臺灣博碩士論文加值系統

背景：許多研究指出社區的健康與社區的支持性環境有密切關係。1986年WHO發起健康城市計畫並建立健康城市指標，期望透過健康的公共政策，創造支持健康的環境。然而城市層級之評估指標，通常不易為社區所理解，也與社區生活和需求無關，因此無法協助社區能力之發展。本研究目的即是建構社區層次的支持性環境之指標，以為健康社區之評估量表，並以台南市為例，實地收集和評估台南市健康社區之發展情形。

方法：包括健康社區之理論回顧及整理台南市居民對健康城市的需求調查，首先建構54個健康社區指標，接者邀請台南市里長和協會理事長進行焦點團體，及專家學者進行問卷之校度檢視後，進行台南市232個里之健康社區發展評估。

結果：共篩選出25題為健康社區指標。經因素分析後指出健康社區的發展差異以「休閒組織與活動」及「乾淨環境」最重要，其次為「健康促進與社區照護」、「社區表現」及「生活空間」。進一步分析各指標與健康社區發展之關係發現，當某個指標達成率越高時，不同發展程度的社區其差距不大；反之，若該指標達成率不到一半時，不同發展程度的社區在該指標的差異則極大。

結論：不同發展程度的社區在各指標的差異可能是因為社區的關切點不同、或是這些指標在社區發展上有優先次序、或是社區在實際推動上有難易程度。未來各社區在選定議題時，應透過社區參與的方式，規劃適合社區的計畫，與社區共同建立促進健康的環境，創造符合其生活所需的健康社區。

Background: Many researches have indicated that the health of a community is associated with its supportive environment for health. Through building healthy public policies, WHO launched healthy city projects and set up healthy city indicators in 1986 to help establish a supportive environment for communities. However, city-level indicators are not easy to understand for community residents and are also irrelevant to their life and needs. Neither does these incators could facilitate building up community capacity. The purpose of the study was to develop community-level supportive environment indicators to serve as a healthy community assessment scale. We used this scale to evaluate the current status of healthy community development in Tainan, as a case example.

Methods: We first reviewed theories related to healthy community and summarized residents’ expectations and needs assessment conducted in Tainan in 2003. Fifty-four contructs related healthy community indicators were built up and 15 community leaders were invited to participate in a focus group to discuss the appropriateness of these indicators. After all indicators were reviewed by associated professions, we started to collect the data of healthy community development of 232 neighborhoods in Tainan in 2004.

Results: Only 25 healthy community indicators were selected out according to the homological principle. The result of factor analysis showed that “leisure organization and activity” and “cleaning environment”are the most significant factors in the development of healthy communities, then factors of “health promotion and community caring”, “community performance ”, and “living spaces”. In further analyzing the relation between each indicator and the status of community development, we found that when the overall achievement rate of an indicator was high, the difference of development between communities was small; however, when the achievement rate was low, the difference became larger and wider.

Conclusion: The differences of achievement rate among indicators of communities in different developmental status may be because communities have their concerns or have their own priority among indicators, or have difficulties to practice some indicators. This study suggested that when setting an issue, communities should consider these factors though increasing community participation in order to build up a more comfortable and health promoting environment in the community.

第一章　前言　　　　　　　　　　　　　　　　1
　第一節�研究背景　　　　　　　　　　　　　1
　第二節�研究動機　　　　　　　　　　　　　2
　第三節�研究目的　　　　　　　　　　　　　3
　第四節�名詞定義　　　　　　　　　　　　　4

第二章　文獻探討　　　　　　　　　　　　　　6
　第一節�支持性環境對健康的影響　　　　　　6
　第二節�從社區健康到健康社區　　　　　　　12
　第三節�健康社區指標的發展現況　　　　　　16
　第四節�健康社區量表發展之理論背景　　　　22

第三章　研究方法　　　　　　　　　　　　　　30
　第一節�量表發展　　　　　　　　　　　　　30
　第二節�台南市健康社區發展情形　　　　　　37

第四章　結果　　　　　　　　　　　　　　　　38
　第一節�量表發展　　　　　　　　　　　　　38
　第二節�台南市健康社區發展情形　　　　　　49

第五章　結論與討論　　　　　　　　　　　　　58
　第一節�結論　　　　　　　　　　　　　　　58
　第二節�量表建構　　　　　　　　　　　　　59
　第三節�研究限制　　　　　　　　　　　　　63
　第四節�健康社區之建立　　　　　　　　　　65

