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社區代謝症候群高危險群之中老年人使用健康服務行為與其健康促進生活型態之相關性探討－以台北市北投區為例TheRelationshipbetweentheUseCommunityHealthServicesandHealthPromotingLifestyleforHighRiskPopulationwithMetabolicSyndrome:AnExampleofBeitouDistrictofTaipei.藍靜渝Ching-YuLan臨床暨社區護理研究所關鍵詞:代謝症候群高危險群;使用健康服務行為;健康促進生活型態;Keyword:HighRiskPopulationwithMetabolicSyndrome;theUseCommunityHealthServices;HealthPromotingLifestyle;摘要:本研究目的欲瞭解代謝症候群高危險群中老年人之使用健康服務行為，並探討基本特性及使用健康服務行為對其健康促進生活型態的影響。本研究為相關性研究，選取台北市北投區94年度社區整合式篩檢，四十歲以上其含代謝症候群危險因子中凡一項及以上異常之社區民眾共246位。研究對象以女性有配偶為主，平均年齡58.12歲，國小及以下居多(27.6%)。腰圍異常居冠(72.8%)。40～49歲及50～59歲民眾以一項危險因子異常為主；分別為50.0%及51.6%，70歲以上民眾以三項以上異常為主(55.3%)。健康服務使用率67.1%。整體健康服務使用排序，以醫院最高(46.8%)，其次為保健站(19.1%)、診所(13.0%)。有使用健康服務者，平均年齡較大，為60.85歲，以無職業(65.5%)及國小及不識字者為主(32.7%)，多數有個人病史(72.7%)、長期服藥(55.8%)及三項以上代謝危險因子(36.4%)為主。未使用健康服務者佔32.9%，平均年齡較低，為52.56歲，以高中職（26.0%）及有職業者(59.3%)為主，多數沒有個人慢性病史(65.4%)及長期服藥情形(87.7%)，以一項代謝危險因子(61.7%)為主。未使用健康服務主要原因為工作忙碌(43.2%)及自覺健康好，不需要定期檢測(43.2%)。健康促進生活型態得分指標71.1分，屬中上程度，以自我實現最佳(72.28)，健康責任(69.37)及運動休閒(63.10)最差。教育程度低及長期服藥者，健康促進生活型態明顯較差(p＜0.01)，不同年齡層在自我實現、人際支持及運動休閒有顯著差異。使用社區保健站服務者，健康促進生活型態得分最高，但未達統計意義。長期服藥及教育程度可解釋健康促進生活型態變異量為7.5%。綜合研究結果，提出以下建議，都會型社區保健站應增加服務時段。代謝症候群的防治應推廣定期篩檢及職場衛生健康管理。鼓勵高危險群民眾善用保健站服務並強化健康飲食行為，推動上班族動生活化，運用合適衛生教育策略於國小及不識老年人，建立長期服藥民眾健康觀念，學習與慢性病共處與自我照顧。Abstract:Thisstudyaimstounderstandthebehaviorsofusinghealthserviceforthemiddle-andoldageelderlywhoareathighriskofmetabolicsyndromeandtoexplorerelationshipsofdemographischaracteristicsandtheuseofhealthserviceandhealth-promotinglifestyle.Thedesignofthisstudyiscorrelationalresearch.AstructuredquestionnairewasusedtosurveyhighriskpopulationwithmetabolicsyndromefromBeitouDistrictofTaipei.Totally246questionnairesweredistributed.Subjectsaremostlymarriedfemaleswithanaverageageof58.12.Subjectsindicatetheireducationalbackgroundsaselementaryschoolorbelowareinthemajority(27.6%).Theresultshowsthatabnormalwaistcircumferencerankstopamongfiveriskfactorsofmetabolismsyndrome(72.8%);subjectsintheagegroupof40-49and50-59generallyexhibitoneriskfactorat50.0%and51.6%respectively.Subjectsagedover70mostlyexhibitatthreeriskfactors(55.3%).Theutilizationrateofhealthserviceis67.1%andthepriorityofthetypeofoverallhealthservice:hospitalsranktop(46.8%),followedbyhealthcenters(19.1%)andclinics(13.0%).Theusersofhealthservicetendtobemoreseniorwithanaverageageof60.85andmostareunemployed(65.5%),withaneducationalbackgroundofelementaryorilliterate(32.7%).Alargenumberoftheusershaveapersonalmedicalhistory(72.7%),onlong-termmedication(55.8%)andwithoverthreemetabolicriskfactors(36.4%).Thosedonotusehealthserviceaccountfor32.9%withaloweraverageageat52.56,aneducationalbackgroundofhighschool/vocationalhighschool(26.0%)andemployed(59.3%).Amajorityofthemdonothaveapersonalhistoryofchronicdiseases(65.4%)noronlong-termmedication(87.7%);generallypossessonemetabolicriskfactor(61.7%).Thereasonsfornotusinghealthservicearemainly:preoccupiedbywork(43.2%);healthyself-imagewithoutconsideringtheneedforregularcheckups(43.2%).Thescoreforhealth-promotinglifestyleprofileis71.1withanaboveaverageperformance.Amongthem,self-actualizationisthebest(72.28)whilehealthresponsibility(69.37)andrecreation/leisurearetheworst(63.10).Subjectswithloweducationalbackgroundandonlong-termmedicationshowsignificantlylowhealth-promotinglifestyleprofile(p＜0.01)andtherearesignificantdifferencesamongdifferentagegroupwithself-actualization,socialsupportandrecreation/leisure.Usersofcommunityhealthcentersrankhighestinhealth-promotinglifestyleprofilebutfailtoreachstatisticalsignificance.Long-termmedicationandeducationalbackgroundmayexplainthevarianceofhealth-promotinglifestyleprofileat7.5%.Basedontheresultsofthisstudy,thefollowingsuggestionsareproposed:Increasetheopeninghoursofcommunityhealthcentersinmetropolitanareas;regularscreeningandestablishoccupationalhealthmanagementtopreventmetabolicsyndrome;encouragetheuseofhealthcentersforhighriskgroupsandreinforcehealthydiets;promoteexerciseamongofficeworkers;provideappropriatehealtheducationstrategiesforilliterateelderlyorthosewithelementaryschooleducation;buildupthecorrectandhealthyattitudeforthoselong-termmedicationusers;andeducatehowtolivewithchronicdiseaseaswellasperformingself-carebehaveiors.