社區參與永續性與登革熱防治-一個對高雄地區的田野比較研究

Abstract

背景： 登革熱是台灣極重要的蟲媒病毒傳染病，近三年來，台灣每年病例數皆超過千例，顯示出台灣在病媒蚊控制上仍有應加強之處。自1980年代起，登革熱防治逐漸轉向以社區為基礎的 (community-based)整合性方式進行。隨著各項防治策略的推動，「社區參與」逐漸成為登革熱相關防治工作之核心概念，「永續性」之議題也漸受強調。本研究在高雄的登革熱流行區域進行，探索其以社區為基礎的防治策略。 目的：本研究以Shediac-Rizkallah的「永續性」概念為理論架構，期望能發掘社區參與之社會脈絡與社會意涵，了解社區中「社區參與永續性」各層面之程度與實踐，探索「社區參與永續性」對登革熱防治可能產生之影響。 方法：本研究為以社區為基礎之田野比較研究，於高雄市前鎮區中選擇物理環境相似的兩個里為研究場域。資料收集從2012年12月至2013年5月，藉由對里長及社區志工之深入訪談，以及社區活動之參與觀察，輔以社區各項活動記錄與文件檔案進行探討。由於資料來源多元，透過各項資料的交叉檢視比對，能提升研究之效度。 結果： 本研究結果顯示：(1) 由於環境具有「多重性」與「時效性」，因此社區應有必要成立環保志工隊，以進行社區整體之環境維護，(2) 對於登革熱防治策略，不應限縮在「孳生源清除」的概念，而應將視角提至環境維護之層次， (3) 慣例的環境維護行動能夠提升社區志工對社區的認同，並且有助於社會網絡以及社區意識之增強，是建立「社區參與永續性」之重要起點，(4) 「由下而上」進行的環境維護行動較「由上而下」能夠持續，並且能達到更大的效益，(5) 資訊分享的社區制度以及社區領導者的理念，都能改變社區文化，並對「社區參與永續性」產生影響。 結論： 社區應超越登革熱防治，以環境維護為號召，並使社區的環境維護行動成為慣例，建立出「由下而上」的社區參與型態，並同時透過資訊分享等方式，針對「社區參與永續性」各層面進行提升，而能在促進社區健康的同時，達到登革熱防治之目的。

Background: Dengue fever is the most threatening vector-borne infectious disease in Taiwan. In the past three years, approximately 1,000 cases of dengue fever have been reported, which suggests urgency in implementing effective strategies in dengue control in Taiwan. Since 1980s, the strategy of dengue control worldwide has shifted to community-based, integrated approaches in which the sustainability of community participation has become the core principle and practice. This study explores community-based strategies for controlling dengue in Kaohsiung City, the dengue endemic area in Taiwan. Objective: By applying the framework developed by Shediac-Rizkallah, the purposes of this study are: (1) to explore the meanings of community participation and the social context in which it was embedded, (2) to assess to what extent the “sustainability of community participation” was practiced, and (3) to explore the impact of sustainability of community participation on dengue control. Methods: This study adopted a community-based comparative fieldwork approach. Two neighboring villages comparable in their physical environments were selected as research settings. From December 2012 throughout May 2013, data were collected through in-depth and informal interviews, participant observations, and archival and government document investigation. Data from multiple sources were analyzed interactively and the validity was assured by triangulation. Results： (1) Due to the “multi-facet” and “urgency” feature of the environmental problems, a volunteer team was a crucial infrastructure for sustainable environmental interventions, (2) An efficient dengue control strategy should be extended to a wider scope of overall environmental management rather than simply focusing on “eliminating breeding sites,” (3) While practiced regularly and collectively, community-wide environmental management actions could strengthen community identity and enhance social networking and community awareness, which constituted a solid starting point for launching sustainable community participation, (4) Community-based environmental management strategies implemented from a “bottom-up” approach were more sustainable and efficient than from a “top-down” one, and (5) A community-wide information sharing system and the leadership of village chief could change community culture and impacted on the sustainability of community participation. Conclusion: Dengue control should be approached from the perspective of total environment management. By applying a “bottom-up” model of community participation, routinizing environmental management actions and assuring local information dissemination, dengue control could be achieved as a result of overall promotion of community health through the improvement of various facets of sustainability in community participation.