蘭嶼雅美人求醫行為之研究

A Study of Medical Care Seeking Behavior of the Yami on Botel Tobago

10.6288/CJPH1997-16-04-05

吳炳輝(Ping-Fuai Wu)；季瑋珠(Wei-Chu Chie)；洪其璧(Chi-Byi Horng)

蘭嶼 ； 雅美人 ； 求醫行為 ； Orchid Island ； Yami tribe ； health care seeking behavior

中華公共衛生雜誌

16卷4期（1997 / 08 / 01）

329 - 338

繁體中文

蘭嶼雅美人的經濟及健康條件低落、文化特殊、地形隔絕，往往使衛生及醫療政策在當地的執行成果不彰。緣此，本研究之研究目的在於瞭解蘭嶼雅美人的求醫行為，包括影響健康的風俗習慣、醫療信仰和疾病的處理方式，並探討影響雅美人求醫行為的因素，據以提出政策改善的建議。本研究以蘭嶼鄉年滿20歲及以上的成年人為對象、戶為單位，用Kish表家戶內隨機抽樣的方式，每戶抽一人，總計樣本數為712人，由公共衛生護士以結構式問卷進行家戶面訪。調查內容包括：傾向、能力、需要因素、醫療服務的可用性與滿意度、與文化相關的健康信念，及腹瀉與關節痛發生時的求醫行為。扣除空戶及拒訪，共得有效樣本701人。分析結果發現：雅美人的經濟能力低落、健康保險比率偏低、蘭嶼的醫療資源缺乏、滿意度普遍不佳。雖然目前蘭嶼雅美人生病是以現代醫學療法為主，但是受訪者中尚有半數以上民眾在腹瀉及關節痛時使用傳統醫療。年齡在中年、職業非軍、公、學生、對現代醫療的滿意度低、以及現代健康信念低者，腹瀉時傾向於使用傳統醫療；關節痛時使用傳統醫療的相關因素，除年齡無顯著相關外均與腹瀉時相同。據此，吾人建議：政府相關機構應適量增加當地的醫療資源，提升民眾健康教育，使能融合傳統與現代，並重塑正確的文化與健康信念。

The Yami tribe on the Orchid Island (Botel Tobago) have been suffering from poor economic and health condition for decades because of their culture background and geographic isolation. Past health policy had only limited achievements. The aims of this study were to understand the medical care seeking behavior and associated factors of this tribe and to make policy suggestions accordingly. Based on the records of the Orchid Island household registry office, we did random sampling to select 712 family units and one person aged 20 and above in each family with the Kish Table. Trained public health nurses did home visit and face-to-face interview with a structured questionnaire. The questionnaire covered predisposing, enabling, need factors, availability of and satisfaction with medical services, culture-related health beliefs, and health care utilization when having diarrhea and joint pain. Multiple logistic regression were used to study the effects of the possible associated factors. A total of 701 completed the interview. We found that Yami people had low income and coverage of health insurance, inadequate medical resources and low satisfaction. Although modern medicine was the major source of care, more than half of the subjects used traditional treatment. Middle-aged, those whose occupation were not government employee, military, and students, those who were unsatisfied with modern medicine, and had low modern health beliefs, tended to use traditional medicine when having diarrhea. The result of joint pain was the same except that the age had no significant association. In conclusion, we suggested the government to enrich local medical resources, improve health education, and incorporate the modern health beliefs and practice with the traditional one.