C級巷弄長照站長者參與動機與持續意圖之初探

Abstract

研究背景：台灣正快速邁入超高齡社會，預估2025年65歲以上人口將超過20%。隨著人口老化，長者的健康與預防延緩失能的議題日益重要。長照2.0政策下所設置的C級巷弄長照站，以社區為基礎，提供健康促進、社會參與、共餐、以及預防失能等多樣性服務，已逐漸成為高齡長者維持健康老化的重要場域。而多數現有研究多集中在政策推動與巷弄長照站營運層面，較少深入探討長者實際參與動機與持續意圖，本研究期望從C級巷弄長照站參與者角度深入探索，了解長者對於據點的看法與實際的參與動機與持續意圖。目的：本研究目的透過質性訪談的方式，探討新竹某一C級巷弄長照站中長者參與C級巷弄長照站的參與動機及持續意圖，以期望能有效提升長者的參與意願，達成健康老化之目的。方法：本研究採用質性研究設計，透過深度訪談持續穩定參與C級巷弄長照站的長者為研究對象。訪談內容圍繞著參與動機與持續參與意圖兩個核心主題，並利用主題分析法逐步編碼與整理訪談逐字稿，將關鍵字概念化，逐步歸類，最後結合馬斯洛需求理論架構，從生理需求為基本，到安全需求，中階的社會需求，一直到中高階的尊重需求跟自我實現需求的五個層級，進行分析。透過不斷的概念比對最終將確定的概念結合馬斯洛需求理論，將研究資料進行更深層次的理論分析與解釋，形成「參與動機」與「持續意圖」兩大路徑分析。結果：共訪談10位C級巷弄長照站之長者，訪談內常出現的關鍵字共83個、530頻次，將其分類並概念化，得到15個次概念，其中以<活動>、<時間彈性>、<社區服務>、<健康資訊>、<醫療照顧>提及次數最高，再收斂成6個概念「社交心理」、「生活安排」、「成就學習成長」、「社區環境」、「醫療與健康照顧」、「生理健康與安全」。藉由概念橫跨不同需求階層，「社交心理」圍繞著社會需求、尊重需求、自我實現需求，「生活安排」圍繞著社會需求、生理需求，「成就學習成長」圍繞著社會需求、自我實現需求，「社區環境」圍繞著社會需求、安全需求，「醫療與健康照顧」圍繞著社會需求、尊重實現需求、生理需求，「生理健康與安全」圍繞著社會需求、尊重需求、安全需求、生理需求。進一步呼應馬斯洛需求層次理論去計算概念與需求的數量，本C據點使用者中，概念最多圍繞馬斯洛社會需求涵蓋，尊重需求次之，生理需求排列在後，最後則是安全需求與自我實現需求。透過概念與需求的結合，本研究提出「動機路徑」與「持續參與路徑」的雙軌模式。 在「動機」路徑方面，多數長者初期參與據點主要動機源自於社會需求，即渴望與人互動。長者大多帶著「想與人互動」的社會需求走進據點，為了要維持社會需求，並在參與的過程中發現巷弄長照站的功能，所帶來生理需求的維持，而產生動機。社會需求往更基礎的生理需求邁進便形成了「參與動機」的路徑，甚至發展出「據點就像家」的情感連結。參與一段時間後，當長者的基礎需求獲得提升與正向回饋持續累積，長者將據點視為實現個人成長目標的地方，有人想精進技能、有些人想提供志願服務貢獻一己之力，長者則轉而追求更高層次的自我實現需求，於是社會需求往更高階的自我實現需求邁進並進一步形成了「持續意圖」的主要路徑。結果額外發現健康狀態不同的長者呈現出三種變化型：健康組的動機是社會需求往生理需求邁進，持續參與則是社會需求往尊重需求及更高階的自我實現需求邁進，前衰組的動機則是在社會需求與生理需求之間多了安全需求，持續意圖則只有到尊重需求，然而衰弱長輩的動機以社會需求為出發往生理需求邁進，而後持續意圖轉為生理需求往社會需求邁進。由此可知，不同健康狀態的族群在動機與持續意圖之間，呈現出不同的動機與持續參與的需求差異。結論：本研究建議C 級巷弄長照站在了解長者實際動機與持續意圖的基礎上，應在參與過程中以社會需求優先作為設計與推動服務的核心出發點，並持續提供促進學習與自我實現的課程，以支持長輩穩定參與。並對於不同健康狀態的長者同時擴大健康與醫療資源服務，滿足其生理需求與安全需求。此外，巷弄長照站朝向「社區交誼廳」的方面發展，成為一個兼具安全、彈性、社交互動、醫療健康照顧與自我實現的場域，依長者不同衰弱狀況調整課程與服務，持續深化長者參與動機與持續意圖。

