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題名：社會資本與身心健康關係之研究─以南台灣原住民為例
作者：張肇松
作者(外文)：Chao-Sung Chang
校院名稱：國立中山大學
系所名稱：人力資源管理研究所
指導教授：黃英忠
學位類別：博士
出版日期：2006
主題關鍵詞：生活品質；心理健康；原住民；身體健康；社會資本；社區；quality of life；physical health；mental health；community；Social capital；indigenous people
原始連結：連回原系統網址new window
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有關健康議題的研究，過去多著重於以醫學或基因學角度來探討疾病的致病機轉與其因果關係，近二十年來，隨著對健康觀念的演進，從疾病的治療到健康促進，從個人健康到族群健康，研究學者開始注意到一些社會因素如收入、貧窮、社會網絡對健康的影響，相對於過去使用罹病率、死亡率和失能率當做研究的健康指標，而近來族群健康之研究取代使用一些非醫學的指標如社會和心理健康、生活品質、生活滿意度、收入情況、教育程度、僱用等等做為研究指標。
近十幾年來社會資本與健康的關係已引起許多研究學者之注意，雖然對社會資本的概念尚未定義清楚，社會資本理論已被許多研究學者應用探討其與健康的關係。許多的研究報告顯示，高的社會資本與較低的死亡率或疾病相關死亡率。但是大多數的研究係使用次級資料來分析，雖然有許多的研究進行，但是對於社會資本的定義學者仍有許多分歧，也缺乏標準的測量工具來衡量社會資本，台灣仍鮮有社會資本與健康關係之實證的研究報告，因此，本研究最主要的目的有二，在第一階段研究，建立一適用於台灣地區的原住民社區社會資本測量工具，第二階段透過所建立的社會資本測量工具探討原住民社會資本對於其身心健康之關係和影響。
本研究基於Onyx & Bullen (2000) 的社區社會資本測量建立了臺灣本土的社會資本測量工具，以原住民為研究對象確立了五構面之臺灣地區原住民社區社會資本量表，量表各構面皆有良好的內在信度與建構效度，以Amos ver 5 分析軟體進行社會資本問卷的驗證性因素分析，結果發現此五構面的社會資本測量工具，應用於原住民族群具有良好的適配性。
本研究第二階段使用所建立的台灣地區社會資本量表探討其與個人身心健康之關係，研究結果顯示在個人層次上，社會資本與自覺非特異性焦慮程度或自覺憂鬱程度皆呈現顯著的負向相關，而與自覺生活品質和健康滿意則呈現正向相關；原住民個人具有較高的社區社會資本者，無論在是自覺健康或生活與健康滿意情形皆有較佳的身心健康狀態，而社會資本較低者則呈現較差的健康狀態。而在社會資本與健康有關行為分析中，本研究發現原住民社經地位尤其是工作和個人收入與其嚼檳榔、吸菸和喝酒習慣有影響，個人收入與其嚼檳榔習慣呈負向影響，而工作則對吸煙和喝酒有正向影響，亦即個人收入愈低愈有嚼食檳榔的習慣。而原住民非特異性壓力對於三種健康不良行為，只有在喝酒習慣上有顯著正向影響，當心理壓力愈高時，也愈有喝酒的行為。原住民社會資本因素對於三種健康不良行為無顯著直接影響，只有在鄰居連結社會資本與喝酒習慣有顯著負向影響。
原住民在身體疾病方面，年齡與教育程度是有否身體疾病的重要影響因素因素，年齡愈大，身體疾病也愈多，教育程度愈高者，身體疾病發生率則愈低。在社會資本對於身體健康的影響上，本研究結果發現原住民個人多元文化容忍性社會資本因素對其身體疾病的發生率有顯著負向影響，亦即多元文化容忍社會資本愈高者，其身體疾病率也愈低。而在心理疾病方面，原住民個人喝酒行為對心理健康有正向影響，個人有喝酒習慣者，其心理健康也較差。而個人社會資本在控制年齡與社經地位變項時，結果得到原住民個人社會資本各因素對於心理疾病則無顯著影響。
在社會資本在壓力身心健康模式的機制，本研究結果發現個人社區社會資本在壓力與身心健康模式中所扮演的機制可以是中介的角色，亦即社會資本為個人非特異興壓力的重要前因變項，個人整體性社會資本愈高，其所自覺的壓力則愈低，壓力愈低則其身心健康的情形也愈好，生活品質也愈好。然而當探討社會資本的不同構面是否對於壓力身心健康模式中也有扮演干擾的作用時，本研究結果發現社會資本的不同的構面在身心健康上也有不同程度的干擾作用；此意味著社會資本在壓力與身心疾病模式中所扮演的調節作用，誠如Halpern (1999) 認為社會資本能作為社會壓力的緩衝來吸收和減少社會壓力，也因著社會資本的存在而產生康樂感與歸屬感。綜合本研究結果，在原住民族群中，個人高社區社會資本者有較佳的身心健康狀態，社會資本在壓力疾病模式中具有部份中介和干擾調節的作用。
The association of social capital and health has gained much research attention and interest during the past decade. Many a study has demonstrated that a higher social capital is associated with a better population health state including lower total or disease related mortality or more benign health related behaviors. However, most studies reported were using secondary data analyses of survey data. Though there are many ongoing studies and application of social capital survey worldwide, it still lack of consensus to define social capital and its standard instrument to measure it. There is also lack of empirical studies to investigate the causal relationship and mechanism how social capital could affect the individual or population health. Few empirical studies concerning social capital have been done in Taiwan. Hence, this study has two major aims, first in phase I study, to develop and test psychometric properties of a social capital instrument for measuring social capital among adults Taiwan’s indigenous people. The specific aims are to identify the content dimensions for the indicators of social capital and evaluate the internal consistency and construct validity of this instrument. Second, in phase II, this study investigated the relationship between community social capital and physical-mental health at individual level using the social capital instrument. We also study whether social capital plays a role of moderating or mediating effect on the relationship between individual non-specific psychological distress and health.
In phase I, this study based on Bullen and Onyx’s measurement of social capital in community and developed a five-factor’s social capital scale in Taiwan area using indigenous people in Southern Taiwan as studying population. Psychometric testing demonstrated satisfactory internal consistency, validity and Goodness of fitness index for this instrument for indigenous people of Southern Taiwan using first-order and second-order confirmatory factor analysis.
In phase II, a total of 898 indigenous people of Rukai and Paiwan lived in four townships, mountainous area, Pingtung county of Southern Taiwan, aged 30 to 93, were surveyed during December 2004 to December 2005. Our results show individual community social capital was inversely correlated with perceived distress level and positively correlated with quality of life. In hierarchical regression analysis, individual social capital has a moderating effect on the relationship between individual perceived distress and individual quality of life in Taiwan’s indigenous people. In structural equation model analysis using Amos statistical software also demonstrated that individual social capital has a partial mediating effect on the relationship between individual perceived distress and individual quality of life in Taiwan’s indigenous people.
In conclusions, this study demonstrated that individual with higher community social capital was associated with better physical and mental health in indigenous people of Rukai and Paiwan lived in Pingtung county of Southern Taiwan. Individual social capital has a moderating effect and partial mediating effect on the stress-health model.
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