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研究生:劉育秀
研究生(外文):Yu-Hsiu Liu
論文名稱:社區健康營造的具體實踐: 台灣離島地區 20 年經驗
論文名稱(外文):Concrete practice of community health construction: 20 years experience in Taiwan offshore islands
指導教授:周碧瑟周碧瑟引用關係
指導教授(外文):Pesus Chou
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:公共衛生碩士學位學程
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:2019
畢業學年度:107
語文別:中文
論文頁數:73
中文關鍵詞:社區健康營造中心台灣離島
外文關鍵詞:community health constructionTaiwan offshore islands
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目的:自2000年辦理原住民部落暨離島社區健康營造委員會,同時開始創立離島社區健康營造中心至今持續推展,多年來也成為推動離島社區健康相關工作的樞紐,但迄今尚未有研究針對此議題的緣起、發展,進行系統性的整理及討論。因此,本研究擬針對離島社區健康營造20年的具體實踐經驗作深入探討。
方法:本研究採焦點人物口述歷史、實地觀察、在地訪談,結合彙總智能科技Web 2.0的健康人權教育網數據與發展社區特色,以回顧輔導中心20年循序建立各離島社區健康營造中心的機制,並且發展中結合衛生局與在地委員共同輔導之重要性,藉由了解社區天使的培訓、當地社區居民參與狀況與執行困難和阻礙等相關情形,最終探討影響推動離島社區健康營造經驗永續經營之因素。
結果:回顧離島社區健康營造中心20年,分為循序建立離島地區機制之創建期、輔導團隊與因地制宜之發展期與結合智能科技之成熟期的三階段,目前20間離島社區健康營造中心承辦機構以一般民間團體(含社區發展協會)佔50.0%,衛生所約佔45.0%,醫療院所相對少數僅佔5.0% ,社區天使留任性皆達95%以上,但人數上並未如期成長,僅澎湖縣、琉球鄉超過100%以上,仍需持續培訓社區天使。其中透過在地委員與輔導委員的共同領導下,為促使社區民眾以由下而上的方式主動自願共同參與活動,並學習自主尋求協助管道的能力,本研究討論2 項社會議題,一為新住民家庭暴力,根據內政部移民署截至 2019 年 03 月底統計資料,以外籍人口數不到本國人口數的 1%,離島地區家暴案件卻佔 16%,不容忽視之議題,透過社區天使與經理人採取家庭訪視或家庭日活動的方式瞭解並關心新住民的生活,逐漸形成社區網絡,日益減少家暴發生的可能性。二為獨居長者,離島地區外移人口居多,根據內政部戶政司 2018 年統計顯示,離島 65 歲人口佔總數的 1.04%,依衛生福利部統計當年度離島地區列冊需關懷獨居長者佔 65 歲以上人口 4.8%,是全國(1.3%)的 3.7 倍,輔導中心以尋求權力(power)與資源(resources)的再分配方式,建議採取地段式照護,就近性使長者較有安全感,增加信任關係,金門縣與澎湖縣結合金門大學、澎湖科大暑期志工活動,注入年輕氣息,使長者真正落實活耀老化的精神,增加長者走出家中參與活動之意願,達到降低獨居長者的危險性與健康疑慮,以持續落實結合民間組織推動,引發社區意識,也是推動社區發展 (community development)的原動力。
執行期間的困難以社區資源不足且整合不易、衛生所庶務繁雜之困境、衛生局與社區承辦人留任性不佳為主,本研究建議一可持續開拓離島社區資源;二可持續提供社區賦能;三是培養社區所需人力,以維護離島社區網絡與永續經營。
結論:隨著工業 4.0 時代的到來,運用科技產物來「量化自我」的模式層出不窮,已漸漸滲透我們的日常生活。 2011年輔導中心導入個人健康訊息量化自我的健康人權教育網,歷經以紙本收案過渡期,2018年結合智能科技Web 2.0轉換成移動式APP,能立即提供長者了解自身現況的健康與衛教的介入,建立後續轉介與關懷機制,其中2015-2018年以青光眼、健康體位BMI、睡眠困擾三大議題紅燈率位居前三,紅燈率分別為25.4%、19.3%、13.2%,透過社區經理人與社區天使就醫轉介與後續居家關懷,減少不可挽回之疾病,仍持續加強輔導,已漸漸擴展點、線、面滲透離島的鄉里間。
Objective: In Taiwan, the indigenous community and offshore islands community health construction committee has been established since 2000. At the same time, the establishment of the offshore islands community health construction center has been continuously promoted. The centers have become a hub for promoting health related work in the offshore islands. However, there has not been research on the origin of this issue, development, systematic organization and discussion. Therefore, the purpose of our study was to explore specific practical experience of community health construction in offshore islands over the past 20 years.
Method: The research focuses on the oral history, field observation, local interviews, and combines the data of the Health Human Rights Education Website and characteristics of community development. To Review the 20 years of counseling center for the establishments of the community health centers in the offshore islands and the importance of the public health bureau and the local committee in developing common guidance of the combination. By understanding the training of community volunteers, the participation of local community residents and the difficulty and obstacles in implementation, we will finally explore the factors that influence the promotion of sustained operations of the community health construction in the offshore islands.
