台灣社區營養推廣中心服務現況、挑戰與契機之質性研究

A qualitative exploration of progress, challenges, and opportunities in community nutrition services in Taiwan

目標：國民健康署自2018年補助縣市辦理延緩失能社區營養示範據點，本研究旨在探討社區營養推廣中心服務的現況、挑戰與契機。方法：本研究訪談14個縣市17名「社區營養推廣中心」營養師，及5名專家學者，並進行設計思考增能與評價。結果：（一）現況：營養師表示「社區營養推廣中心」服務包括：營養風險篩檢及調查、營養教育推廣、輔導餐飲業者及長者據點、社區營養行銷及人員培訓等。（二）困難：人力有限、缺乏具信效度長者營養調查問卷、不同區域長者營養需求與資源差異大、營養教育深度與廣度不足、社區營養行銷成效難量化、跨單位合作機制不完備、社區營養師招募不易、新冠肺炎疫情影響介入執行。（三）契機：專家學者建議強化社區營養社會行銷、營養教育體驗學習、社區營養中心成果展現、跨單位合作等。設計思考增能有助於提升社區健康工作人員運用設計思考認知、態度、效能、使用意願與應用。結論：我國「社區營養推廣中心」在增進長者健康飲食型態扮演重要角色，本研究有助於了解社區營養服務推動困難與優化服務契機。

Objectives: In 2018, Taiwan's Health Promotion Administration funded the establishment of community nutrition centers in various cities and counties to prevent frailty among community older adults. This study investigated the current suite of community nutrition services and the challenges and opportunities therein. Methods: In total, 17 community dietitians from 14 counties/cities and 5 professional community health workers were interviewed. These community dietitians and community health workers underwent design thinking training, and its effects were evaluated. Results: (1) Services: The community dietitians reported that the current services provided by the community nutrition centers include older adult nutrition screening and surveys, nutrition education, consultations aimed at helping community centers and restaurants to establish healthy food environments, nutrition promotion, and the recruitment of dietitians and other personnel. (2) Challenges: The community dietitians reported that the challenges included a lack of human resources, a lack of reliable and valid dietary questionnaires, overly large variations in older adult-related nutrition needs and resources across multiple areas, difficulties in implementing nutrition education at an intensive and large-scale level, difficulties in evaluating the effects of nutrition education, obstacles in collaborations with other sectors, low uptake in dietitian recruitment, and difficulties in coping with the COVID-19 pandemic. (3) Opportunities: The professional community health workers suggested strengthening community nutrition promotion, providing nutrition-related experiential learning opportunities, establishing collaborations among multiple sectors, presenting and promoting the community nutrition achievements of the centers, and applying design thinking to promote community nutrition services. The evaluation of the design thinking training intervention revealed its positive effects on increasing the knowledge, attitudes, and performance of community health workers and their intention to apply design thinking. Conclusions: Taiwan's community nutrition centers play a key role in reinforcing healthy eating habits among older adults. This study provided insights regarding the challenges and opportunities pertaining to the promotion of community nutrition services.