參考文獻　　　　　　　　　　　　　　　　　　68

附件一：健康社區自我評估表（54題本）
附件二：健康社區自我評估表（25題本）


表目錄
表1：社區評估的歷史進程　　　　　　　　 　　　12
表2：社區健康與健康社區的差異　　　　 　　　　16
表3：健康城市指標　　　　　　　　　　　 　　　19
表4：健康城市與社區指標整理　　　　　　　 　　20
表5：項目與總分之相關　　　　　　　　　　　 　39
表6：極端值比較　　　　　　　　　　　　　　 　41
表7：題目列入題本與否之目錄　　　　　　　　 　43
表8：變異量解釋　　　　　　　　　　　　　　　 46
表9：因素負荷量表　　　　　　　　　　　　　　 47
表10：原分類之量表之內部一致性　　　　　　　　48
表11：經因素分析後之分量表之內部一致性　　　　48
表12：健康社區發展情形之描述性資料　　　　　　49
表13：健康社區發展情形之頻率分佈　　　　　　　49
表14：各社區發展指標與社區發展程度之關係　　　52
表15：地理位置及社區組織與社區發展程度之關係　56
表16：社區領導者與社區發展程度之關係　　　　　57
表17：刪除的29題與社區發展程度之分析　　　　　60


圖目次
圖 1：種族的社經不平等透過中界因子及近端因子影響健康　　　　　　　　　　　　　　　　　　　　　11
圖 2：社區資本模式式　　　　　　　　　　　　　23
圖 3：健康社區量表發展之理論架構　　　　　　　29
圖 4：健康社區指標之架構　　　　　　　　　　　33
圖 5：陡坡圖　　　　　　　　　　　　　　　　　48

Abraham T, Fallon PJ. 1997. Caring for the community: development of the advanced practice nurse role. Clinical Nurse Specialist. 11: 224-30

Addy CL, Wilson DK, Kirtland KA, Ainsworth BE, Sharpe P, Kimsey D. 2004. Associations of perceived social and physical environmental supports with physical activity and walking behavior. American Journal of Public Health 94: 440-3

Balfour JL, Kaplan GA. 2002. Neighborhood environment and loss of physical function in older adults: evidence from the Alameda County Study.[see comment]. American Journal of Epidemiology. 155: 507-15

Baum F. 2002. The new public health evolves. In The new public health, ed. F Baum, pp. 29-58. Victoria, Australia: Oxford University Press
Baum F, Palmer C. 2002. 'Opportunity structures': urban landscape, social capital and health promotion in Australia. Health Promotion International. 17: 351-61

Bazos DA, Weeks WB, Fisher ES, DeBlois HA, Hamilton E, Young MJ. 2001. The development of a survey instrument for community health improvement. Health Services Research. 36: 773-92

Billings JR, Cowley S. 1995. Approaches to community needs assessment: a literature review. Journal of Advanced Nursing. 22: 721-30

Brownson RC, Baker EA, Housemann RA, Brennan LK, Bacak SJ. 2001. Environmental and policy determinants of physical activity in the United States. American Journal of Public Health. 91: 1995-2003

Byrne C, Crucetti JB, Medvesky MG, Miller MD, Pirani SJ, Irani PR. 2002. The process to develop a meaningful community health assessment in New York State. Journal of Public Health Management & Practice 8: 45-53

Champan J. 2003. Developing local community health indicators project-work in progress(abstract). Presented at 2003 international healthy cities conference, Belfast, U.K.

