*中心館藏網址:http://tulips.ntu.edu.tw/record=b2180430*cht

[ 摘要 ]
背景：依過去研究顯示，平地鄉原住民在醫療照護上長期受到漠視。故本研究的目的在探討在同一族群中，被歸為平地鄉原住民與山地鄉原住民在醫療行為與醫療資源利用的差異。方法：本研究的研究對象為台東縣南部太麻里（平地鄉）、大武（平地鄉）、金峰（山地鄉）及達仁（山地鄉）四個鄉之排灣族人。資料收集方式是針對年滿二十歲且在此四個鄉連續居住六個月以上之居民進行結構性問卷訪談，問卷內容含健康認知、醫療行為及醫療資源利用滿意度。研究資料收集後，以SAS 8.2版軟體進行敘述性分析，資料檢視分析、卡方檢定及複迴歸分析。結果：問卷共完成612件問卷，合格問卷計480件。結果顯示山地鄉與平地鄉兩者在年齡、 性別、教育程度及婚姻狀態並無差異，但在醫療照護之可近性卻有顯著之差異〈p=0.03〉。而鄉外就醫及台東縣外就醫的行為上，山地鄉排灣族人也高於平地鄉排灣族人（p=0.04）。此外，對於衛生所的滿意程度上，平地鄉排灣族高於山地鄉排灣族（P<0.0001）；而影響排灣族人縣外就醫的若干因素如罹患慢性病（OR:2.1;95%CI: 1.0-4.0）、罹患急性病（OR:2.5;95%CI: 1.4-4.5）、對於自己健康滿意度較差（95%CI: 1.0-9.6）、加入健保（95%CI: 1.0-9.6）。而罹患慢性病（OR:2.1;95%CI: 1.0-4.0）、罹患急性病（OR:2.5;95%CI: 1.4-4.5）、對於自己健康滿意度較差（95%CI: 1.0-9.6）、加入健保（2.6;95%CI: 1.0-6.3）及對於衛生所醫護人員專業人能力較不滿意者（OR:15.4;95%CI: 1.0-227.5）有較高比例的鄉外就醫。總之,影響山地鄉與平地鄉排灣族原住民鄉外就醫的因素差異是該鄉衛生所的醫療設備及醫護人員專業能力。結論：山地鄉與平地鄉排灣族原住民在醫療資源利用與醫療行為有差異。
關鍵字：排灣族、原住民、醫療資源利用、醫療行為

[ 英文摘要 ]
Abstract
Background: Aboriginal health topics were often ignored in the review of past study. To investigate the difference of medical resource utilization, accessibility between mountain-area and plain-area aborigine and the influenced factors of their behavior in getting medical resource, the four countries were chose for further study. Method: The research subjects are Paiwan tribe people in southern Taitung of Taiwan where lived in four countries such as Taimali (plain-area country), Tawu (plain-area country), Jinfong (mountain-area country), Tajen (mountain-area country). They must have lived in these areas over 6 months and their ages are over 20 years old at least. The structure questionnaire was performed for further investigate about attitude, medical behavior and satisfaction of medical utilization. The SAS 8.2 Version is used in descriptive analysis, explore data analysis, Chi-square test and logistic regression. Result: There were 612 questionnaires completed and 480 were eligible. There are no differences of demographic data such as age, sex, educational level and marriage status between mountain and plain area Paiwan tribe people but there are significant difference in medical care out-reach accessibility (p=0.03). In addition, mountain area Paiwan tribe people often go to non-Taitung county hospital for treatment (p=0.04) and Plain area Paiwan tribe people had more satisfaction about local medical resources (p<0.0001). Besides, there are several factors influencing Paiwan tribe people to use out-county medical resources such as chronic disease, acute disease, dissatisfaction of self-health, insurance-cover. The factors influencing them to use out-country medical resources are such as chronic disease, acute disease, dissatisfaction self-health, insurance-cover, and dissatisfaction to regional health center. However, the difference between the factors influencing out-country medical utilization in mountain-area and Plain-area Paiwan tribe is due to dissatisfaction to instrument and professional ability in regional health center. Conclusion: There were differences in using medical resources and medical behavior between mountain and plain- area of Paiwan people.
Key words: Paiwan tribe, aborigine, medical resource utilization, medical behavior