the residents’ attitudes towards outdoor breeding source cleansing versus overall community environment maintenance. The latter was much more concerned about by community residents. As many as 67% of the household participants in this study were willing to be responsible for overall environmental health of the community, but only 14.4% considered outdoor container cleaning as their responsibility.

The results of the study lead to propose a broader approach to the control of infectious disease. That is, the prevention and control of a specific disease such as dengue should be placed in a more comprehensive frame of conceptualization and actions, instead of the conventional disease-specific approach. From such point of view, dengue prevention should not be targeted simply on the change of knowledge and attitudes through fragmentally implemented community interventions. Community mobilization and participation cannot be fully initiated without taking the citizens’ point of views into account. Two strategies are thus suggested: (1) Re-packaged the dengue control programs from action-for-dengue to action-for-environment and, by emphasizing the change of approach, which can be accomplished through (2) building up community organizations to enhance residents’ sense of community, which in turn may facilitate participation. It is expected that the comprehensive rather than disease-specific approach of infectious disease control can assure not only the effectiveness but also the sustainability of community-based interventions.
內 容 目 錄
第一章 前言........................................1

第二章 文獻探討
第一節 登革熱的流行現況與防治策略.........2
第二節 社會科學角度看登革熱議題...........4
第三節 登革熱與社區的關係.................9
第四節 社區意識..........................11
第五節 風險知覺..........................12
第六節 小結..............................13

第三章 研究方法
第一節 先驅研究..........................15
第二節 社區與家戶調查....................19

第四章 受訪者及社區環境特質
第一節 社區調查..........................25
第二節 社區環境特質......................27

第五章 研究結果
第一節 研究變項描述性統計結果............30
第二節 不同盛行程度社區間的比較..........38
第三節 影響參與意願之相關因素探討........48
第四節 里長里幹事訪談結果................58

第六章 討論
第一節 提昇社區整體狀態的防治觀點........60
第二節 宣導方式的適切性..................63
第三節 社區特質與盛行程度................64

第七章 結論與建議
第一節 結論..............................67
第二節 建議..............................68

參考文獻...........................................70
附錄一 抽樣流程圖.................................73
附錄二 問卷內容...................................75
附錄三 先驅研究街頭訪談內容.......................83


圖 表 目 錄

表2-1 各國防治計劃成效及失敗原因.......................7
表4-1 研究樣本之社會人口特質,按社區別分..............26
表4-2 各里的環境特質,按社區別分......................28
表4-3 各里與登革熱有關的環境特質,按社區別分..........29
表5-1 民眾的病媒蚊知識................................30
表5-2 民眾對孳生源的看法..............................32
表5-3 民眾對登革熱的風險知覺..........................34
表5-4 民眾對登革熱及社區的相關環境知覺................35
表5-5 民眾對社區清除工作責任歸屬的態度................36
表5-6 民眾的社區意識..................................36
表5-7 民眾參與里長招募義工活動的意願..................37
表5-8 病媒蚊知識的分布,按社區別分....................38
表5-9 民眾對孳生源的看法-有無聽過孳生源、
孳生源是什麼的分布,按社區別分..................40
表5-10 民眾對孳生源的看法-登革熱蚊子幼蟲長在哪裡
及為什麼的分布,按社區別分......................41
表5-11 民眾對孳生源的看法-住家外蚊子多、
清除孳生源的效果、無效原因分布,按社區別分......42
表5-12 民眾對登革熱的風險知覺分布,按社區別分.........43
表5-13 社區環境知覺,按社區別分.......................45
表5-14 清除工作責任歸屬,按社區別分...................46
表5-15 社區意識-里民一起做事可能性、
社區組織效能觀感,按社區別分...................47
表5-16 參與自願服務意願-按社區別分....................48
表5-17 病媒蚊知識、孳生源看法、風險知覺
與參與自願服務意願的關係.......................50
表5-18 社區環境知覺、清除工作責任歸屬與參
與自願服務意願的關係...........................52
表5-19 社區意識與參與自願服務意願的關係...............53
表5-20 社會人口學變項與參與自願服務意願的關係.........53
表5-21 民眾參與清理里環境意願影響因素之邏輯氏迴歸.....55
表5-22 民眾參與幫忙清孳生源意願影響因素之邏輯式迴歸...57
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