社區健康營造經驗分享

Experiences on implementation of healthy community programs

我們自2007-2009年對桃園都會原住民及復興鄉的山地居民執行社區健康營造計劃，有許多實務經驗，撰文分享。我們結合醫、官及學三方，蒐集營造社區民眾的人口學、健康及需求資料，評估需求的優先順序，考量生活方式、風俗、文化等，擬定健康促進活動及評估介入成效，定期開會及會議記錄掌控工作進度。介入活動包括：（1）健康促進活動：有健康飲食講座及實作、健康體適能活動、戒菸。（2）疾病管理：針對高血壓、代謝性症候群的民眾作個案管理。工具使用上，建議用現成且具有信效度的問卷，也應取得原作者同意。各項測量，如腰圍應事先訓練測量者，血壓機、血糖機要定期校正。因社區民眾多是自願參加，樣本數少及代表性不足，是一大限制。倫理上，建議申請人體試驗委員會的同意，考量簽署受試者同意書的可行性。已經撰寫六篇論文，三篇已發表，一篇已接受。期待更多對社區健康營造團隊，也撰寫文書切磋經驗。我們在非健康議題、社區自主、介入性社區健康計畫及永續經營方面仍需努力。

We implemented two healthy community programs in Taoyuan County, one in urban aborigine since 2007, and the other in Fushing Village since 2008. This paper is to report our experiences on implementing these two healthy community programs. Our group included professionals from medical, government, and school. We first collected information of demographic, health, need from the residents who lived in the community. The activities of health promotion were based on the priority of their need, their lifestyle, custom, and culture. After providing the activities, statistical analysis was performed to evaluate the efficacy. We had regular meetings to monitor and record the progress of the study. Intervention activities include: (1) health promotion: healthy diet with actual cooking, exercise, and smoking cessation. (2) case management for certain chronic diseases: hypertension or metabolic syndrome. In regards to quality of measurements, we used a well-established questionnaire with acceptable validity and reliability. Consent of the questionnaire use should be obtained from the original designer. Training on how to measure waist circumference is recommended. Calibration on the sphygmomanometer and glucose meter is a must. Because we cannot force the residents in the study area to participate our activities, small sample size and lack of representative are the major limitations of our study. On the ethic issue, we suggest an application of institute of review board (IRB) in advance and consider a feasibility of signing the inform consent. Up to this point, we have written six journal articles, three were published, one was accepted. We hope that more groups who have been working on healthy community report their finding and share their experiences. Finally, non-health issue, community empowerment, community involvement in health (CIH), and sustainability of healthy community are the point we all aim at