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研究生:吳桂華
研究生(外文):Kuei-Hua Wu
論文名稱:更年期婦女使用社區骨質密度篩檢之身體政治
論文名稱(外文):Body Politics of Bone Mineral Density Screening for Menopausal Women
指導教授:盧孳艷盧孳艷引用關係
指導教授(外文):Zxy-Yann Lu
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:臨床暨社區護理研究所
學門:醫藥衛生學門
學類:護理學類
論文種類:學術論文
論文出版年:2010
畢業學年度:98
語文別:中文
論文頁數:247
中文關鍵詞:民族誌研究更年期婦女骨密度篩檢身體政治風險
外文關鍵詞:Ethnographymenopausal womenBMD screeningbody politicsrisk
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WHO(2007)指出預防骨質疏鬆為21世紀重要議題。預防醫學論述以流行病學方法計算個人潛在罹病機率,化風險為可見,視更年期為骨質疏鬆風險因子,形塑更年期婦女之「風險身體」需接受管理。然而,社區骨密度篩檢工具之特異性與敏感性存有爭議,卻普遍於台灣社區衛生篩檢對更年期婦女進行招募。究竟台灣社區脈絡下,骨密度篩檢如何可以作為風險管理之科技?更年期婦女如何建構「風險身體」?社區骨密度篩檢實務中,婦女身體呈現為什麼樣貌?婦女又如何看待社區骨密度篩檢科技?
本研究目的在於探討更年期婦女如何建構風險身體及使用社區骨密度篩檢之身體政治意涵。研究者以民族誌研究法,採中度參與式觀察台北縣、市社區整合性篩檢及診所骨密度篩檢,紀錄篩檢活動及相關人員和婦女的互動,並以理論性抽樣,訪談自然停經且曾使用骨質密度篩檢的婦女,至理論飽和為止,共計16位。研究期間,以「骨質密度」、「更年期」、「骨質疏鬆」等作為關鍵字,收集98年1月1日至6月30日期間之報紙文本資料,並以持續性分析比較與民族誌分析法,進行資料之歸納與分析。結果得到兩個核心主題,各涵蓋三個理論主題,描述如下。
壹、「骨密度篩檢召喚更年期骨質疏鬆風險身體」:
一、骨質疏鬆風險身體:婦女以「荷爾蒙缺乏」描繪自身的骨質疏鬆風險,並害怕發生骨折、駝背、變成家庭與社會的經濟負擔與照護累贅。
二、骨密度篩檢披掛多樣外衣召喚更年期婦女:藥廠放送更年期骨質疏鬆應該補充「鈣片」之廣告內容,並與診所合作推廣骨質疏鬆講座及骨密度篩檢服務,藉以促成鈣片商機。衛生所配置骨密度篩檢當作子宮頸抹片的「贈品」,吸引婦女參與篩檢,以提昇子宮頸抹片篩檢目標數。
三、「視」與「不識」:骨密度篩檢開啟婦女認識骨質疏鬆的可能,婦女相信骨密度篩檢「揭露」身體所無法得知的「真實」,並認為「數字」呈現骨密度是「具體」、「明確」、「有說服力」。然而,婦女感到骨密度篩檢結果變動大而充滿不確定,亦認為配置的人、事將影響篩檢結果的可信度。
貳、「骨密度篩檢之規訓與更年期婦女之自我重新定位」:
一、身體的經驗與骨密度數值交織,再現脆弱的身體意象與自我監控:骨密度篩檢數值與婦女的生活經驗相互證成,婦女解讀自身骨密度篩檢異常代表骨骼是「空的」、「碎的」、「酥的」、「易斷的」,因而弱化日常行動與負重的信心,並持續監控骨密度是否趨向正常。
二、自我重新定位—骨密度篩檢與自我保健之文化意涵:骨密度篩檢促使婦女重新看見過去的生命經驗與多重社會角色,包括做為人母的犧牲與成全,實踐妻母、職業女性角色而錯失坐月子復原母體的關鍵期等。現在,婦女為了促進家庭和諧關係以及實現自由自主的中老年生活,而使用骨密度篩檢。且以骨密度篩檢異常為由,要求子女、媳婦共同為自身的骨骼保健盡心力。
三、促進自我安適:婦女挑戰骨質疏鬆醫學知識的矛盾,並發展出多元的在地固骨策略,藉以達到自我充權與安適。
以上顯示「醫療化」的更年期婦女身體勾勒出骨質疏鬆的風險,國家照護成本考量及家庭照顧角色的責任,規訓老化身體接受骨密度篩檢,同時也形塑更年期婦女的自我定位與社會關係。此外,婦女以自身經驗協商篩檢結果,從而發展出促進自我安適的策略,並成為骨密度篩檢的行動者,使超音波骨密度篩檢科技網絡能穩固續存。從本研究結果有助於理解骨密度篩檢科技、婦女生活脈絡及其健康之多重互動關係,提供社區護理人員推動篩檢時,反思目標數導向的篩檢策略,能更具文化敏感之思考,並能提供具台灣文化特異性的措施。
The prevention of osteoporosis has been the significant health policy worldwide in the 21st century (WHO, 2007). The discourse of preventive medicine focuses on individual risk, and claims that the menopause is a risk factor of osteoporosis. The menopausal women has come to be the major risk population of osteoporosis, and need surveillance by the bone mineral density screening (BMD screening) in Taiwan. Recently, the BMD screening program for menopausal women has been a part of public health services in Taiwan, and the Quantitative Ultrasound (QUS) has been the most common surveillance technology used in the community-based and clinic-based health service. However, the technology of QUS is controversial, especially its sensitivity and specificity. It is significant to understand how QUS becomes a popular program and what body image is shaped by the BMD screening practice?