Results: The community health construction centers in the offshore islands has been divided into 3 stages: the establishment period of the offshore islands mechanism, the development period of the counseling team and the local conditions, and the maturity of the combining with intelligent technology. Currently, the sponsoring agencies of the 20 community health construction centers in the offshore islands are civil society organization and nongovernmental organization accounted for 50.0%, health centers accounted for 45.0%, and medical institutions accounted for only 5.0%, and community angles were more than 95%, but the number did not grow as expected. More than 100% of Penghu County and Liuqiu Township but still need to continue to train community angels. Through the joint leadership of local committee and the counselors, expedition of community residents to voluntarily participate in the activity in a bottom-up manner and the ability to proactively seek help are to be established. The research discussed two social issues, one of the new immigrant domestic violence. According to the statistics Ministry of the Interior National Immigration Agency (M.O.I.) as the end of March, 2019, the foreigners account for less than 1% of the total population, and the number of domestic violence incidents in the offshore islands account for 16%. The issue that can’t be ignored to understand and care for lives of new immigrant through home visit or family day by the community angels and managers and gradually form a community network to reduce the possibility of domestic violence.
The second is solitary elder. Most of the emigration in the population in offshore islands. According to statistics of the Department of Household Registration, M.O.I., those over 65-year-old in population of offshore islands account for 1.04% of the total. According to the Ministry of Health and Welfare, the listed solitude elders in the offshore islands account for 4.8% of the over 65-year-old population, which is 3.7 times that of the national (1.3%). For the redistribution of power and resources, the guidance center recommended to adopt localized care. The proximity makes the elders feel more secure and enhances the relationship of trust. The Kinmen County and Penghu County joined with the summer volunteers from National Kinmen University and National Penghu University of Science and Technology. Injecting youth into the program, to truly implement the spirit of activating the elders and increase the willingness of the elder to go out of their homes to participate in activities. To achieve the risk and health concerns of reducing solitude elders, to continued effort of joint promotion with the non-governmental organizations to induce community awareness, will be the motivational force behind the community development.
The difficulties during the execution are mainly the lack of community resources and integration, the dilemma of health care, and the poor retention of health bureau and community organizers. Recommendations for future research: firstly, sustainable development of the resources of offshore islands community; secondly, to provide community empowering; and thirdly, to cultivate the manpower resources need by the community to maintain the network of the offshore islands and sustained development.
Conclusion: With the advent of Industrial Revolution 4.0, the use of high-tech products to “Self -quantification” has emerged in an endless stream that has gradually penetrated our daily lives. In 2011, the guidance center introduced the Health Human Rights Education website.
After the transition period of paper period, 2018 combined with high-tech Web 2.0 into a mobile APP, it can immediately provide the elders their own current health status and intervention of health education for establishing a care and referral system.
In 2015~2018, the top red-light issues was glaucoma, BMI, and sleep disorder with 25.4%, 19.3%, and 13.2%. Through referral of community angels and managers for medical treatment and follow-up household visit. Reducing irreparable diseases, and continued guidance and counseling, has gradually expanded into local villages and communities in the offshore islands.
論文電子檔著作權授權書………………………………………… i
論文審定同意書………………………………………………………… ii
誌謝………………………………………………………………………………… iii
中文摘要………………………………………………………………………… iv
英文摘要……………………………………………………………………… vii
目錄………………………………………………………………………………… xi
圖目錄………………………………………………………………………… xiii
表目錄…………………………………………………………………………… xiv
第一章 緒論…………………………………………………………… 1
第一節研究背景與動機………………………………………… 1
第二節研究目的……………………………………………………… 4
第二章 文獻回顧…………………………………………………… 5
第一節台灣離島社區健康營造之組織特性……… 5
第二節台灣離島社區健康營造之永續經營………… 7
第三節量化自我的概念與Web2.0應用……………… 12
第三章 研究方法………………………………………………… 21
第一節研究架構……………………………………………………… 21
第二節研究設計與過程.……………………………………… 22
第三節研究工具…………………………………………………………… 26
第四章 結果與討論……………………………………………… 30
第一節結果…………………………………………………………………… 30
第二節討論…………………………………………………………………… 54
第五章 結論與建議………………………………………………… 61
第一節結論…………………………………………………………………… 61
第二節建議…………………………………………………………………… 67
參考文獻………………………………………………………………………… 68
圖目錄
【圖1】量化自我系統的分類…………………………………… 13
【圖2】研究架構………………………………………………… 21
【圖3】健康人權教育網外部連結QR code………………….… 33
【圖4】現況離島社區健康營造輔導中心之架構與關係圖…… 35
表目錄
【表1】我國離島社區健康營造階段性發展……...……………… 37
【表2】離島地區新住民遭受家庭暴力之統計表………...……… 39
【表3】離島社區2015-2018年健康人權教育網紅燈統計表…… 43
【表4】離島社區健康營造中心特性與留任性………...………… 53
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