利用健康行為模式探討「社區健康營造」實施之成效—以桃園地區都市原住民健康營造為例

Evaluation of one Community Health Development Plan Applied Health Behavior Model A Study of one Urban Aboriginal Health Development Plan in Taoyuan County

面對社區醫院評鑑新制，各社區型態的醫院無不積極參與各項社區健康促進或健康營造計劃發展社區醫學，但成效往往不盡理想。本研究藉由研究醫院於桃園縣八大鄉鎮所進行都市原住民健康營造與巡迴醫療的活動的過程，經由受過訓練的訪員調查取得有效問卷318份，運用Andersen和其他學者於後期發展出的健康行為模式，探討免費提供醫療服務改善醫療環境可近性或增加醫療利用率是否有助於提升部落社區健康營造之成效。研究結果顯示，有參加過巡迴醫療者願意參與健康營造活動顯著大於未參加者（p＜0.001），且分析接受巡迴醫療與否與對社區健康營造滿意度之相關亦有顯著差異（p＜0.001）。雖有些社區醫學的文獻指出實施社區健康營造應避免醫療的介入，以落實社區居民主動參與達到自發性從事健康活動，進而增進社區全體之健康。但針對諸如山地部落或都市原住民等醫療資源較貧乏之社區弱勢族群，如配合實施巡迴醫療，可能會增加其參與社區健康營造的意願，同時也可能提升整體健康營造之成效與滿意度。

In order to adopt the new hospital accreditation, community-based hospitals launch many health promotion activities and health development plans in community. No matter how much effort hospitals devoted to initiate community-based health plans, the outcomes are still dissatisfactory. The current study applied Anderson＇s health behavior model to collect the information from urban aboriginal health development plans and mobile medical programs investigating how free medical service would increase the medical utilization, hence, benefit health promotion activities in Taoyuan County. The study showed that those community residents who had ever attended mobile medical programs were more likely to participate in health promotion activities compare to those who never engaged in such activities. It is also found that by improving mobile medical programs in mountain areas and urban aboriginal areas where lack of medical resources would increase willingness of residents to participate in health promotion activities, further, effectiveness and satisfaction of these activities can be anticipated.