從障礙形成過程模型看台灣高齡身心障礙者之社會參與

Exploring barriers to social participation among Taiwanese older adults with disabilities by using the Disability Creation Process Model

目標：本研究以障礙形成過程模型（Disability Creation Process, DCP）為理論基礎，探討台灣高齡身心障礙者社會參與之限制情形，並分析個人、社會角色與環境因素對參與障礙之影響。方法：採用2015至2019年通過身心障礙鑑定之全國性FUNDES（the Functioning Disability Evaluation Scale, FUNDES）」資料，篩選65歲以上樣本共33,716筆。進行敘述性統計、t檢定、單因子變異數分析、積差相關與多元邏輯迴歸，分析社會參與困難程度與相關變項之關聯。結果：1. ICF（International Classification of Functioning, Disability and Health, ICF）第三、五、七類障礙者的社會參與困難程度顯著較高。2.教育程度較高（國中以上）與仍具就業身分者，參與障礙程度較低。3.居住於南部或非都市地區者，其參與限制相對較低。4.家庭經濟弱勢者、無照顧者者，其社會參與困難程度較高。5.四處走動、自理與居家活動功能與社會參與呈顯著相關。結論：本研究所觀察之教育、就業、居住區域等變項，皆可透過DCP模型中所提及的『社會角色』與『環境因子』予以整合詮釋，進而理解參與障礙非單一結果，而是多層次交互過程的產物。（台灣衛誌2025；44（3）：306-324）

Objectives: This study applied the Disability Creation Process model to explore barriers to social participation among older adults with disabilities in Taiwan. The study focused on the influence of personal, social, and environmental factors. Methods: A total of 33,716 adults aged 65 years or older were selected from Taiwan’s national FUNDES (the Functioning Disability Evaluation Scale) disability assessment database (2015-2019). Descriptive statistics, Student t tests, analysis of variance, Pearson correlation, and multinomial logistic regression were used for analysis. Results: Older adults with disabilities under International Classification of Functioning, Disability, and Health grades 3, 5, and 7 experienced major social participation difficulties. Higher educational levels and current employment were associated with reduced barriers to social participation. Older adults residing in southern or less urbanized areas experienced fewer limitations. Moreover, older adults from economically disadvantaged households or without caregivers exhibited greater social participation difficulties. Functional mobility, self-care, and household activities were strongly associated with positive social participation outcomes. Conclusions: The findings regarding the study variables, including educational level, employment status, and residential area, can be explained through the Disability Creation Process model, particularly through its constructs of social roles and environmental factors. These findings suggest that barriers to social participation arise not from a single factor but from a complex, multilayered interaction process. (Taiwan J Public Health. 2025;44(3):306-324)