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研究生:蕭偉宗
研究生(外文):Hsiao, Wei-tsung
論文名稱:糖尿病防治政策之性別分析
論文名稱(外文):Gender Analysis Policy of Diabetes Mellitus
指導教授:張菊惠張菊惠引用關係
指導教授(外文):Chang, Chu-hui
口試委員:張珏陳芬苓張菊惠
口試委員(外文):Chang, ChuehChen, Fen-lingChang, Chu-hui
口試日期:2011-07-12
學位類別:碩士
校院名稱:長榮大學
系所名稱:醫務管理學系碩士班
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:2011
畢業學年度:99
語文別:中文
論文頁數:109
中文關鍵詞:糖尿病性別分析衛生政策分析焦點合成法文本分析
外文關鍵詞:DiabetesGender AnalysisPolicy AnalysisFocused SynthesisText Analysis
相關次數:
  • 被引用被引用:2
  • 點閱點閱:513
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  • 下載下載:19
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目的:糖尿病在十大死因中男性排第六、女性排第四,國外研究已證實其罹
病風險具明顯性別差異,且疾病後果女性較差,但現行照護政策缺乏性別觀點。
本研究以政策分析法檢視糖尿病政策、糖尿病衛教師培訓教材與民眾衛生教育教
材之性別敏感度,並提出如何融入性別觀點之建議。
方法:採多元方法,以政策分析之焦點合成法輔以文本分析法分析官方釋出
之糖尿病相關衛生政策、糖尿病衛生教育學會培訓糖尿病衛教師之核心教材、與
衛生署國民健康局之糖尿病衛教資料。引用世界衛生組織之性別診斷架構(社會
性別角色、資源可近性與控制、性別需求)進行性別分析。先比較美國疾病管制
局之糖尿病與女性健康政策與臺灣之糖尿病相關政策資料,再以資料探勘方法彙
集分析國內外之糖尿病性別相關實證研究,據此檢視衛教教材中是否反映生物性
別與社會性別差異。
結果:台灣之糖尿病衛生政策在流行病學資料與服務提供皆無性別意識。美
國糖尿病政策正視性別間的差異外,亦關注性別內的差異,落實至各生命週期女
性,特別是姙娠高血糖與第一型糖尿病女性患者之青春期、妊娠與更年期期間的
特殊挑戰與需求,以及多元文化背景民眾之特殊性需求。實證資料探勘結果,亦
呈現糖尿病風險於生命周期中的性別差異,女性較男性增加育齡期與更年期的罹
病風險,若以社會性別角色的觀點出發,亦可發現女性其照護角色帶來的包袱與
經濟上的相對弱勢,都再再的增加女性於風險與照護上的劣勢。台灣於實施全民
健康保險後,以醫療為主之方式帶領糖尿病的防治與照護,從家庭照護出發至建
立社區與相關團體的支持網絡,最後延伸至機構醫療的照護,但皆無提及女性之
特殊的性與性別的照護方式;專業照護上仍以教育照護知識為主,唯有闡述女性
獨特之育齡期時,才有其特殊的妊娠糖尿病衛教計劃,但也只侷限於生產期中的
母嬰健康,並無提及往後之母嬰的罹病風險與機率,更無針對更年期進行探討;
衛生教育資料則著重提供照護知識,於妊娠部分提出監測血糖、荷爾蒙波動及往
後之二型風險,但在遺傳部分則未闡述親屬性別間的遺傳風險差異,且於社會角
色中隱含女性需要為家庭的患者進行膳食上的管理,雖有提及種族之罹病差異,
卻無提出適合該族群的飲食與照護方式,且並未對於女性之照護角色提出解套方
式。
結論:具有性別敏感度的健康指標將有助於兩性健康的提升,兩性健康應不
只侷限於無性別分列或以男性為出發所指之健康資料的呈現。在釐清糖尿病之性
別差異的風險後,顯示國內於糖尿病預防與照護上未重視女性獨特之育齡期與更
年期所帶來的荷爾蒙變化,並未提供第一型糖尿病之女孩於青春期時適切的照護
知識與計畫,使其往後自身與嬰孩都身陷糖尿病風險的威脅。
Objectives: The diabetes in ten leading causes of death is ranked sixth for males
and fourth for females. According to study aboard proved that risk of disease has
gender difference and females have more high risk outcome. But now the health
policy lack of gender perspectives. This study stands on policy analysis surveying the
diabetes‟s policy, the certified diabetes educator, the gender sensitivity of health
education material and proposing how to add gender perspective in health policy.
