臺北市低劑量輻射屋居民之健康照護需求評估

1992年國內第一棟輻射汙染建築物意外被發現，臺灣輻射屋事件就此爆發。輻射屋肇因於鋼筋建材中含有鈷60輻射源，截至2012年統計資料顯示，該批輻射鋼筋主要分布在1982-1984年興建於北臺灣的建築物當中，目前已被偵測出有300多棟，共有1,661戶輻射屋，根據官方統計約有13,300人曾經在居住、就業或就學的過程中接觸過輻射屋。原能會對此實施救濟金補助、價購5毫西弗以上之住戶。而在1,661戶輻射屋中，年劑量小於5毫西弗就佔了1,300多戶，因此，這些設籍、就讀或居住於臺北市的低汙染戶後期也納入臺北市政府管轄，提供鑑定、改善、拆除重建、房屋稅減免及健康檢查等措施。本研究主要是為了： (1)瞭解臺北市低劑量輻射屋居民之健康照護需求 (2)瞭解影響低劑量輻射屋居民健康照護需求之可能因素 (3)發展低劑量輻射屋居民之健康照護需求評估工具。本研究以健康照護需求為研究主軸，引用Andersen健康行為模式中的健康需求作為概念核心，研究方法採質性焦點團體訪談進行研究。焦點團體訪談共分兩個階段，首先是進行三場(共8人)專家學者焦點團體訪談以定義低劑量輻射屋居民可能的生理與心理疾病之範疇與構面，進而擬定居民焦點團體訪談大綱，於2013年9月至12月間利用輻射屋居民健康檢查時間至該醫院進行十二場(共46人)輻射屋居民焦點團體深入訪談，藉以瞭解居民之健康照護需求及其影響因素，並發展出臺灣低劑量輻射屋居民之健康照護需求評估問卷；為了瞭解本研究依據文獻及質性訪談結果所發展出問卷的各問項是否具可靠度，因此本研究於2014年4月至6月間先後共邀請了14位專家進行效度檢測、及46位輻射屋居民進行問卷試測。低劑量輻射屋居民之健康需求乃疾病與健康導向之需求，可歸因於免於罹癌、遺傳不良、基因變異、精神壓力及健康促進等五項主要需求；而造成此健康需求之因素為輻射健康識能、個人生活習慣、生活壓力程度、輻射(屋)暴露擔憂程度、自覺健康狀態及個人健康行為，本研究以此結果作為健康照護需求評估工具之發展架構。目前居民生理層面的健康照護需求及心理層面的擔憂，主要乃其暴露經驗與致病的不確定性所造成，因此應該要針對居民輻射健康識能及對其自覺健康狀態提供衛教諮詢與輔導。另外，也建議相關單位可以公布歷年整體健檢統計結果，以利居民對於自身暴露經驗的健康趨勢能更進一步瞭解，並做好自我健康管理，以降低心理層面的焦慮。

關鍵字

輻射屋；低劑量輻射；健康照護需求

並列摘要

An extraordinary incident occurred 30 years ago in Taiwan. Recycled steel, accidentally contaminated with cobalt-60, was formed into construction steel for more than 300 buildings (about 1,661 households), including dozens of school complexes and buildings. More than 13,300 residents and students have been suffering from prolonged exposure to ionising radiation at low-dose-rates for 10 to 30 years. The contamination was not identified until mid-1992. There were about 1,300 households that received excess annual radiation doses of 1-5 mSv among 1,661 households. The City Government established a comprehensive healthcare program in 1995 in Taipei city for those contaminated residential and school buildings. This research is to understand residents’ health care needs and the key factors of impact on their health care needs, and aim to develop an assessment tool to discover their needs through qualitative study. The qualitative interviews were conducted on experts and residents: there were three focused groups of expert, and twelve focused groups of residents (totaling 46 persons). Transcripts were transcribed and analyzed based on health behavior patterns in Anderson Health Service Utilization Model to develop the health care needs questionnaire. We invited 15 experts and 45 low-dose-rates residents to participate the survery, in order to proof the reliability and validity, The interview results demonstrated that the residents’ health care needs were disease-oriented and health-oriented. Disease-oriented needs may be attributed to avoiding cancers, bad genetics, genetic variation, and mental stress. Furthermore, the health care needs may be associated with their perception to radiation literacy, lifestyle, stress levels, disease-oriented needs, health behavior and perceived health status. We have designed qestionnaire of health care needs specifically for radiation-affected residents based on conceptual framework of health need. The results suggest that low-dose-rates residents’ radiation literacy and health status perception need to be improved by providing with health education and psychological consultation. By the way, it is suggested that the overall statistical results can be notified and thus to enhance residents’ heath management and reduce their anxiety.