南澳鄉泰雅族人健康行為、健康狀況與健康識能之探討

目的：在台灣儘管政府針對偏遠地區及原住民社區提出了許多健康政策及健康計畫，但原住民與非原住民的平均餘命還是有所差距。本文因此藉由健康識能的探討，以瞭解原住民健康識能，以及其與健康狀況、健康行為之關係。方法：本研究以宜蘭縣南澳鄉泰雅族滿20歲以上的成年人為研究對象，以便利取樣及滾雪球方式尋找受訪者，共收回194份有效問卷。問卷內容包含人口特性、健康行為、傳統文化習俗健康行為、健康狀況和歐洲健康識能量表(HLS-EU-Q47)，資料分析以描述性統計及推論性統計-變異數分析、相關及迴歸統計分析，以瞭解人口特性、健康行為、傳統文化健康行為、健康狀況與健康識能之間的關係。結果與討論：本研究受訪者人口特性分佈比與當地人口組成類似，其中只有性別稍有差異，以女性居多，主要因為在問卷訪問過程中男性較多拒絕訪問，整體而言，受訪樣本應該足以代表當地人口狀況。就健康狀況受訪結果來看，BMI平均超過26(26.7)，顯示當地人口可能過重。在健康危害行為中，目前有嚼檳榔習慣者佔受訪者的四分之一，目前有抽菸習慣者佔三分之一，而目前有喝酒習慣者佔的比率較高為66.5%，有運動習慣者比率也相當高，約有70%，受訪者中有一半以上的人有收集健康資訊的習慣。從受訪者健康識能回答資料，算出受訪者整體健康識能分數等級為足夠(34.49)。健康識能分數在性別及職業類別上變異數分析有顯著差異(p<0.05)，其中女性分數大於男性，勞動型行業分數最低，被歸類為健康識能有問題。健康識能分數與年齡、教育程度、嚼食檳榔習慣、收集健康資訊頻率、自覺健康狀況、與同齡/同性健康狀況相比自覺健康狀況、心理健康狀況、運動頻率呈現顯著性相關(p<0.05)。其中，與年齡、嚼食檳榔呈現負相關，而與教育程度、收集健康資訊頻率、自覺健康狀況、與同齡/同性健康狀況相比自覺健康狀況、心理健康狀況與運動頻率有顯著正相關。結論：本研究計算出南澳鄉原住民健康識能分數，與Duong(2015)測量台灣民眾整體健康識能平均34.4±6.6分約略相同。也就是說，南澳鄉泰雅族之成年人整體而言，與台灣大眾的健康識能分數並無不同，健康識能屬於「足夠」。但是在更深入分析人口特性及健康行為，則發現有所差異，本研究受訪者以青壯年為主，其中女性多於男性，健康識能也較佳，這與Duong指出男性健康識能高於女性不同。本研究分析原因，可能在於教育程度的介入效果，原住民男女性受教育統計顯示，在高中職前男性就讀人數比高於女性(54.4：45.5)，而大專校後女性就讀人數比高於男性(60.6：39.4)，本研究之受訪者顯然女性高教育程度者較多。再者本研究受訪者男性大多為從事勞動型行業，工作時間較長體力耗費大，並對於健康資訊較無時間去瞭解，同時也有較多健康危害行為，其健康識能分數相對會不佳。其意義在於，教育程度及健康危害行為的影響，教育程度沒有提升，影響工作型態，同時產生工作文化上的健康危害行為，進而與健康識能分數關聯。而南澳鄉泰雅族人在健康危害行為的比例較高，長期吸菸、飲酒、嚼食檳榔，進而影響其健康狀況，甚至影響平均壽命，雖然90%以上的受訪者認為自己健康狀況為「普通」以上，但有三分之一的受訪者有長期疾病或健康問題，其中高血壓、心血管疾病、糖尿病的患者居多，因此泰雅族人若要提升健康識能，應該要從教育改善，並且減少健康危害行為，使民眾可以從教育及學習中提高自身的健康知識及促進健康，維持良好的健康狀況。

關鍵字

泰雅族；健康識能；健康狀況；健康行為；歐洲健康識能量表

並列摘要

Objectives: Although the government has put forward many health policy and health plans for remote areas and indigenous communities to improve the health status of Taiwan’s indigenous people there is still a gap of healthcare provision and life expectancy between the non-indigenous and the indigenous population. Therefore, the objective of this study is to examine the interrelation between the levels of health literacy (HL) and health behavior among indigenous people. Method: The cross-sectional study design was conducted by the convenience sampling method among the over 20-year-old of the Atayal tribe living in north-west Taiwan. and 194 valid questionnaires were collected by convenient sampling and snowballing. The questionnaire contents included demographic characteristics, health behavior, traditional cultural health customs, health status and HLS-EU-Q47. The analysis method also includes descriptive statistics and correlation analysis for analyzing the degree of correlation between health behaviors traditional cultural health customs, health status and health literacy. Results: The distribution ratio of demographic characteristics of the respondents in this study is similar to that of the local population. There is only a slight gender difference, and most of them are women. The main reason is that more men refuse to answer during the questionnaire interview. On the whole, the sample should be enough to represent the local population. According to the results of health survey, the average BMI is more than 26 (26.7), indicating that the local population may be overweight. Among the health risk behaviors, one fourth of the respondents have the habit of chewing betel nut, one third the habit of smoking, 66.5% the habit of drinking, and 70% the habit of exercising. The people mentioned above 55.1% have the habit of collecting health information. According to the data the overall HLS of the respondents is sufficient (34.49). There are significant differences in the variance analysis of HLS in gender and occupation category (P < 0.05). Among them, the score of females is higher than that of males, and the score of labor-oriented industry employees is the lowest, being classified as HL problematic. The HLS is related to age, education level and the habit of chewing betel nut. A comparison of the respondents with a sample group of same age and sex shows that health status, self-conscious health status, mental health status and exercise frequency were significantly correlated (P < 0.05). Conclusion: In this study, we calculated the HLS of the Atayal’s people in Nan'ao, which have about the same as the average score of 34.4 ± 6.6 measured by Duong (2015). On the other hand, the HLS of Atayal’s people in Nan'ao is not different from that of the Taiwanese population as a whole, and the HL is "sufficient". However, in a more in-depth analysis of the demographic characteristics and health behaviors, we find that there are some differences. Most of the respondents in this study are young adults, among which women have a higher share than men, and their HL-score is also ahead, being different from Duong's point that men's HL are higher than women's. The Analysis of this study may be due to the intervention effect of education level. According to the education statistics of Indigenous men and women, the ratio of male students to female students before senior high school is higher (54.4:45.5). The respondents in this study obviously have more female students with higher education level. Moreover, most of the male respondents in this study are occupied in labor-oriented industries, with long working hours, high physical consumption, and less time to understand health information. At the same time, they also have more health risk behaviors, and their HLS are relatively poor. The significance is that the education level and health risk behaviors are not improved, which affects the work style, and at the same time produces work-related problems The health risk behavior factors are related to the HLS.