| 摘要: | 動機：截至2012年5月為止，在台灣的東南亞籍婦女有138,875人，其中75%都是在35歲以下的育齡婦女，因此來台初期，多數新住民婦女都經歷到婦幼預防保健服務使用的經驗。先前的研究指出新住民婦女有產前檢查服務及兒童預防保健服務使用達成率偏低的狀況，顯示在臨床上針對新住民家庭服務尚有可進步的空間，但國內針對移民者的涵化影響其健康行為之相關研究仍付之闕如。
目的：本研究旨在瞭解新住民婦女產前檢查服務及其兒童預防保健服務使用達成率現況，並以Andersen行為模式理論探討涵化及相關因素是否為產前檢查服務及其兒童預防保健服務使用的預測因子。
方法：本研究採橫斷性資料收集設計，以育有7歲以下之新住民婦女（包含越南、印尼、泰國、菲律賓）為對象。根據Andersen行為模式 (1995)，在個人特徵的使能因素中加入涵化及就醫障礙變項，而需求因素中加入懷孕及新生兒問題。最後資料以SPSS軟體17.0版及Amos軟體18.0版進行線性結構方程式分析。
結果：根據284位個案資料結果分析，產前檢查服務使用達成率模型及兒童預防保健服務使用達成率模型配適度良好，分別為χ2 =568.74, df =206, p=0.001; χ2 =539.86, df =206, p=0.001；卡方值/自由度為2.76及 2.62；兩個模型的RMSEA 均小於0.08。進一步分析產前檢查服務使用達成率模型結果發現，在台灣時間對產前檢查服務使用達成率呈現顯著負相關；原國家學歷、產前檢查服務支持、涵化之整合等對產前檢查服務使用達成率呈現顯著正相關。兒童預防保健服務使用達成率模型結果顯示，家庭月收入、涵化之整合、兒童預防保健服務支持等皆正向影響兒童保健服務使用達成率。
結論：此結果驗證傾向及使能因素為婦幼預防保健服務使用的預測因子。本研究結果突顯出使能因素中，涵化之整合因素在婦幼預防保健服務使用達成率模式中的重要性，未來醫療人員應了解涵化的內涵，以促進新住民婦女之婦幼預防保健服務使用達成率。
Aim. This is a report of utilization of maternal and child’s preventive care based on Andersen health seeking behavior model. The purpose of this study was to examine the influence of predisposing, enabling, and need factors on maternal and child’s preventive care use among immigrant women in Taiwan, and further to explore role of acculturation and other predictors of both utilizations.
Background. Previous studies revealed that utilizations of maternal and child’s preventive care were different among women from various origins. The acculturation phenomenon is believed to be an important factor influencing immigrants’ health behavior.
Method. A cross-sectional survey was conducted. Immigrant women who were living in Taiwan with their Taiwanese husbands and with children under 7 years old were included. Andersen behavior model (1995) was used to identify influencing factors with acculturation and medical access barrier be added in the enabling factors, and health problems in need factor. The Structural Equation Modeling (SEM) method was used by SPSS 17.0 and AMOS 18.0 for data analysis.
Results. The completed sample included 284 women lived in 2 counties of Taiwan who were 28.6 years old (SD=4.33) in average. Results showed that the Chi-square test for the model produced a statistically significant finding (χ2 =568.74, df =206, p=0.001; χ2 =539.86, df =206, p=0.001) of maternal and child’s preventive care use. Based on the χ2/ df ratio (2.76; 2.62), the second-order factor baseline model fits the data quite well (CFI =0.826, RMSEA =0.079; CFI =0.837, RMSEA =0.076). There were four factors significantly predicted utilization of maternal preventive care: length of stay in Taiwan, educational level in original country, perceived support and integration. And three factors significantly predicted utilization of child’s preventive care: family income, perceived support and integration.
Conclusion. Our findings indicated a significant relationship of predisposing and enabling factors with utilizations of maternal and child’s preventive care use. This study demonstrated that acculturation was a vivid factor to influence the utilizations of maternal and child’s preventive care use. Clinical interventions based on these results should be developed and further to examine its effects in order to improve health behavior of immigrant women who might be in different acculturation and need more health support. |