Background and Objective: Taiwan is rapidly transitioning into a super-aged society, with projections indicating that the proportion of the population aged 65 years and older will exceed 20% by 2025. In response to this demographic shift, issues related to elderly health promotion and the prevention and delay of disability have become increasingly critical. Under Taiwan’s Long-Term Care 2.0 policy, community-based “Tier C Community Long-Term Care Stations” have been established, providing a range of services, including health promotion activities, opportunities for social participation, communal meals, and interventions aimed at disability prevention. These stations have gradually become key community settings for supporting older adults in achieving healthy aging. However, existing research has predominantly focused on policy implementation and operational management aspects of neighborhood long-term care stations, with limited in-depth exploration of older adults’ actual motivations and sustained intentions for participation. Therefore, this study aims to explore deeply, from the perspective of older adults participating in Tier C Community Long-Term Care Stations, their perceptions of the stations as well as their actual motivations and intentions to maintain sustained participation. Aim:This study aims to explore, through qualitative research, the participation motivations and continuance intentions among older adults attending a Tier C community-based long-term care station located in Hsinchu. By interviewing elders’ motivations and their sustained intentions for participating in this community service, the study seeks to effectively enhance older adults’ willingness to engage, ultimately contributing to the goal of healthy aging. Methods:This study adopted a qualitative research design utilizing in-depth interviews with older adults who continuously and stably participate in Tier C Community Long-Term Care Stations. The interview content revolved around two central themes: participation motivation and continuance intention. Thematic analysis was applied to systematically code and categorize interview transcripts, conceptualize keywords, and progressively classify emerging concepts. These were subsequently analyzed within the theoretical framework of Maslow’s hierarchy of needs, spanning from basic physiological needs, through safety needs and intermediate social needs, to higher-level esteem and self-actualization needs. Through continuous comparative analysis, the finalized concepts were integrated into Maslow’s theoretical structure, enabling a deeper theoretical interpretation of the research data. Ultimately, this resulted in the formation of two distinct analytical pathways: “participation motivation” and “continuance intention.”Results:This study interviewed 10 older adults at a Tier C Community Long-Term Care Station and identified 83 frequently occurring keywords, which were grouped into 15 sub-concepts and further consolidated into six main themes: social psychology, life arrangement, achievement learning growth, community environment, medical and healthcare, and physical health and safety. These themes were mapped to Maslow’s hierarchy of needs, revealing that social needs were most frequently represented, followed by esteem and physiological needs. Building on these findings, the research proposes a dual-pathway model to explain older adults’ participation in community care stations. Most participants are drawn to the care station by their desire for social interaction and belonging. As they become more engaged, they discover that their physiological needs, such as health and well-being, are also being met, fostering a sense of comfort and even home-like attachment. Over time, as these fundamental needs are consistently satisfied and positive experiences accumulate, participants begin to seek opportunities for personal growth, skill development, or to contribute through volunteering, thus shifting toward the fulfillment of higher-level needs like esteem and self-actualization. Importantly, the study found that health status influences these participation pathways: healthy older adults tend to move from social to esteem and self-actualization needs, pre-frail individuals emphasize safety and esteem, while frail participants focus more on the dynamic between social and physiological needs. Overall, this dual-pathway model highlights how social engagement serves as a critical entry point, but the evolving needs and sustained participation of older adults in community-based long-term care are ultimately shaped by their health status and personal growth aspirations. Conclusion: Understanding older adults’ actual motivations and continuance intentions, this study recommends that Tier C Community Long-Term Care Stations should prioritize social needs as the core guiding principle in the design and delivery of services. Stations should continuously provide programs that promote learning and self-actualization to foster stable, long-term participation among older adults. Furthermore, long-term care stations should expand their provision of health and medical resources to meet the diverse physiological and safety needs of participants with varying health conditions. Station evolves towards the model of a "community lounge," they should strive to become inclusive spaces that integrate safety, flexibility, social interaction, medical and health care, as well as opportunities for self-fulfillment. Importantly, stations should also tailor their programs and services in response to the differing levels of frailty among older adults. By providing differentiated and responsive interventions according to each participant’s health status, stations can continuously deepen older adults’ motivation and intention for sustained participation. Through such comprehensive and responsive approaches, Tier C Community Long-Term Care Stations can play a pivotal role in supporting the well-being and quality of life of community-dwelling older adults.