| 摘要: | 台北縣市政府為鼓勵醫療院所積極參與兒童療育相關醫療服務，對早期療育特約醫院提供療育補助。此外，為提升品質，台北縣市政府也對參加醫院進行品質督考。本研究的主要目的在於了解台北地區家長對於發展遲緩兒童在醫院接受早期療育復健治療的滿意度為何及探討影響家長滿意度之因素。
本研究採問卷調查，對象為台北縣市在醫療院所接受復健治療的發展遲緩兒童家長，問卷共發出775份，回收問卷536份，回收率69.2%，最後有效問卷共515份。家長滿意度的評量以李克特（Likert）五分量表，共分為四個構面，包括「對孩童的協助」、「對家長的協助」、「對醫療資源及社會福利資源訊息的提供」、及「對醫院復健治療安排、設備及專業人員能力」，滿意度統計包括此四構面分數以及整體滿意度合計之平均分數。
研究之結果顯示，大多數家長對於醫院所提供的早期療育整體醫療服務滿意度持正面態度，家長對整體醫療的平均滿意度為3.82分，介於「尚可」到「滿意」中間，接近「滿意」的程度。四個構面中，相對滿意度較高的構面為「對家長的協助」，平均值3.93分，而「對醫療資源及社會服務訊息的提供」構面，平均滿意度相對較低，為3.50分，主要較不滿意的部份是醫療院所提供給家長相關早期療育之衛教刊物、親職講座、轉銜說明，及社會福利的協助。在「對孩童的協助」的滿意度評量中、針對治療師所提供訓練內容、居家活動建議、或是服務態度，家長都給予極高的滿意度評價。孩童的進步情形中，以粗大動作的進步程度較明顯也較令家長感到滿意，而孩童在生活自理及情緒的控制部分，家長的滿意度較低。
整體而言，發展遲緩兒童的特質，如年齡、性別、疾病診斷、障礙程度與家長對整體醫療平均滿意度並無關連，然而醫院層級、家長學歷、家庭收入、母親與否、接受復健治療時間的長短、及等候復健安排的時間則與家長對整體醫療的平均滿意度高低有關。其中，非母親、高中學歷、及家庭平均月收入小於3萬元及7-10萬元的家長，對於孩童在醫學中心接受復健治療、開單後2星期以內即安排到復健治療、並且治療已經達3-6個月的家長滿意度較高。
依據研究結果，本研究提出下述建議：一、建議提供發展遲緩兒童早期療育復健治療的醫療院所，針對在發展遲緩疾病相關的衛教書刊、親職教育講座、轉銜及教育訊息、及社會福利資源部分，多提供家長相關的訊息。並建議醫院規劃專職的社工人員服務發展遲緩兒童的家庭，增加社工人員在早期療育服務的參與程度。二、建議政府可以參考台北縣市在推動早期療育醫療復健治療的情形，對於療育資源較不足的縣市，規劃補助及督考的制度，讓其他縣市在推動早期療育的篩檢、醫療鑑定、及療育部份，能更加積極，也讓更多有需要協助的發展遲緩兒童儘早被發現、診斷及接受合適的療育及安置。
To encourage more hospitals to deliver early intervention medical services to those children with developmental delay problems, the governments of Taipei City and Taipei County have started to subsidize them financially. Besides, these governments also monitor their service quality. The purposes of this study are to understand the degree to which the parents are satisfied with the early intervention medical rehabilitation services and to explore the factors that are associated with parents’ levels of satisfaction.
This study surveyed 775 parents using self-administered questionnaires. Five hundred and thirty-six responded and the response was 69.2%. The final valid sample size was 515. Using Likert’s 5-points scale, the questionnaire consisted of four dimensions of satisfaction measures: ‘assistance to the child’, ‘assistance to the parents’, ‘the provision of information regarding medial, educational, and social welfare resources’, and ‘program arrangement, hospital facilities, and professional capability’. We calculate the mean score for each dimension and the overall mean score.
The questionnaires results revealed that most parents were satisfied with early intervention medical program services. The mean score of overall satisfaction of the medical service is 3.82, approximately between ‘fairly satisfied’ to ‘satisfied’. Among these four dimensions, parents were most satisfied with ’assistance to the parents’, with mean score 3.93. The least satisfied dimension was ‘the provision of information regarding medial, educational, and social welfare resources’, with mean score 3.50. Specifically, they were less satisfied with the provision of information of parenting skills, the transition planning, and social welfare resources. In the dimension of ’assistance to the child’, parents felt very satisfied with the training program, home program, the service attitude of the therapists, and the gross motor improvement of their children. But they felt dissatisfied with the self-care skills and emotional control of their children. In the dimension of ‘program arrangement, hospital facilities, and professional capability’, parents were generally very satisfied.
In general, parents’ overall satisfaction was not associated with children’s characteristics such as age, sex, diagnosis and disease severity, but associated with hospital type, parents’ education, household income, mother or not, duration of receiving rehabilitation services, and the waiting time for the rehabilitation program.
Based on the findings, the suggestions of this study were：(1) The early intervention medical service providers should improve the provision of information regarding parenting skills, transition planning, and social welfare resources. It is recommended that full-time social workers are available to provide help for families with developmental delay children. (2) Governments may refer to the experience of Taipei, and set up the subsidy system to promote the early intervention services in other cities to benefit more children with developmental delay. |
