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標題: | 探討文化健康站服務使用者之長照未滿足需求 Exploring the Long-term Care Unmet Needs Among Users of Cultural Health Stations |
作者: | 王子軍 Tzu-Chun Wang |
指導教授: | 陳雅美 Ya-Mei Chen |
關鍵字: | 長期照顧,原住民族,文化健康站,未滿足需求, Long-term care,indigenous people,Cultural Health Stations,unmet need, |
出版年 : | 2023 |
學位: | 碩士 |
摘要: | 研究背景:伴隨臺灣平均餘命提升,老年人口也快速增加,政府近年來為滿足民眾日益增加的長期照顧服務(以下簡稱長照服務)務需求,透過擬定相關法規、政策發展長照服務,於2017年實施長期照顧服務法及首次將原住民族專章納入長期照顧十年計畫2.0(以下簡稱長照2.0),並將文化健康站(以下簡稱文健站)視為長照服務體系中重要的資源之一。然而,國內目前雖然有豐富的文健站相關研究,但大多是以特定區域或族群瞭解文健站的服務效益或發展困境為主,針對整體文健站服務使用者之未滿足需求相關研究付之闕如,因此,期待本研究釐清影響文健站服務使用者未滿足需求的相關因子,補足研究缺口。
研究目標:1) 探討文健站服務使用者的未滿足需求、2) 探討影響文健站服務使用者的未滿足需求的相關因子、3) 探討文健站服務使用者在使用長照服務後未滿足需求的差異。 研究方法:本研究為橫斷性調查研究。採取立意取樣,並以實地並使用長照服務未滿足需求量表訪談臺灣文健站列冊之服務使用者,據以評估文健站服務使用者的未滿足需求。並根據安德森健康行為模型,以前傾、使能及需要因素分析其與未滿足需求的關聯性。另本研究利用雙變量分析、多元迴歸探討文健站服務使用者的人口學特性與未滿足需求間的關聯。此外,還使用了分層分析來比較文健站服務使用者在有使用長照服務與非使用任何長照服務之間的未滿足需求相關因素。 研究結果:文健站服務使用者之未滿足需求前五名為交通接送、身體健康、外出活動、社會支持、取得福利和資源;前傾因素年齡越大則未滿足需求越高。使能因素低收入戶較一般戶、較中低收入戶的未滿足需求高。需要因素失能等級越高則未滿足需求高、領有身障手冊較無身障手冊未滿足需求高。「單一文健站服務使用者」與「文健站及其他長照服務使用者」在人口學變項分布以及與未滿足需求相關性略有不同,前者身障比例、失能等級平均數均較後者高;另在「單一文健站服務使用者」失能等級是相當有力的預測指標,但在「使用文健站及其他長照服務的服務使用者」則影響力大幅下降且不顯著。 結論:文健站服務使用者除了交通服務之外,最高的4個未滿足需求分別為身體健康、戶外活動、社會支持以及福利和資源的取得。身體健康的未滿足需求反應了對醫療服務的需求,建議於文健站提供醫療巡迴或是居家醫療服務。戶外活動和社會支持的未滿足需求則顯示有擴大生活範圍以充實對文健站服務使用者在身、心理上的支持。福利和資源取得的未滿足需求顯示文健站服務使用者取得和連結所需資源的障礙。這些需求的滿足程度與交通服務的便利性有一定的相關,強調優先解決交通便利性以及其他未滿足需求項目的重要性。此外,文健站服務使用者的未滿足需求與臺灣長照服務使用者略顯差異,特別是文健站服務使用者並未顯現生活照顧與家務處理的未滿足需求,雖然可能是受文健站使用者普遍失能程度較輕的影響,但另一種解釋推測是文健站服務可能已滿足了使用者在此類的照顧需求。另依據安德生健康行為模型與過去研究發現,年齡、社會福利身份、失能等級、慢性病數量和有無身障手冊是預測文健站服務使用者未滿足需求的重要影響因子。另外,對於單一使用文健站服務而不使用其他長照服務的長者,隨著失能等級提高則未滿足需求也增加。然而,如果文健站服務使用者再同時使用其他長照服務,失能等級的影響力將顯著降低。因此建議未來政策應加強文健站連結或導入其他長照服務資源,以及針對文健站及其他長照服務的服務使用者的未滿足需求預測因子值得未來進一步探討。 Background: With the increase of life expectancy and rapid growth of the older population in Taiwan, the government has recently devoted efforts to meet the growing demand for long-term care services among older people. In 2017, the Long-Term Care Services Act and the Long-Term Care 2.0 Ten-Year Plan were introduced, which included a dedicated chapter for indigenous peoples for the first time. As part of the long-term care service system, Cultural Health Stations were recognized as important service bases. However, despite the abundant studies on Cultural Health Stations in Taiwan, most of them focus on understanding the service effectiveness or development challenges of specific regions or ethnic groups through qualitative studies. There is a lack of research on the unmet needs of the users of Cultural Health Stations. Therefore, this study aimed to clarify the factors that influence the unmet needs of Cultural Health Station service users. Target: This study aimed to explore the 1) unmet needs and 2) related factors of Cultural Health Station service users, and 3) examined the differences of unmet needs among Cultural Health Station service users who used long-term care services versus those who have not. Method: This cross-sectional survey study employed purposive sampling and face-to-face interviews with registered service users of Cultural Health Stations in Taiwan. The study used a Long-term Care Unmet Needs Appraisal Scale to assess the unmet needs in Cultural Health Stations users. Based on Andersen’s Health Behavioral Model, predisposing, enabling, and need factors were included for investigating their association with unmet needs. The research utilized bivariate analysis and multiple regression to explore the associations between the demographic characteristics and unmet needs of Cultural Health Station service users. Additionally, a stratified analysis was used to compare factors of unmet needs between Cultural Health Station service users, who used long-term care and those who have not. Results: The top five unmet needs among Cultural Health Station service users were transportation services, physical health, outdoor