越南移民在日本與臺灣之醫療近用障礙：次級資料之比較分析

Abstract

醫療可近性是一個持續性的過程，障礙可能在尋求與接受照護的不同階段出現並相互影響。然而，目前仍不清楚影響移民的障礙中，哪些具有跨移居國情境的共通性，哪些則具情境特異性。為回應此研究缺口，本研究採探索性比較取向，整合兩組證據：日本九名越南移民半結構式訪談之質性次級分析，以及臺灣九篇越南移民實證研究之證據綜整。兩組資料皆採演繹—歸納混合分析，以社會生態模型的五個層次組織障礙，並從資料發展各層次的具體主題，再透過架構矩陣比較共同障礙、主要出現於單一資料組的模式及障礙間的關聯。 研究結果顯示，各類障礙可能沿就醫歷程逐步累積，造成就醫前的猶豫、醫療互動中的困難，以及降低未來再次求醫的信心。共同障礙包括語言與醫療體系知識、醫病溝通、非正式支持及服務組織。日本訪談較凸顯就醫準備與醫療體系導航的高度負擔；臺灣文獻則較常呈現透過家人及其他中介者取得醫療的情形。 整體而言，本研究顯示，正式醫療服務的存在並不必然轉化為實際可使用、可理解且可信賴的醫療可近性。

Healthcare access is a process in which barriers may arise and interact across different stages of seeking and receiving care. However, little is known about which barriers affecting migrants are shared across host-country contexts and which are context-specific. To address this gap, this study used an exploratory comparative approach combining two bodies of evidence: a qualitative secondary analysis of nine semi-structured interviews with Vietnamese migrants in Japan and an evidence synthesis of nine empirical studies concerning Vietnamese migrants in Taiwan. The two bodies of evidence were analyzed using a hybrid deductive–inductive approach. The Social Ecological Model provided five broad levels for organizing barriers, while more specific themes were developed from the data within each level. These themes were then compared using framework matrices to identify barriers documented in both datasets, patterns visible primarily in one dataset, and relationships among barriers. Findings showed that barriers could accumulate across the care pathway, contributing to hesitation before care, difficulties during healthcare encounters, and reduced confidence in future care seeking. Shared barriers involved language and healthcare-system knowledge, provider communication, informal support, and service organization. The Japan interviews more prominently reflected high preparation and navigation demands, whereas the Taiwan literature more prominently documented access mediated through family members and other intermediaries. Overall, the study shows that formal healthcare availability does not necessarily translate into usable, understandable, and reliable access.