衰弱長者未參與改善衰弱的健康促進課程之因素探討

An Exploratory Study on the Factors of Frail Elders not Participating in Health Promotion Courses for Improving Frailty

黃瑋絜(Wei-Chieh Huang)

指導教授 ： 陳雅美

國立臺灣大學/公共衛生學院/健康政策與管理研究所/碩士(2021年)

https://doi.org/10.6342/NTU202100809

摘要

研究目的：探討衰弱與前衰弱老年人對衰弱、現行能改善衰弱之健康促進課程的了解和看法，以及影響他們是否參與健康服務中心或社區據點舉辦之健康促進課程的因素。
研究方法：本研究採立意取樣，研究對象為經SOF量表測定為衰弱與前衰弱，曾接受健康服務中心以電話轉介至健康服務中心或社區據點主辦之健康促進課程，或是曾由台北市、新北市或桃園市的預防及延緩失能據點聯繫過，最終婉拒課程邀請之65歲以上長者。本研究使用社會生態模型為模板，擬定半結構式訪談大綱，並以此對研究對象進行一對一的深入訪談。訪談結果則同樣以社會生態模型為基本架構，使用內容分析法進行分析。
研究結果：本研究共訪談16位衰弱或前衰弱長者，經社會生態模型分析訪談內容後發現：（一）衰弱及前衰弱的長者對「衰弱」的概念並不了解，也沒有衰弱預防或改善的觀念，對「衰弱」資訊的接收還侷限於「個人」及「人際」層次。（二）受訪者對現行預防及延緩失能計畫等健康促進課程認知度低，約一半的長者先前並未聽過類似課程；過去曾聽說過健康促進課程的長者，課程相關資訊大多來自「人際」、「組織」及「社區」層級的管道，他們認為，課程的社交功能、課程的難易度等因素會影響他們參與的意願。（三）除了對衰弱的理解、對健康促進課程的想法之外，還有其他因素會影響衰弱長者參與課程的意願，例如，需要照顧家人、人際互動障礙、長照政策等，而這些因素遍布於社會生態模型中五種層級，而且彼此之間具有交互作用。另外，參與健康促進課程之影響因素存在性別差異，部分男性長者雖然衰弱，但自認為健康狀況良好，而照顧責任則是影響女性長者參與意願的重要因素。而台灣的健康促進活動內容與設計受長照政策直接或間接影響，可知「公共政策」層級也深深影響衰弱長者的參與意願。
結論：本研究發現台灣的衰弱長者對於自身的「衰弱」、健康促進課程的重要性以及課程相關資源認知仍不足，而影響他們參與意願的因素從個人到公共政策層級皆有。未來應自老年族群時常接觸健康資訊的管道下手，透過大眾媒體加強宣傳以提升衰弱相關議題的認知度。另外，長者在參與健康促進課程時有許多阻礙因素，為減少這些阻礙，未來的課程應多元化發展，增加活動形式、活動內容、活動地點的彈性，例如舉辦線上課程，以提升衰弱長者的健康促進課程參與率。而社會衰弱的長者是身體衰弱的高風險族群，因此也是未來健康促進課程的重點對象。

關鍵字

老年人 ； 衰弱 ； 健康促進課程 ； 阻礙因素 ； 社會生態模型

並列摘要

Objective：The purpose of this study is to explore the frail and pre-frail older adults’ perspectives regarding frailty and health promotion courses that can improve frailty. Factors that affect whether older adults’ participation in health promotion courses organized by health service centers or community care centers were also explored.
Method：This study adopts purposive sampling. The subjects of the study were elderly people over 65 who were judged to be frailty or pre-frailty by the SOF scale. These participants have been referred by the health service center to a health promotion course hosted by the health service center or community care centers, or have contacted the community cites to prevent or delay disability in Taipei City, New Taipei City or Taoyuan City, but they did not accept the invitation to the course in the end. Using social ecological model, the current study conducted in-depth interviews based on individual semi-structured interviews. The data was analyzed by using the content analysis method, with social-ecological model as an analysis template.
Result：A total of 16 frail or pre-frail elders were interviewed in this study. After analyzing the content of the interview using the social ecological model as study framework, we found that: (1) The frail and pre-frail elders do not understand the concept of "frailty", nor do they have the concept of frailty prevention or improvement. The perception of "frailty" information is still limited to the "intrapersonal" and "interpersonal" levels. (2) Respondents have low awareness of health promotion courses such as the programs to prevent or delay disability, and about half of the elderly have not heard the courses before. For the elderly who have heard of health promotion courses in the past, most of the course-related information comes from the "interpersonal", "organization" and "community" level channels. They believe that the social function of the course, the level of difficulty of the course and other factors affect their participation willingness. (3) In addition to the understanding of frailty and the idea of health promotion courses, there are other factors that affect the willingness of frail elderly to participate in the course. For example, responsibility of taking care of the family, barriers to interpersonal interaction, long-term care policies and so on. These factors are all over the five levels in the social-ecological model, and they interact with each other. Gender differences were found regarding the reasons of not participating in health promotion courses. Despite being frail, one reason for older men not to participate in health promotion courses is perceiving themselves in good health. The major reason for older women is the responsibility of taking care of the family. In addition, the content of Taiwan's health promotion activities is directly or indirectly affected by the long-term care policy. It can be seen that the "public policy" level also affects the willingness of frail elderly to participate the health promotion courses.
Conclusion：The study found that the frail elderly in Taiwan are still insufficiently aware of being "frailty" and the importance of health promotion, and resources health promotion related courses. The factors affecting their participation in health promotion courses varied from personal to policymaking. In the future, we should start from the channels where the elderly is often exposed to health information, and raise awareness of frailty-related issues through public health media. In addition, there are many barriers for the elderly to participate in health promotion courses. In order to reduce these obstacles, future courses should be diversified with flexible schedules and method, such as online courses. Older adults with social frailty are a high risk group for physical frailty and shall be a priority for future health promotion programs. Policy related interventions are feasible to further promote.

並列關鍵字

Elderly ； Frailty ； Health Promotion Courses ； Barriers ； Social-ecological Model

參考文獻

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