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研究生:吳寶榮
研究生(外文):Bao-Jueng Wu
論文名稱:菲籍勞工在台就醫經驗之文化適切性感受
論文名稱(外文):A Perception of Cultural and Linguistically Appropriate Service and Experiences of the Taiwan Medical System by Filipino Migrant Workers
指導教授:張菊蕙
學位類別:碩士
校院名稱:長榮大學
系所名稱:醫務管理學研究所
學門:商業及管理學門
學類:醫管學類
論文種類:學術論文
論文出版年:2009
畢業學年度:97
語文別:中文
論文頁數:89
中文關鍵詞:菲籍勞工英語醫療環境具文化適切性之健康服務健康不平等
外文關鍵詞:Filipino migrant workerEnglish medical environmentCulturally and linguistically appropriate serviceHealth inequality
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隨著東南亞外籍勞工及婚姻新移民的增加,台灣醫療工作者面臨多元文化挑戰。如何提升外籍人士就醫之便利性,語言溝通並非唯一的條件,大多醫院侷限於醫療人員語言能力訓練或環境指標英語化,卻忽略體察求醫者之文化背景,服務流程與健康資訊之文化可近性。本研究目的為探討菲籍勞工在台期間,對於整體就醫環境滿意度、就醫可近性、醫護或醫事人員醫病溝通能力、以及對於醫療單位最需要改進的地方進行探討。其次,檢視行政院衛生署推動的「醫院營造英語醫療作業環境」是否達到預期的果效。

研究採自填式問卷調查法,針對來台超過六個月(不論有無就醫經驗者)菲籍勞工,探討其醫療機構是否滿足勞工語言與文化需求。參考美國CLAS(Culturally and Linguistically Appropriate Service)概念,與仲介公司生活輔導員的訪談結果設計問卷,並進行表面效度、結構效度、及問卷預試。樣本數為630人,依工廠規模分為大中小三級,以等比例分層抽樣方式選取樣本,大中小型工廠人數分別為77.3%、16.4%、6.3%。

結果發現:(一)五成左右菲籍勞工認為台灣醫療環境比菲律賓好。但是更進一步探討她們對於語言可近性及醫療文化適切性這兩個面向的感受時發現,儘管許多醫院標榜設置英語環境,但是在這群使用者身上覺得普通或差的比例有六、七成,這個結果與近五、六成左右的菲籍移工感到不滿意的就醫經驗是「沒有可取得的就醫英文說明書」及「佈告欄沒有英文標示的醫療相關訊息」相互呼應。(二)至於文化適切性這個面向,超過半數以上是普通或偏差。以多選項問題分析照護能力的文化適切性感受滿意度達40.1%;語言可近性滿意度僅32.7%,對醫療組織支持滿意度為45.0%。(三)醫院規模大小、有無陪伴就醫(朋友或通譯員)、門急診、教育程度、自覺健康、輪班狀態等因素,對於菲籍勞工就醫語言可近性、文化適切性或整體滿意度大多無統計學上的意義。

建構具文化適切性的醫療環境,必須除了硬體及軟體方面的加強外,可
以用更簡單又有效的方法,與仲介公司合作,建立良性互動。讓生活輔導員
熟悉醫院就醫環境,甚至給予充實醫療常識的課程,甚至於招募他們成為通
譯員,成為醫療提供者與移工間最佳語言與醫療文化的橋樑。


