雙溪鄉人力互助健康照顧制度之先驅研究

A pilot study on the mutual-help system of health-care about the elders in Shuang-shi Shiang, Taipei County

本研究旨在瞭解人力互助健康照顧制度之建立，對鄉村社區中老年人在社區服務參與意願、社區參與的心理需求層次及執行健康生活的影響。本研究以參與式行動研究為主要研究方法，由研究者和研究地區之民眾共同進行建立互助服務網絡，並立意選取台北縣雙溪鄉為研究地區，以五十五歲以上之人口數為研究母群體，以社區志工實際進行社區服務，介入時間為期三個月。共計取得242份完整資料進行量性分析，研究進行過程中並收集質性資料，以輔助量性資料之不足。研究結果發現：(1)介入後，研究對象健康生活行為有顯著改變；社區服務參與意 願以男性的參與意願改變較為顯著；社區參與的心理需求層次有向上提昇的效果。(2)社區參與的心理需求層次與對人力互助制度之看法並不因社會人口學特徵的不同而有不同，但社區參與的心理需求愈高者愈認為人力互助制度是需要的，且期望能夠實施。(3)研究對象及社區志工對人力互助制度的建立有偏向正向肯定的評價，且得到行政單位、民間團體的支持、中老年民眾的肯定及社區人士不斷加入，人力互助制度在雙溪鄉實施的評價良好是可以繼續經營的模式。分析本研究建立之人力互助健康照顧制度在雙溪鄉進行之情形有下列幾點值得提出：介入後發現志工為中老年民眾提供服務的比率有增加的趨勢，有必要加強志工的訓 練，提升保健基本能力；研究進行過程中面臨最大困難是提供服務者人數不足的問題，介入後期獲得行政單位及民間組織的支持，廣召熱心人士共同參與，對早期志工有鼓舞作用；提供服務的社區志工在服務中不斷學習及成長，不但得到民眾的讚美，也對自己從事社區服務更有信心，且也認為這是一個有意義值得繼續推行的制度；從介入前後證實人力互助制度的實施對中老年人的健康行為有實質上的助益。

The purposes of this research are to exam the effect of the establishment of the mutual-help system of health-care on the elders' willingness and the level of psychological need of community services participation, and to exam how the health life execution in rural community influences on rural community. Shuang-shi Shiang in Taipei County was selected as the research setting. Made the elders above the age of 55 as the whole research target, and the community volunteers did the health services lasted for 3 months. There were 242 subjects who completed pre-test and post-test questionnaires. Also, the qualitative research method was used because qualitative research could not reflect the deeper health-care problems. The main results of this research were as follows: (1) After the intervention, the subjects had significant improvement in health life behaviors. Male subjects, especially, had more improvement in willingness of community services participation than female. The effect of psychological level in community participation was also elevated. (2) The effect of demographic factors on psychological level in community participation and opinions in mutual-help system were not consistent. Subjects who had higher psychological level in community participation were more likely to require & expect execution of the mutual-help system. (3) Host subjects and community volunteers welcomed the establishment of mutual-help system. Also, it got support from the administrative departments, local civil groups, the elders and members in the community. The mutual-help system of health-care in Shuang-shi Shiang was highly praised It may also be a good model for other communities. There are several important notions found from the research process. ( 1) It was necessary to enhance medical training for community volunteers. (2) The insufficiency of volunteers was the biggest barrier in this study. (3) The volunteers who provided services in the community could keep learning and being more mature. They not only received praise from the elders, but also became more confident in giving community services. The volunteers considered the mutual-help system as a good policy that could be continued. (4) The mutual-help system was proved a helpful system which can enhance the elders' health behaviors.