以社會網絡觀點探討 居家外籍監護工之健康求助行為

The Study on Health Help-Seeking Behaviors of Foreign Nursing Aides in View of Social Network

顏閩嘉(Min-Chia Yen)

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.2009.00157

摘要

目的：近年來外籍監護工已成為許多家庭中的主要照護及勞務工作者，在過去的相關議題之研究中，大部份都是關注於他們的醫療服務利用情形，而且是以量表或結構式問卷為評估工具，將監護工們抽離原來的場域，研究結果往往常顯示他們的勞動條件不好，多重就醫障礙等弱勢處境。本研究則有別於以往，以社會網絡的觀點，依循時序演進做更深入的探討，瞭解其網絡建構的型態、健康需求與健康求助行為。
方法：採用參與式觀察及半結構式的深度訪談方式，研究場域為南部某眷村改建的國宅，是監護工密集度相當高的社區，以立意取樣和滾雪球取樣，共訪談十五位外籍監護工，其中有十二位為印尼籍，三位為越南籍。研究過程歷時近三年，以她們的生活作息、交友情況、健康求助行為、健康問題等為主要關注，多元資料檢證為原則，將訪談與觀察的資料交叉檢核驗證與整理分析，期望能完整呈現研究過程，包括觀察、參與活動過程、非正式訪談及深入的訪談。
結果：分為網絡型態、網絡的流動方向與健康求助網絡的機制三個部分。透過網絡的視角看他們的關係，由於地域性的因素，監護工們只要能到國宅中庭活動，就能很快的認識其他同（異）國姊妹，雖然雇主及被照顧者常是跟她們朝夕相處，互動最多的人，但不管行動是否受限於雇主，姊妹們間的鼓勵與支持，對許多監護工來說是非常大的力量，是克服困難、勇敢向前的動力。部份較具同理心的雇主，或是社區中熱心助人的媽媽，比公部門或仲介業者等更能提供監護工們可近性、可及性高的協助與資源。在網絡中的核心人物扮演了重要的角色，除了能夠聯結不同範圍或性質的網絡外，對網絡的功能及強度、密度也有決定性的影響，當核心人物被抽離時，整個網絡便更容易受到外來環境變化的影響而分散或瓦解，即使再重組，在新的核心人物出現之前，將無法維持原有的型態和角色功能，網絡的流動方向及健康求助網絡的機制，也隨之變動，呈現不同的面貌。
討論：不同國籍別、社區環境，與不同特質雇主、仲介業者等條件，形成了多重的網絡型態，當網絡成員間的關係越緊密時，網絡內部的支持力就越大，能夠提供的資源也就越多。相對地，與監護工的身心健康狀態及工作穩定性、雇主滿意度，都有很大的正相關。因此，同儕間所凝聚的力量是不容小覷的！除此之外，用社會網絡的觀點及架構來看外籍監護工們之間，以及與雇主、仲介、公部門、民間友好團體（如四方報等）之間的串聯，是微妙又有趣的，值得往後的研究者繼續做更深入的探討。

關鍵字

外籍監護工 ； 社會網絡 ； 健康求助行為

並列摘要

Purpose: For the past few years, foreign aides have become the major workers to supply nursing service. By reviewing past relevant researches, most were focused on the consumption of medical care service. Also, evaluation scales and structured questionnaires were used as appraisal tools with nursing aides set apart from their working sites. Naturally, research results show their environmental disadvantages in inferior labor conditions and multiple obstacles in searching for medical care. This research is quite different from past ones and it is operated in view of social network with orderly in-depth exploration. It is aimed to understand the types of network construction, health needs and health help-seeking behaviors.

Methods: The research is operated with participating observation and semi-structured in-depth interviews. The survey site is located at re-built military apartments in southern Taiwan. It is a community with numerous nursing aides. The research is operated with purposive sampling and snowball sampling. There are 15 foreign aides interviewed where in 12 foreign workers come from Indonesia and 3 aides come from Vietnam. The research last for 3 years focusing on their daily life, social network for making friends, health help-seeking behaviors and other health issues. The effort is principled with multiple data examinations. The data collected from interview and observation is operated with double checks and compiling analysis. It is expected the overall research process can be clearly shown inclusive of observation, activity participating process, informal interviews and in-depth interviews.

Results: There are totally 3 parts with the patterns divided into network, network flowing direction and health help-seeking network. In a perspective to inspect their network relationship, due to graphical factors, whenever foreign aides step outside to the front yards, they can get acquainted with peers from their homelands or other countries quickly. Although employers and care-receivers often get along with these foreign aides and interact mutually day and night, yet despite whether their action is confined by employers or not, peering encouragement and support are the most valuable strength to overcome difficulties and step ahead. Some employers filled with empathy or enthusiastic aunties in the community can provide these foreign aides with more reachable and accessible aids and resources than public sectors or job brokers. To play core roles in the network will also cause decisive influence on network function, magnitude and density aside from linking to networks with different ranges or attributes. When core roles are set apart from the their working sites, the overall network will be dispersed or crashed easier due to the influence caused by external environment. Even if the reorganization is made, however, before the occurrence of new core roles, it will be unavailable to keep original patterns and role functions. It follows that the mechanisms of network flowing directions and health help-seeking network will be changed with numerous facades shown.

Discussion: Various nationalities, community environments, employers with different attributes and conditions of job brokers naturally form multiple networks. Whenever the relationship among network members is getting closer, the internal network support becomes larger with more information available. In contrast, both work stability and physical-mental health of nursing aides are actually highly correlated to employer satisfaction. Therefore, peering cohesion can never been underestimated! In addition, in a perspective of social network and structures to view the linkages to nursing aide peers, employers, job brokers, public sectors and friendly civilian organizations (such as the Four Direction Report) delicately interesting worthy of upcoming researchers’ more in-depth exploration continuously.

並列關鍵字

Foreign Nursing Aide ； Social Networks ； Health Help-Seeking Behavior

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