台北市社區對失智症預防準備度的群集分析

Cluster analysis of community readiness for dementia prevention in Taipei City

目標：失智症預防需要依據不同社區的認知程度、準備度與共同行動能力，制定適切的介入策略。本研究應用社區準備度模型（Community Readiness Model, CRM）評估台灣社區在失智症預防的準備程度，並結合集體效能理論（collective efficacy theory），探討社會凝聚力與共同行動能力是否與社區準備度類型有關。方法：本研究於2021年3月至6月進行橫斷面調查，調查對象為台北市456個社區(里)的社區領導者，共邀請3,129名領導者(里、鄰長及社區發展協會理事長)參與，最終獲得447份有效回應，涵蓋288個里（占全市總里數的63.16%）。調查內容包括社區知識、領導力、資源可用性、對政府計畫的認知，以及集體效能（如共同行動能力與社會凝聚力）。結果：本研究透過聚集分析出四種類型的社區準備度，並針對不同類型社區提出相應的公共衛生策略建議：對於低能力社區，應強化領導力培訓並優化資源分配；對已具備政策相關計畫認知的社區，建議擴展失智症教育與推動在地參與倡議；對於準備度較為平衡的社區，應維持其參與程度並促進資訊共享；至於高資源社區，則應進一步協助其提升對失智症的正確認知與持續參與。研究亦發現，不同群集的社區在集體效能（p < 0.001）得分不同，在曾推動失智症預防計畫（p < 0.001）上亦有顯著差異。多項式邏輯迴歸分析進一步指出社區失智症預防準備度較好的社區群集，在社區的社會凝聚力表現上也較佳（p < 0.01）。結論：針對不同社區類型進行量身訂製的介入措施，並增進社區社會凝聚力，將可能有助於將口號轉為行動，提升失智症預防工作的成效，並促進長期的公共衛生成果。

Objectives: Effective dementia prevention requires tailored interventions that account for varying levels of community awareness, preparedness, and collective capacity for action. In this study, the community readiness model was employed to assess the readiness of Taiwanese communities for dementia prevention, and the theory of collective efficacy was utilized to investigate the association between collective efficacy and community readiness. Methods: A cross-sectional survey was conducted from March to June 2021 among leaders from 456 communities in Taipei City. A total of 3,129 leaders, including community heads and chairpersons of community development organizations, were invited to participate in the survey. In total, 447 valid responses were obtained from 288 communities, with this representing 63.16% of all communities in the city. The survey assessed community knowledge, leadership, resource availability, awareness of government programs, and collective efficacy (willingness to intervene/act and social cohesion). Results: A cluster analysis revealed four distinct types of community readiness. Corresponding public health strategy recommendations were proposed: communities with low capacities should strengthen leadership training and improve resource allocation, those familiar with government initiatives should expand dementia education and promote local engagement initiatives, those with balanced readiness should sustain participation and foster information sharing; and those with high resource levels should improve the accuracy of dementia knowledge and encourage continual involvement. The community readiness clusters varied significantly in terms of collective efficacy (p < .001) and prior implementation of dementia prevention programs (p < .001), indicating that disparities in community readiness correlate with varying levels of collective efficacy and proactive policy participation. A multinomial logistic regression analysis indicated that communities with greater readiness for dementia prevention demonstrated stronger social cohesion (p < .001). Conclusions: Implementing tailored interventions for different community types and fostering social cohesion may help translate slogans into action, thereby enhancing the effectiveness of dementia prevention efforts and ultimately improving long-term public health outcomes.