Chapman JM, Coulson A. 1972. Community Diagnosis: an analysis of indicators of health and disease in a metropolitan area. international journal of epidemiology 1: 75-81

Chiou ST. 2001. Developing Healthy Communities in I-lan County: The Process and the Progress. The Journal of Nursing(Chinese) 48: 28-35

Cibula DA, Novick Lf, B.Morrow C, Suphen SM. 2003. Community health assessment. American Journal of Preventive Medicine 24(4S): 118-23

Curtis DC. 2002. Evaluation of community health assessment in Kansas. Journal of Public Health Management & Practice 8: 20-5

Diez Roux AV, Merkin SS, Arnett D, Chambless L, Massing M, et al. 2001. Neighborhood of residence and incidence of coronary heart disease.[see comment]. New England Journal of Medicine. 345: 99-106

Dorling D. 2004. Healthy places, healthy spaces. British Medical Bulletin 69: 101-14

Doyle YG, Tsouros AD, Cryer PC, Hedley S, Russell-Hodgson C. 1999. Practical lessons in using indicators of determinants of health across 47 European cities. Health Promot. Internation. 14: 289-99

French SA, Story M, Jeffery RW. 2001. Environmental influences on eating and physical activity. Annual Review of Public Health. 22: 309-35

Frumkin H. 2003. Healthy places: exploring the evidence. American Journal of Public Health. 93: 1451-6

Gee GC, Takeuchi DT. 2004. Traffic stress, vehicular burden and well-being: a multilevel analysis. Social Science & Medicine 59: 405-14

Giles-Corti B, Donovan RJ. 2002. The relative influence of individual, social and physical environment determinants of physical activity. Social Science & Medicine. 54: 1793-812

Goldstein G. 2000. Healthy cities: overview of a WHO international program. Reviews on Environmental Health 15: 207-14

Goumans M, Springett J. 1997. From projects to policy:'healthy cities' as a mechanism for policy change for health? Health Promotion International 12: 311-22

Hancock L, Sanson-Fisher RW, Redman S, Burton R, Burton L, et al. 1997. Community action for health promotion: a review of methods and outcomes 1990-1995.[see comment]. American Journal of Preventive Medicine. 13: 229-39

Hancock T. 1993. The evolution, impact and significance of the healthy cities/healthy communities movement. Journal of Public Health Policy 14: 5-18

Hancock T. 2001. People, partnerships and human progress: building community capital. Health Promotion International 16: 275-80

Hancock T, Labonte R, Edwards R. 1999. Indicators that count! Measuring population health at the community level. Canadian Journal of Public Health. Revue Canadienne de Sante Publique 90: Nov-Dec

Hancock T, Minkler M. 1999. Community health assessment or healthy community assessment. In Community organization & community building for health, ed. M Minkler, pp. 139-56. New Jersey: Rutgers Univeristy Press

Harpham T, Burton S, Blue I. 2001. Healthy city projects in developing countries: the first evaluation. Health Promotion Internation. 16: 111-25

Kegler MC, Twiss JM, Look V. 2000. Assessing community change at multiple levels: the genesis of an evaluation framework for the California Healthy Cities Project. Health Education & Behavior. 27: 760-79

Laverack G, Labonte R. 2000. A planning framework for community empowerment goals within health promotion. Health Policy & Planning. 15: 255-62

LaVonna LB, Sloane DC, Nascimento LM, Diamant AL, Guinyard JJ, et al. 2005. African Americans' Access to Healthy Food Options in South Los Angeles Restaurants. American Journal of Public Health 95: 668-73

MacDougall C, Cooke R, Owen N, Willson K, Bauman A. 1997. Relating physical activity to health status, social connections and community facilities.[see comment]. Australian & New Zealand Journal of Public Health. 21: 631-7

McNight JL, Kertzmann JP. 1999. Mapping community capacity. In Community organizating & community building for health, ed. M Minkler, pp. 157-72. New Jersey: Rutgers University Press

Minkler M, Thompson M, Bell J, Rose K. 2001. Contributions of community involvement to organizational-level empowerment: the federal Healthy Start experience. Health Education & Behavior. 28: 783-807

Minkler M, Wallerstein N. 1999. Improving health through community organization and community building－A health education perspective. In Community organization & community building for health, ed. M Minkler, pp. 30-52. New Jersey: Rutgers Univeristy Press

Nettle C, Laboon P, Jones N, Pavelich J, Pifer P, Beltz C. 1989. Community nursing diagnosis. Journal of Community Health Nursing 6: 135-45