關鍵字:菲籍勞工、英語醫療環境、具文化適切性之健康服務、健康不平等
Abstract

The trend of larger numbers of migrant workers, and Taiwanese marrying people from south-east Asian countries has presented a major challenge to those working in the Taiwan health care system. It is a challenge which needs to be addressed. Despite much emphasis being placed on language training and the provision of relevant information in English to explain the medical process, there is still an important need to better understand a patient’s cultural background, to provide information in a more culturally sensitive way, and to make the service process more user friendly. The purposes of this research are to investigate the rate of satisfaction, the convenience of the service process, and the ability of the physicians, nurses and other medical staff to communicate clearly with the Filipino migrant workers during their stay in Taiwan. Furthermore, to investigate and recommend improvements that could be made to the medical system. And finally, to assess the impact of “the implementation of an English language medical working environment” which has been promoted by the Department of Health under the Executive Yuan.
The research adopted a “self-filled” questionnaire investigation about the satisfaction of a language friendly and culturally appropriate service. The research group is Filipino migrant workers who have resided in Taiwan for a period exceeding six months (no matter whether they have sought medical assistance or not.) The format of the questionnaire and its ratio scale is modeled on the format of the “Cultural and Linguistically Appropriate Service” as used in the United States, and from the results of a semi-structured interview with coordinators working for the broker companies who have the experience of accompanying those migrant workers requiring medical assistance. The questionnaire also incorporates a “face validity”, “structure validity” and “pilot test”. A total number of six-hundred and thirty questionnaires with layered sampling according to the size of the company – large: 77.3%; medium: 16.4% and small: 6.3% were used respectively.
The findings of the questionnaire revealed that more than 50% of Filipino migrant workers felt that the health care system in Taiwan is better than that found in the Philippines. However, when asked about the language provision and appropriate cultural understanding, despite many hospitals being satisfied with the English environment that they provide, around 60%-70% of Filipino migrant workers considered it to be average or less. This is compatible with the response rate of 50%-60% of those asked who felt that they: “could not understand the English used by doctors” and “the lack of medical information provided in English on the bulletin boards.” Second, according to the item of appropriate cultural competence, more than half felt it to be average or less. The inclusion of multiple questionnaire integration revealed that the rate of satisfaction for the provision of a culturally appropriate service to be 40.1%, the rate of satisfaction for the provision of language access to be 32.7%, and the rate of satisfaction for the provision of organized medical support to be 45.0%. Third, there is no obvious statistical significance about the influence of language access medical services, appropriate cultural competence care, and rate of satisfaction according to the hospital size, accompanying coordinator, types of medical services provided by the emergency or out-patient departments, educational status, self evaluation of health status and recent working shift.
The establishment of a user-friendly English speaking medical environment, in addition to the reinforcement of a hard and soft medical environment will enable the medical administration to use easier and more effective methods, such as establishing a better relationship with the brokers. Furthermore, improved training to enable coordinators to become more familiar with the medical system, equipping them with better medical care knowledge, and even recruiting them to become partners, thus enabling them to become the most effective bridge of language, culture, and medical service between the medical provider and migrant workers.

Key words: Filipino migrant worker; English medical environment; Culturally and linguistically appropriate service; Health inequality
摘要 III
第一章 緒論 1
第一節 研究背景 1
第二節 研究動機 3
第三節 研究目的 6
第二章 文獻探討 7
第一節 跨文化的醫學教育 7
第二節 文化適切性健康照護 11
ㄧ、美國的CLAS 12
二、亞洲的 CARAM 15
三、台灣的文化適切性醫療照護現況 18
第三節 影響外籍勞工就醫的文化因素 23
第四節 外籍勞工在台醫療資源利用情形 26
第五節 外籍勞工健康需求與求醫行為模式 30
第三章 研究方法 33
第一節 研究設計 33
第二節 研究架構 34
第三節 研究對象 35
第四節 研究工具 37
第五節 統計分析 43
第四章 研究結果 44
第一節 基本資料及健康狀態 44
第二節 就醫經驗及滿意度分析 48
第三節 就醫文化適切性感受分析 53
第五章 討論與建議 66
第一節 研究討論 66
一、假象的文化適切性健康照顧 66
二、健康不平等的醫療資訊與地位 68
三、溝通技巧與方式 70
第二節 研究建議 71
第三節 研究省思 75
第六章 參考文獻 76
附錄ㄧ 80
中文問卷 86
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