運用PRECEDE模式分析老人生活滿意度之多重因素結構

論文名稱(中/英文)	研究生	指導教授
運用PRECEDE模式分析老人生活滿意度之多重因素結構 Applied PRECEDE model to to analyze the multifactor structure of the elderly people’s life satisfaction Study on PRECEDE model of the elderly people’s life satisfaction	賴玫娟	林寬佳博士
[ 摘要 ]
隨著人口老化現象益趨顯著，高齡化的現象儼然已成為我國公共衛生之重要議題。本研究以PRECEDE模式為基礎，分析老人生活滿意度之多重因素結構，探討老人教育的面向及內容，進一步針對老人生活滿意度為例，研究多重因素結構之四年變化。本研究為使用行政院衛生署國民健康局人口與健康調查中心所提供之「台灣地區中老人保健與生活問題調查1989-1999」資料。第一、結構方程式之分析結果：PRECEDE模式之教育與組織診斷層次中，傾向因素部分達到統計上顯著意義之變項為心境與態度因素；促成因素部分，達到統計上顯著意義之變項有全民健康保險滿意度、對醫療保健服務的利用情形、義工會性服務等因素；增強因素部分，達到統計上顯著意義之變項涵括親屬共同居住人數或互訪、鄰居或朋友互訪、情緒支持和參與社團活動和經濟狀況等。第二、傳統路徑分析之分析結果：PRECEDE模式之行為與環境層次，「休閒活動」是影響老人生活滿意度之最具顯著意義的一個變項，而「休閒活動」也較「健康相關行為」對流行病診斷層次之「自評健康」具影響力，「自評健康」進而對社會學診斷層次之「生活滿意度」產生影響。本研究為一固定世代追蹤研究，進一步結合上述之兩階段分析成果，歸納出，1996年，「全民健康保險滿意度」為「促成因素」層面主要的相關因素，「憂鬱傾向」為「增強因素」層面主要的相關因素，「休閒活動」是行為與環境診斷層次，最主要的相關因素。1999年，「義工服務」為「促成因素」層面主要的相關因素，「憂鬱傾向」為「增強因素」層面最主要的相關因素，「休閒活動」仍是行為與環境診斷層次，最主要的相關因素。整體而言，根據整體分析成果及PRECEDE模式之延宕效應理論，「自評健康」的感受影響生活滿意度，而老人「休閒活動」的參與成效是影響「自評健康」最重要的直接與間接因素，而教育與組織的診斷層次之「憂鬱傾向」則為「增強因素」層面之最重要的結構因素。
[ Abstract ]
With the rise of population aging, the phenomenon of aging has become one of the important issues in the public health of Taiwan. Based upon PRECEDE model, this study is designed to analyze the multifactor structure of the elderly people’s life satisfaction and to study the aspects and contents of their education. The life satisfaction of the elderly people was taken as an example to study the four-year-long change of the multi-factor structure. The database analyzed in the current study was the “Survey of the health and lives of the mid-aged and elderly people in Taiwan area, 1989-1999,” provided by the Investigation Center of Bureau of Health Promotion, Department of Health, Taiwan. The study results of the structure equation model are shown as follows: according to the educational and organizational diagnosis level of PRECEDE model, the factors of mood and attitude were the ones which, in the predisposing factors, showed significant meanings in statistics. And in terms of reinforcing factors, significantly, in statistics, meaningful were the satisfactory degree of natural health insurance, the current usage state of medical heath service, and volunteering service. In addition, in terms of enabling factors, significantly, in statistics, meaningful were the number of relatives dwelling together, mutual visits of neighbors and friends, depressive tendency, group activities participation, and economic status. The study results of path analysis are shown as follows: in terms of behaviors and environment of the PRECEDE model, recreation activity was the one which most influenced the life satisfaction of the elderly people. And recreation activity tended to be more influential than healthy behaviors to “health self-evaluation domain in the diagnosis level of the epidemiology. In addition, health self-evaluation did make an influence on the life satisfaction of sociology diagnosis. This study is a fixed cohort study. As stated above, the results are shown as follows: in 1996, the satisfaction toward national health insurance was the major relevant factor among reinforcing ones; depressive tendency was the major relevant factor in enabling ones; recreation activity, the major relevant factor in the diagnosis level of behaviors and environment. And in 1999, volunteering service was the major relevant factor among reinforcing ones; depressive tendency was still the major relevant factor among enabling ones; recreation activity, the major relevant factor on the diagnosis level of behaviors and environment. In conclusion, according to the whole spectrum of PRECEDE model, the health self evaluation affected the life satisfaction, while the elderly people’s participation of recreation activities turned out to be the most important in directly or indirectly influencing the health self evaluation. Moreover, the depressive tendency on the diagnosis level of education and organization was the most important structure factor among the enabling ones.