以溝通適應理論檢視台灣心理健康照護者與外國病人之醫療互動：一個質性研究取徑

Abstract

在全球化脈絡下，隨著跨國移動與移居的頻率增加，關照多元文化背景的心理健康照護更顯重要。心理健康不單單是個人層面議題，更是一攸關社群與社會福祉與健康不平等的重要議題。本研究的目的探討跨文化脈絡之下的心理健康諮商服務，並透過人際健康傳播的理論視角，分析台灣心理諮商師如何對外國人提供諮商服務。 本研究是一個「台灣心理諮商師提供外國人醫療服務」的質性研究，計畫主持人以及其團隊的既有人際網路進行招募，我們透過立意取樣以及滾學球方式，招募到9位在北台灣地區（以台北與新北市兩地為主）職業的心理諮商師，或稱「心理健康服務提供者」(MHCPs)進行訪問，透過半結構式的訪談法，每個訪問約進行了一至一個半小時，以英文進行。透過Communication Accommodation Theory（Giles et al., 1987）作為理論架構，本研究探討本地醫療提供者如何溝通並文化再譯外國人的醫療需求，並分析醫病溝通策略的類型。訪談資料計畫主持人與團隊製作逐字稿，並運用扎根理論分析方法進行主題式分析。研究結果透過人際溝通與跨文化健康傳播的理論視角充實了醫病關係的文獻，並對台灣醫療現況以及外國人心理健康服務提出政策建議。

Mental health is an aspect of individual and community wellbeing that cannot be limited to a single domain. In Taiwan, existing public health studies on mental health tend to focus on population health with limited cultural considerations. Efforts to highlight cultural elements in mental healthcare are often oversimplified to dichotomous categorizations—such as “Eastern” vs. “Western” perspectives and direct vs indirect approaches. However, given the continually globalizing nature of Taiwanese society, there is a pressing need to better develop mental healthcare studies in multifaceted cultural contexts. This study approached such a need by examining the nature of mental health consultations between foreigners and their local Taiwanese providers from a sociocultural perspective. We considered aspects such as individuals’ social positions and cultural backgrounds. Due to their essential roles in promoting mental health, we chose to explore mental healthcare in Taiwan according to the perspective of providers. As such, semi-structured interviews were conducted with nine Taiwanese mental healthcare providers (MHCPs), including six psychologists and three psychiatrists, in the Taipei and New Taipei areas from 03/2023- 05/2023, Each MHCP was interviewed in English for 60-90 minutes. Using Communication Accommodation Theory (CAT, Giles et al., 1987) as a framework, this study (1) characterizes providers’ understanding of foreigners’ mental health issues and (2) investigates the communicative strategies they use in mental health consultations. All data was transcribed and analyzed thematically using principles of grounded theory. Four themes were identified and given conceptual titles, namely: experiential origins, collectively individual, managing reflections, and spoken barriers & perceptual openings. Providers largely understood their mental health care receivers’ (MHCRs’) identity and mental health issues to include intertwined experiences and original nature. They identified influences of collectivism and individualism, and described treating their MHCRs as both individuals and members of cultural groups. In consultations, they explained managing their MHCRs reflections, or attempts to understand their internal predicaments. Finally, they noted a need for balance between verbal and nonverbal communication in their consultations. Together, these themes challenged and enriched common dichotomous understandings concerning cultural and communicative dynamics in mental healthcare. Specific communication strategies are explored within each theme according to CAT. The findings contribute to global health studies by exploring nuanced relationships between sociocultural elements and mental health as well as by revealing communicative strategies for mental healthcare professionals in intercultural contexts. Such results have the potential to advance mental healthcare for diverse populations.