台灣山地鄉口腔醫療保健服務計畫之初期評價

The Formative Evaluation on the Oral Health Survice Project for Aboriginals at Taiwan

姚振華(Jenn-Hua Yao) ； 季麟揚(Lin-Yang Jih) ； 黃耀慧(Yao-Hui Huang) ； 林麗芳(Li-Fang Lin) ； 張進順(Chin-Shun Chang)

《Taiwan Journal of Oral Medicine & Health Sciences》 19卷2期 (2003/10) Pp. 34-47

摘要

前台灣省政府衛生處為提供可近性、完整性、及延續性的口腔醫療保健服務網，於民國八十七至九十年開辦「加強山地離島儘暨偏遠地區口腔醫療保健服務計畫」，該項服務計畫第一年以桃園縣復興鄉等十二個無牙醫師山地鄉為對象，由台灣地區十一個口腔醫療團分別支援各責任鄉。本研究係針該項服務計畫中各醫療團服務模式與績效之過程評價（formative evaluation）研究。以自擬結構式問卷為主，另參考實地參訪及座談會記錄為評價工具。問卷有三類，分別適用於醫療團成員、地方衛生機構人員及民眾，共寄出728份問卷，回收207份有效問卷，回收率為28.43%。經資料建檔、整理、分析後發現：除準備時間相對不足外，在計畫執行時所遭遇的困難：醫療團提出：「經費不足」、「無法做到精緻醫療」、「設備不足」等問題。衛生所提出的是：「民眾就診意願不高」、「民眾對口腔保健認知不足」、以及「行政手續繁瑣」等。民眾最希望「延長門診時間」、「有定點式及持續性之服務」，有88%民眾希望醫療團繼續來該地服務，期望本計畫繼續辦理的民眾更高達90%。其改善之道包含：在中央及地方分別成立「社區口腔健康推動委員會」、加強橫向及縱向的聯繫管理、簡化作業流程、及時反映問題，並有效解決問題。服務內容初期需以醫療切入，再導入預防之觀念。醫療團之服務模式應因地制宜，先進行社區診斷與評估再推動社區組織與動員，以建立健全有效的運作模式。希在後續計畫中繼續追蹤，以建立符合民眾需求之社區口腔健康發展模式。

關鍵字

原住民 ； 口腔醫療保健 ； 過程評價

並列摘要

In 1998 the former Taiwan Health Service started a three years dental health care service project for off-islands and aboriginals. This project focused on twelve aboriginal villages, where no any dental care service was available, with the help of eleven local dental care groups in the first year. The purpose of this investigation was to formatively evaluate the effectiveness of this service model. Three different structural questionnaires, for the aboriginals, local health care services and dental care groups personnel separately, daily working report and visitations were used as data sources. After data processing and analysis, the response rate was 28.43% (207/728). It was found that short of preparation time was the major problems of this project. The common problems encountered by the dental care groups were: not enough budgets, poor service quality and lack of facilities. Problems faced with local health care personnel were: low motivation to reach the service, lack of oral health recognition, and too many administrative procedures. Villagers hope to have a long-term with continuous health service, and about 90% of them hope this project could keep on going. We suggested that establishing the community oral health commission both in central and local scale to solve any oral problems in time. Understanding the oral needs of the villagers, motivating community people and enhancing effective communication were essential for this project.

並列關鍵字

aboriginal ； Oral health ； formative evaluation