Methods:Using multivariate method, the focused synthesis of policy analysis is
main method and the text analysis strengthens it. The method analyzed the data of the
diabetes about health policy, the material for certified diabetes educator in Taiwanese
Association of Diabetes Educators and the diabetes education materials from the
Bureau of Health Promotion, Department of Health, R.O.C. (Taiwan).
The gender analysis, gender role, accessibility and control and gender need are
references to WHO. These data are used to analyze gender. Comparing the diabetes
and female health policy at the Centers for Disease Control and Prevention, USA with
the diabetes policy in Taiwan and using the data mining analyzes the sex of diabetes
and empirical research to survey the health education material weather reflecting
organism's sex differs from gender or not.
Results: The diabetes‟s policy in USA respects for the gender differences and
executes the policy in the each life stages of female. Especially, the female patients
who are gestational high blood sugar or type 1diabetes in adolescent years, gestational
or menopause confront different challenges, needs and understand the multicultural
background people‟s demands. The study proved that the diabetes risk has gender
difference in life stages. The female have more probability to raise reproductive years
and have high menopause risk than the male. According to the gender point shows the
health care role of female to bring pressure in life and expense. The diabetes
prevention and care are built home care to community care and other support network;
finally it became the care of medical institutions after Taiwan enforces the National
Health Insurance. But all the way did not show the care of gender about female, the
care of specialty still stands on the knowledge of education care. The health education
program of gestational diabetes only execute in reproductive years of the female but it
limit to the health of mother and infant in pregnancy period. The program does not show the probability of gestational diabetes in the mother and infant after life and the
female of menopause. The health education data emphasize care knowledge. In part of
gestational, the data show to monitor the condition of blood sugar, hormone and the
risk of type 2 diabetes. But the data do not provide the different risk of the family
gender in inherit, and the female who play the social role for family need to control
the diet for the patients at home. The data indicated that the dissimilar races have
different diabetes risks, but did not show the right way of diet and care and provide
answer to the female in care way.
Conclusions:The gender sensitivity in health indicators will improve gender
health. The gender health should not limit no sex difference or the healthy datum
about the male. The diabetes prevention and care in nation did not attach the hormone
change of female in reproductive years and menopause after cleaning the difference of
diabetes gender risks. The type 1 diabetes of the girl in adolescent years did not obtain
proper care knowledge and plan that made themself and infant in the risk of the
diabetes.
致謝 ................................................................................................. I
摘要 ................................................................................................ II
Abstract ........................................................................................... IV
目錄 ................................................................................................ VI
表目錄 ............................................................................................. VII
圖目錄 ............................................................................................ VIII
第一章 前言 ....................................................................................... 1
第一節 研究背景與動機 ........................................................................... 1
第二節 研究目的 ................................................................................ 3
第二章 文獻探討 ................................................................................... 4
第一節 健康狀態之風險與預防 ..................................................................... 5
一、 危險因子 .................................................................................. 6
二、 預防方式 ................................................................................. 10
第二節 糖尿病之流行病學 ........................................................................ 13
一、 第一型糖尿病 ............................................................................. 13
二、 第二型糖尿病 ............................................................................. 13
第三節 糖尿病機轉及其風險 ...................................................................... 16
一、 第一型糖尿病機轉及風險 .................................................................... 16
二、 第二型糖尿病機轉及其風險 ................................................................... 21
三、 妊娠糖尿病罹病機轉 ........................................................................ 30
第四節 糖尿病控制與管理 ........................................................................ 31
一、 性別特殊性的健康照護 ...................................................................... 31
二、 性別角色的差異 ............................../............................................ 32
三、 生活型態管理 ............................................................................. 34
第三章 研究方法 .................................................................................. 35
第一節 研究設計 ............................................................................... 36
第二節 分析材料 ............................................................................... 38
第三節 研究架構 .............................................................................. 45
第四節 分析方法 ............................................................................... 48
第四章 研究結果 .............................................................................. 55
第一節 衛生政策的性別觀點分析 .............................................................. 56
第二節 專業教育的性別觀點分析 .............................................................. 70
第三節 衛教資料的性別觀點分析 .............................................................. 79
第五章 結論、討論、限制與建議 ................................................... 87
第一節 結論 .................................................................................. 88
第二節 討論 .................................................................................. 90
第三節 研究限制 ............................................................................... 95
第四節 建議 .................................................................................. 96
第六章 參考文獻 .............................................................................. 97
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