失智、污名與健康促進－－評析我國對老人的健康宣導策略

Dementia, stigma and health promotion: An analysis of health campaign strategy toward older people in Taiwan

關於疾病污名及由此導致民眾排斥就醫等負面後果的研究，不勝枚舉。包括愛滋病／ HIV 感染、癲癇、痲瘋病、結核病、癌症與精神病等，污名標籤都令若干患者對尋求治療感到卻步。由於我國即將步入高齡社會，失智問題值得重視。而若要成功進行健康宣導工作，首先就必須了解此一症狀與背後的污名化現象，包括昔日俗稱的老人癡呆症。不同的診斷標籤帶來不同的主觀感受，間接影響就醫行為。其次，我國公衛宣導策略向來著重篩檢，缺乏對可能宣導對象的資訊近用習慣與健康資訊需求的了解。再者，有別於癌症或其他常見的老人疾病，失智症目前仍無藥可醫，且依病情程度的不同，對患者與家庭照顧者的生活品質會帶來不同程度的衝擊，故宜有一套專屬的宣導技巧。本研究從失智污名特色、健康宣導形式、健康宣導內容與健康宣導技巧等四面向評析我國失智症健康宣導策略，並透過訪談花蓮縣志工老人、非營利組織宣導部門主管與失智症專家，整理出老人的資訊近用習慣，論證以健康促進觀點取代篩檢，以及為失智症「去污名化」提出解決方案。期盼藉此改善老人主動尋求相關醫療保健資訊與提升自身認知健康的意願，達到增進家庭照顧者福祉、替老人或潛在失智者「賦權」的終極目標。

A lot of researches have been done about the stigma of illness and its negative consequences on discouraging people to consult doctors. The labels of illness such as AIDS, epilepsy, tuberculosis and mental illness and their metaphors all stop patients from looking for cure. As Taiwan will evolve into the aged society from the aging one in 2018, dementia deserves to be stressed. First, if health promotion is to be brought on successfully, it is necessary to understand the stigma behind dementia. Different diagnostic labels bring different subjective feelings, indirectly affecting the health–seeking behaviors. Second, the strategy of health campaign for dementia in Taiwan focuses on the screening, lack of the command of potential audience‘s information access and health information needs. Furthermore, in contrast to cancer and other diseases common in older people, dementia has been incurable so far and can bring different impact upon the life quality of patients and caregivers to the extent dependent on the disease’s progress. So we may need a set of health campaign techniques exclusive for dementia. This study analyzes the health campaign strategy for dementia in Taiwan from four dimension including stigma, campaign tool, campaign content and campaign techniques. With interviewing in depth older volunteers in Hualien County, a campaign director in a non-government organization and a dementia expert, the author offers information access models by older people, the arguments that promote health promotion other than screening, and anti-stigma approach. It is expected to enhance older people’s will to seek health information about dementia, with the aim of improving caregivers’ welfare and empowering older people and potential patients in the end.