新住民女性生育健康充權的行動研究

The Action Research on Fertility Health Empowerment of Female Immigrants

楊雅琪(Ya-Chi Yang)

指導教授 ： 張菊惠

長榮大學/健康科學學院/醫務管理學研究所/碩士(2009年)

https://doi.org/10.6833/CJCU.2009.00034

摘要

目的：台灣提供新住民女性許多服務資源，現有新住民生育健康/避孕手冊，僅就中文直譯為多國語言，但未考量其主體需求與文化適切性。本研究藉由健康促進團體發展編輯避孕手冊，自行決定主題、內容與資料呈現方式，以達有效的、可理解的與受尊重的健康資訊，並透過充權教育增長新住民女性之解決問題能力與行動意識，暸解新住民女性充權改變的情境脈絡。
方法：採用參與式行動研究的方式，研究之場域為台南縣某外籍配偶家服中心。召募新住民女性組成健康促進團體，參與成員有新住民女性六位，機構社工員兩位。健康需求評估過程，包含田野觀察、問卷調查、講座觀察、焦點團體、組織溝通。以Freire的「傾聽-對話-行動」充權教育三階段方法，激發團體成員分析其處境與阻礙，擬定重要議題順序。研究遵循計劃、執行、反省、再計劃之行動迴圈模式，於每次團體後檢討修正下次團體內容與進行方式。在循環辯證的歷程中，由原先的不確定、不易掌控的情況，逐漸建構出有效且可行的新住民女性健康團體運作知識。共進行六次團體聚會，每週一次，一次三小時，透過不同的充權策略與工具，如個人問題導向、提問模式、填寫量表等，引發成員自我對話與提問，激發身體意識與主體性，及行動的醞釀。資料的蒐集與分析服膺多元資料檢證之原則，將不同時間與來源的資料交叉檢核驗證與整理分析，期能完整呈現研究過程，包括觀察、團體田野筆記、團體歷程紀錄、非正式會談、成員深入訪談。
結果：分成行動過程與行動結果兩部分。行動初期透過討論現行避孕衛教資訊、成員敘說與分享彼此的避孕經驗、子宮內避孕器裝置失敗實例、避孕方法的選擇決策過程、副作用及對不明確資訊的擔憂，營造對避孕的集體問題意識。團體期間以提升成員知能、滿足資訊需求為主，澄清結紮會引起女性內分泌失調、增長對子宮內避孕器、口服避孕藥、生理週期及荷爾蒙的認知。最後，團體任務為編製一本姊姊寫給妹妹的避孕手冊，研究者提供團體過程提問資料與相關圖片，成員主導手冊的發展，包含手冊命名、情境式內容、引發丈夫參與、淺顯易懂資訊，並以當事人來台不同階段之避孕需求作為編排次序依據。行動結果以個人層面的充權成效最為明顯，包含：避孕知識的學習、避孕控制感的覺察、自信的提升。在人際層面上主要為：助人能力的展現。
討論：執行充權團體需確實進行需求評估，事先設計的方案通常無法符合個體的獨特需求，過度單純化當事人的需要，導致苦心規劃換得拙劣的成效。再者，與成員建立信任關係、安全環境，彼此對話且凝聚問題意識，可快速達到充權。藉由成員自行發展的避孕衛教手冊，期望將擴大集合受壓迫的其他新住民女性，共同採取行動，形成全面性的社會結構充權，以醞釀下一波的社會改革行動。

關鍵字

新住民女性 ； 充權 ； 支持團體 ； 避孕 ； 生育健康

並列摘要

Purpose: Taiwan provides female immigrants with numerous service resources. Currently, there are fertility health / contraception manuals available for female immigrants. The manual contents were only translated into several languages from Chinese versions but no prudent consideration of subject demands and culture adequacy taken. This research was aimed to develop and edit contraception manuals through the effort made by health promotion groups. The topics were settled in a self-decision way with contents and data revealing highly effective, comprehensive and well-respected information about human health. Also, through empowerment education, the problem-solving capabilities and action consciousness of female immigrants can be extensively built and enhanced to understand the contexts about the changes happening to empowerment of female immigrants.
Method: The research was operated by means of participatory action research with a research locale at a certain immigrant-spouse service center on Tainan County. Female immigrants were recruited to form a health promotion group including 6 female immigrants and 2 governmental social workers. The appraisal process for health demands covering field observation, questionnaire survey, lecture observation, focus groups and organization communication. The research was operated in 3 stages by using listening-dialogue-action, namely the empowerment education proposed by Freire. Group members were inspired to analyze their own situations and obstacles prioritized by the orders of important issues. This research followed the looping back model with planning, action, reflection and re-planning. After every session of group discussion, the discussion issues and ways for next session were further reviewed. During the process of cycling dialectical authentication, the initial uncertain and uncontrollable situations were gradually solved and established with the effective and plausible operable knowledge for the health promotion group assembled by female immigrants. There had been 6 meeting sessions held totally. The group meeting was held once a week with the session time lasting 3 hours. With various empowerment strategies and tools, such as personal problem orientation, questioning models and scale fill-up, group members were invited for self-dialog and self-questioning with bodily consciousness and subjectivity inspired and action spawned. Data gathering and analysis followed the principles of diversified data verification (triangulation). Data gathered at different times and from various resources were under double check and compilation. It was intended to entirely reflect the overall research process including observation, team field research notes, team experience records, informal interview and member in-depth interview.
Result: Results were divided into 2 parts, action process and action results. During the earlier action period, with the discussion about current contraception hygiene education, member confession and sharing with contraception experience, failure examples of IUD, the decision-making process to opt for contraception methods and the worries about side effects and no concrete information in hand to cultivate the collective issue consciousness about contraception. During group meeting periods, meeting activities were mainly aimed to enhance the knowledge levels and sufficient information absorption of group members. The confusion fretting about endocrine disorders possibly caused by ligation were clarified in meeting sessions. Group members' cognition to womb contraception devices, oral contraception drugs, menstrual cycles and hormones. Finally, the group was tasked to generate a contraception orientation manual for all group members. The researcher provided the group with questioning information and relevant photographies. Group members directed the development for the orientation manual including the manual title, situated contents, inviting husbands' involvement and comprehensive information. The manual orders were arranged and compiled by various Taiwan-stay stages of female immigrants about the contraception demands. In view of action results, individual empowerment showed its most significant effect including update about contraception knowledge, the perception of contraception control sense and enhanced elf-confidence. In view of interpersonal levels, it mainly showed the capabilities to help others.
Discussion: The teams implementing empowerment were required for demand appraisal. Oftentimes, pre-designed measures were impossible to meet specific individual demands. Over-simplified subjective demands would ultimately result in less effect. Furthermore, the trustful relation established between members, safe environment, mutual dialog with the consciousness of focusing issues could reach empowerment swiftly. By using the contraception orientation manual generated by group members themselves, it was expected to assemble the oppressed female immigrants and take a collective action to form an overall social-structure empowerment with an effort to trigger another wave of social reform action.

並列關鍵字

Female Immigrants ； Empowerment ； Support Group ； Contraception ； Fertility Health

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