activities, social support, and access to welfare and resources. Regarding predisposing factors, higher age was associated with higher levels of unmet needs. Among enabling factors, low-income households exhibited higher levels of unmet needs compared to general households. Additionally, general households have higher levels of unmet needs compared to low-to-middle-income households. Concerning need factors, higher disability levels was associated with increased unmet needs, and possessing a disability certificate is associated with higher levels of unmet needs. " Users only used the Cultural Health Station service " and " Users utilized both the Cultural Health Station and other long-term care services " had different demographic characteristics and correlations with unmet needs. Compared to " Users only used the Cultural Health Station service ", " Users utilized both the Cultural Health Station and other long-term care services" had higher proportions of disabilities and average levels of impairment." There were differences in the factors related to unmet needs between " Users only used the Cultural Health Station service " and " Users utilized both the Cultural Health Station and other long-term care services." In both cases, disability level served as a predictive indicator of unmet needs for " Users only used the Cultural Health Station service." However, for " Users utilized both the Cultural Health Station and other long-term care services," the influence of disability level significantly decreases and was not statistically significant. Discussion and Conclusions: For Cultural Health Station service users, apart from transportation services, the top four highest unmet needs were physical health, outdoor activities, social support, and access to welfare and resources. Unmet need of physical health reflects a demand for medical services, while unmet needs of outdoor activities and social support indicate a desire to expand one's scope of life and receive community support. Unmet need regarding accessing welfare and resources represents the need to connect with information and resources. These needs were moderately correlated with the unmet needs of transportation services, emphasizing the importance of prioritizing the convenience of transportation resources as well as other services. Additionally, the unmet needs of Cultural Health Station service users differed somewhat different from those long-term care service users in Taiwan, particularly the area of unmet needs in daily life activities. Although it is possible that the users of Cultural Health Station services may be less disabled, it is also possible that Cultural Health Station services may have addressed certain aspects of daily life needs among the users. Based on the Andersen’s Health Behavioral Model, age, social welfare status, level of disabilities level, the number of chronic diseases, and possession of a disability certificate were all significant factors in predicting the unmet needs of Cultural Health Station service users. Furthermore, for Users only used the Cultural Health Station service , their unmet needs increased as the level of disability escalates. However, if Users utilized both the Cultural Health Station and other long-term care services, the influence of disability level significantly diminishes. This suggests that strengthening the utilization of other long-term care service resources alongside Cultural Health Station service can be crucial and beneficial for addressing their unmet needs. It is strongly recommended for future policy-making. It is also important to further explore other unmet need related factors among Users utilized both the Cultural Health Station and other long-term care services. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/90219 |
DOI: | 10.6342/NTU202302902 |
全文授權: | 同意授權(限校園內公開) |
顯示於系所單位: | 健康政策與管理研究所 |
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