The purpose of this study is to explore how the menopausal women become the risk body for osteoporosis, and the body politics of BMD screening for the menopausal women. The Ethnography was applied. Ethnographic interview and moderate participant observation were used to collect data in Taipei City and Taipei County from February 2009 to the end of April 2010. The procedure of the BMD screening practice and the interaction between the nurses and the women were observed. The field notes of community-based and clinic-based BMD screening including interactions with community nurses, the clinic nurses, and the QUS operators were recorded. In addition, the total sixteen women who are aged from 45- 60 and has participated in the BMD screening at least one time, were study participants. These women were interviewed with grand-tour questions first and followed up by the structural and contrast questions. Each interview lasted 1-2 hours and was tape-recorded. Interviews were transcribed verbatim with Word program. At the same time, newspaper articles about BMD screening dated January, 2009 to the end of June were obtained using the key words of “osteoporosis,” “bone mineral density” and “menopause.” The constant comparison method was used to analyze data.
The first core theme is “The QUS screening calling for the osteoporosis risk body of menopausal women.” Three culture themes include: 1.The risk body of osteoporosis: Menopausal women describe their risk for osteoporosis due to “hormone deficiency,” and afraid of fracture and hunchbacked. The risk for osteoporosis may create financial burden for their families and society. 2. The multiple meanings of QUS screening have attracted the attention of menopausal women: The advertisement of pharmaceutical companies has emphasized the need of calcium by menopausal women. Moreover, the pharmaceutical companies collaborate with the clinics or public health departments to promote BMD screening services, and to facilitate the sale of calcium. On the other hand, the community nurses take BMD screening as the “gift” for cervical cancer screening. 3. Visible and invisible: BMD screening makes the bone density inside the body becomes visible. The menopausal women think that BMD screening could explore the bone density inside by “number,” and the concrete number means “specific,” “clear,” “convincing,” and “credible.”
The second core theme is “The BMD screening disciplines menopausal women to constantly monitor the health of their bone.” There are three culture themes included: 1.The women’s bodily experience integrated with the results of the BMD screening indicated the old, brittle bone, and the need for self-surveillance: The women interpret the abnormal results of BMD screening as “empty,” “broken,” “flaky,” and “easily broken” bone, thus result in their continuous self-monitoring. 2. Changing self: the cultural meanings of participating in the BMD screening. BMD screening facilitates the menopausal women to reflect on their past life experiences with multiple social roles, including wife and mother, which involved sacrifice and hard work. They believe their life experiences were the key factors to result in the abnormal BMD screening result. In order to promote their family relationships and to achieve their independent life, menopausal women decide to comply with the BMD screening. On the other hand, they also have the power to ask their children or daughter-in-law to care for them because of the abnormal screening results. 3. Self-empowerment: The menopausal women challenge the medical knowledge of osteoporosis and develop multiple strategies to achieve self-empowerment and well-being to care for their bone.
