遠距健康照護評估量表之發展與驗證

近年來，資訊通信科技與生物醫學技術的快速發展，使得全球各國逐漸地重視應用遠距醫療技術以增進或擴展現今病患照護與服務，稱之為遠距健康照護。然而，近年來有關遠距健康照護之學術論述，率多注重技術的發展與系統的建構，鮮少以病患或顧客的角度，針對遠距健康照護的服務過程，進行全面性與通盤性的評估與測量，以致於無法發掘高齡者的真正需求或問題所在，在臨床的應用上有其侷限，並造成知識發展上之障礙。此外，遠距健康照護的採用是一個結合技術、社會、管理的過程，目前較缺乏整合三個面向的評估量表的相關研究。另外，侷限於特定領域及樣本規模過小，也是許多研究普遍的現象。本研究透過回顧歷來重要之遠距醫療與遠距健康照護的文獻，簡述其演進過程。並針對效能評估的議題，進行深入的探討，歸納整理評估或測量的面向，界定為三大面向與十個指標，分別為技術面：包括系統品質，社會心理面：功能風險、隱私風險、體制信任與醫病信任，管理面：服務品質、成本效益、滿意程度、使用意向、健康影響等。本研究之研究對象係以台灣中部曾經使用遠距健康照護系統的某鄉村社區居民為調查樣本，以訪員面訪方式進行調查，共獲得262份有效問卷。本研究發展之本土中文化多面向評估量表，預試問卷原為35題，經過相關之心理計量考驗之後，刪除1題，最後版本共計34題項。量表經過探索性因素分析與驗證性因素分析後，確定為十個因素，符合原預期之十個指標，並可解釋82.625%的解釋量。本量表證實具有良好信度與效度，確立了量表之適切性與可行性，可做為未來進一步研究之基礎。期望藉由本文之探討，激發學術理論與臨床實務的深入之探究與洞見，共同型塑與創造在地「安全、安心、安老」的照護網絡之美好願景。

關鍵字

遠距健康照護；功能風險；隱私風險；體制信任；醫病信任

並列摘要

Recently, advances in information and communication technology as well as biomedical technology have introduced numerous ways of telemedicine technology to enhance or expand the services and care provided to patients, that is, telehealth. However, most telehealth studies focused only on the development of technology rather than on comprehensive evaluation of patients' (or customers') perception about service processes. Therefore, it's very difficult to understand the elderly population's actual needs and problems, limiting the clinical implementation of the findings and presenting barriers to knowledge development. Besides, the adoption of the telehealth systems is an integrated technical-social-managing process. There is a paucity of scale research that integrates these three dimensions. In addition, most studies have been limited in special scope or small sample size.This article reviews important literatures on telemedicine and telehealth, discusses deeply the issue of evaluating the effectiveness of such technology. The three key dimensions and ten sub-indictors have been identified. That is, technical dimension, including system quality; social psychological dimension, including functional risk, privacy risk, institutional trust and patient trust; and managing dimension, including service quality, cost benefit, satisfaction, use intention, and influence on health. The 262 elderly samples of this study were collected by face to face interviewed from rural community located in central Taiwan. The preliminary Chinese version of multi-dimensional telehealth scale was validated by psychometric analyses to test the reliability and validity, and reduced the number of scale items from 35 to 34. Using exploratory factor analysis and confirmatory factor analysis methods, the ten factors were extracted that was consistent with proposed ten dimensions and explained 82.625% of the variance. The final Chinese version of multi-dimensional telehealth scale demonstrated excellent reliability and validity, and it provided available and applicable measuring tool to evaluate the effectiveness of telehealth.Through this article, we hope to stimulate deeper exploration and insight of academic theory and clinical practice to help shape and create a better vision of aging in place.

並列關鍵字

Telehealth ； Functional Risk ； Privacy Risk ； Institutional Trust ； Patient Trust

參考文獻

林淑霞、劉榮宏、殷偉賢、陳冠群、葉明陽、蔡勝國、陳俐君(2009)。民眾對遠距健康照護服務之認知與需求調查－以心臟病、高血壓及糖尿病為範疇。台灣衛誌。28(6)，552-564。

行政院內政部（2010），內政統計通報，2010 年2 月8 日，取自http://sowf.moi.gov.tw/stat/week/week9904.doc。

Google Scholar

行政院衛生署（2005），調查統計摘要－民國94 年老人狀況調查結果摘要分析，2010年2 月8 日，取自http://www.moi.gov.tw/stat/survey.aspx。

Google Scholar

Anderson, J. C.,Gerbing, D. W.(1988).Structural equation modeling in practice: A review and recommended two-step approach.Psychological Bulletin.103(3),411-423.

Google Scholar

Bakken, S.,Grullon-Frigueroa, L.,Izquierdo, R.,Lee, N. J.,Morin, P.,Palmas, W.,Teresi, J.,Weinstock, R. S.,Shea, S.,Starren J.(2006).Development, validation, and use of English and Spanish versions of the telemedicine satisfaction and usefulness questionnaire.Journal of the American Medical Informatics Association.13(6),660-667.