Norris T, Pittman M. 2000. The healthy communities movement and the coalition for healthier cities and communities. Public Health Reports 115: 118-24

Norton BL, McLeroy KR, Burdine JN, Felix MRJ, Dorsey AM. 2002. Community capacity. In Emerging theories in health promotion practice and research, ed. RJ DiClemente, RA Crosby, MC Kegler. San Francisco: Jossey-Bass

Perkins JJ, Sanson-Fisher RW, Girgis A, Blunden S, Lunnay D. 1995. The development of a new methodology to assess perceived needs among indigenous Australians. Social Science & Medicine. 41: 267-75

Pickett KE, Pearl M. 2001. Multilevel analyses of neighbourhood socioeconomic context and health outcomes: a critical review.[see comment]. Journal of Epidemiology & Community Health. 55: 111-22

Rafael AR. 2000. Watson's philosophy, science, and theory of human caring as a conceptual framework for guiding community health nursing practice. Advances in Nursing Science 23: 34-49

Raphael D, Renwick R, Brown I, Steinmetz B, Sehdev H, Phillips S. 2001. Making the links between community structure and individual well-being: community quality of life in Riverdale, Toronto, Canada. Health & Place. 7: 179-96
Sanderson DM, Webster P. 2003. Healthy city indicators. Presented at 2003 international healthy cities conference, Belfast, U.K.

Schulz AJ, Williams DR, Israel BA, Lempert LB. 2002. Racial and spatial relations as fundamental determinants of health in Detroit. Milbank Quarterly. 80: 677-707

Seifer SD. 2000. Engaging colleges and universities as partners in Healthy Communities initiatives. Public Health Reports. 115: 234-7
Sharpe PA, Greaney ML, Lee PR, Royce SW. 2000. Assets-oriented community assessment. Public Health Reports. 115: 205-11

Simon PA, Wold CM, Cousineau MR, Fielding JE. 2001. Meeting the data needs of a local health department: the Los Angeles County Health Survey. American Journal of Public Health. 91: 1950-2

Stafford-Alewine S, GH. L. 2002. The Missouri experience in providing tools and resources to promote community assessment. J Public Health Manag Pract. 8(4): 14-9

Sullivan M, Kone A, Senturia KD, Chrisman NJ, Ciske SJ, Krieger JW. 2001. Researcher and researched--community perspectives: toward bridging the gap. Health Education & Behavior. 28: 130-49

Takano T, Nakamura K. 2001. An analysis of health levels and various indicators of urban environments for Healthy Cities projects.[see comment]. Journal of Epidemiology & Community Health. 55: 263-70

Wainwright NW, Surtees PG. 2004. Places, people, and their physical and mental functional health. Journal of Epidemiology & Community Health 58: 333-9

Walsh D. 2003. Health & Well-being community profiles for Scotland(abstract). Presented at 2003 international healthy cities conference, Belfast, U.K.

Werna E, Harpham T. 1996. The implementation of the healthy cities project in developing countries: lessons from Chittagong. Habitat International. 20: 221-8

WHO. 1978. Declaration of Alma-Ata.

WHO. 1986. Ottawa Charter for Health Promotion.

WHO. 1996. Healthy City Indicators Questionnaire. WHO, Copehagen

WHO. 1998. Health Promotion Glossary. WHO, Geneva

Williams RL, Crabtree BF, O'Brien C, Zyzanski SJ, Gilchrist VJ. 1999. Practical tools for qualitative community-oriented primary care community assessment. Family Medicine. 31: 488-94

Wilson K, Elliott S, Law M, Eyles J, Jerrett M, Keller-Olaman S. 2004. Linking perceptions of neighbourhood to health in Hamilton, Canada. Journal of Epidemiology & Community Health 58: 192-8

Yuan W, James P, Hodgson K, Hutchinson SM, Shi C. 2003. Development of sustainability indicators by communities in China: a case study of Chongming County, Shanghai. Journal of Environmental Management 68: 253-61

胡淑貞：健康城市之建構理念與發展需求之初探：以台南市為例。行政院衛生署92年度委託研究計畫，2003。

胡淑貞、蔡詩薏：WHO健康城市概念。健康城市學刊2004；1：1-8。