The results of this study help the health professionals to understand the multiple relationships among the QUS, the culture, and the women’s health, and suggest the community nurses to develop the cultural sensitive care model for the menopausal women who decided to participate in the BMD screening.
目錄
摘要 I
ABSTRACT III
致謝 VI
目錄 VII
圖目錄 IX
表目錄 IX
附件目錄 IX

第一章 緒論 1
第一節 問題陳述 3
第二節 研究目的 7
第三節 研究重要性 7
第二章 文獻回顧探討 10
第一節 預防更年期骨質疏鬆論述之崛起 10
第二節 社區骨質密度篩檢之發展與爭議 20
第三節 社會文化視野探討骨質疏鬆風險體現經驗 26
第四節 更年期婦女使用骨質密度篩檢的身體政治 30
第三章 研究方法論 39
第一節 民族誌學研究法 39
第二節 研究設計 41
第三節 理論性抽樣 45
第四節 研究對象 46
第五節 資料收集過程與方法 46
第六節 資料分析與處理 48
第七節 研究嚴謹度 49
第四章 研究結果 52
第一節 田野觀察 52
第二節 受訪個案基本資料和代表性個案之描述 58
第三節 文本資料收集結果 67
第四節 研究結果的主軸 73
第五章 骨密度篩檢召喚更年期骨質疏鬆風險身體 77
第一節 骨質疏鬆風險身體 77
第二節 骨密度篩檢披掛多樣外衣召喚更年期婦女 96
第三節 「視」與「不識」 119
第四節 章節討論 133
第六章 骨密度篩檢規訓與更年期婦女的自我重新定位 141
第一節 身體的經驗與骨密度數值交織,再現脆弱的身體意象而自我監控 141
第二節 自我重新定位:使用骨密度篩檢與自我保健之文化意涵 159
第三節 以身體經驗向骨質疏鬆醫學知識協商,發展骨骼安適的策略 179
第四節 章節討論 202
第七章 結論與應用 209
參考文獻 216
附件 226
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1. 王昱豐、林俊龍、林英龍、李馥紋(2004).台灣西部婦女其生活區與骨質緻密度關係之研究.中華職業醫學雜誌,11(3),165-172。
2. 王超然(2000).骨質疏鬆的放射學診斷與評估.內科新知,3(2),78-82。
3. 成令方、吳嘉苓(2004).科技的性別政治.婦研縱橫,71,26-34。
4. 成令方、傅大為(2004).初論台灣泌尿科的男性身體觀.台灣社會研究季刊,53,148-204。
5. 李瑋君、韓岳津、吳英黛、曹昭懿(2007).骨質疏鬆相關骨折住院病患之健保申報分析.台灣醫學,11,22-28。
6. 李燕鳴(2008).停經女性骨質疏鬆症的篩檢及預防.臺灣醫學,12(5),613-619。
7. 林淑娟(1998).停經婦女骨質疏鬆症.護理新象,8(2),60-63。
8. 姚維仁、吳重慶(1999).骨質密度測量方法的最新進展.秀傳醫學雜誌,1(4),179-185。
9. 洪秀娟、楊榮森、曹昭懿(2005).台灣髖部骨折之流行病學.臺灣醫學,9(1), 29-38。
10. 郭文華(2003).數字會說話,說什麼話?健康資訊的數字邏輯.科學月刊,34(4), 317-321。
11. 連義隆(2004).從實證醫學觀點談骨質疏鬆症診斷及鈣片治療之爭議.臺灣醫學,8(6),851-856。
12. 張淑芳、陳靜敏、陳品玲(2001a).婦女骨質疏鬆症趨勢面面觀.長庚護理雜誌,12(2),154-159。
13. 張淑芳、陳靜敏、陳品玲(2001b).衛生教育介入對於社區婦女在骨質疏鬆症知識、健康信念及行為成效之探討.新台北護理期刊,3(1),79-89。
14. 黃兆山(2000).骨質疏鬆症.內科新知,3(2),81-85。
15. 楊南屏、楊榮森、周碧瑟(2008).提早因應高齡化社會的特殊醫療保健需求:以骨質疏鬆症為例.臺灣公共衛生雜誌,27(3),181-197。
 
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