COVID-19防治與長照2.0的新契機──從整合性觀點探討社區型遠距健康照護之使用意向

The New Opportunities of COVID-19 Prevention and Long-term Care 2.0- From an Integrative Perspectives to Understand Behavioral Intention of a Community Telehealth System

2019年「嚴重特殊傳染性肺炎」（COVID-19）的疫情蔓延全球，台灣衛生福利部公告針對特殊情況，醫師得以採用遠距醫療方式診察病人。而2017年起，台灣開始推動長照2.0計畫，遠距健康照護也開始受到重視與應用於社區及機構。據此，遠距健康照護的興起，已成為當今醫療照護的重要議題之一。本研究目的在於整合三個理論（計畫行為理論、社會認同理論與自我決定理論）探討民眾使用社區型遠距照護之影響因素及影響程度，以南投縣的居民曾使用過社區遠距照護為研究對象，共發放出400份問卷，回收356份有效問卷（回收率89%），以描述性統計分析、探索性因素分析、驗證性因素分析與結構方程模式等統計方法驗證研究模型。研究結果顯示，整體結構模式配適度良好且具有良好的解釋力。社會規範、態度、自主性支持會正向顯著影響使用意圖。而使用意圖的直接效果方面，態度具有最大的影響效果，自主性支持次之。結論：社區與醫療院所推動遠距健康照護系統時，除了需要加強社區民眾對遠距健康照護的正向態度外，還必須營造良好的支持性環境等重要因素，方可使社區民眾獲得身心靈的照護服務，進而促進社區民眾自我管理，共同營造社區高齡者美好之未來。

The outbreak of coronavirus disease (COVID-19) has been spreading throughout the world since the end of 2019. The Ministry of Health and Welfare in Taiwan has made a public announcement that physicians can examine patients via telemedicine under special circumstances. Meanwhile, due to the launch of long-term care 2.0 project since 2017, telecare also has started to be valued and implemented in communities and institutions. For the above reasons, the implement of telehealth in medical care thus became an important issue. The purpose of this study was to integrate three theories (the theory of planned behavior, social identity theory, and self-determination theory) to explore the influencing factors of community residents' behavioral intention of a telehealth system. The survey subjects of questionnaire were the residents who were the system end users from Nantou County, Taiwan. Of the recruited 400 subjects, there were 356 valid responses (response rate =89%). The proposed hypotheses were validated with descriptive analysis, exploratory factor analysis, confirmatory factor analysis, and structural equation modeling. The findings showed that the proposed research model had good explanatory power and fitness. The findings revealed that social norm, attitude, autonomy support jointly significantly positively affect behavioral intention. The findings also reported that attitude exert the strongest overall effect on intention to use, followed by autonomy support. The implications of the findings can provide hospitals and institutions with some best practices to promote better community health activities and services, which in turn improve community residents' health and welfare in future.