丁志音2006-07-252018-06-292006-07-252018-06-291998-07-31http://ntur.lib.ntu.edu.tw//handle/246246/4560以社會網路之理論架構為基礎，許多 相關的概念已被提出來討論一般民眾對求 醫過程的影響，其中尤以「非專業諮詢與 轉介」最受矚目。本研究探討求醫過程中 個人周遭社會網路與諮詢轉介人士間的關 係與互動型態。根據對兩家醫療院所60 名 門診病患及3 名住院病患的訪談，本研究之主要發現如下：1.在當代社會中，即使訊息的提供已愈趨 科技化及制度化，且醫療服務逐漸邁向商 業化且重視行銷，非專業人士間的諮詢及 轉介仍至為普遍。幾乎所有的個人(或家戶) 皆有在其周遭網路中找出固定諮詢對象的 傾向。當嚴重性愈大且不確定性愈強時， 自動尋求訊息的可能性亦愈大。 2.傳統社會中親屬或初級網路所扮演之角 色已逐漸為職場或其他次級網路取代。 3.以下三類網路中的成員常成為被諮詢的 對象：(1)本身為某一醫療照謢體系中的專 業人員，(2)本身雖非專業人員，但與專業 機構關係密切或其周遭網路中有許多專業 人員，(3)本身的某些疾病遭遇足以提供「經驗談」者。4.除了向固定人士的常規性諮詢之外，還 有於特殊情境中的暫時性諮詢。包括在特 定治療場所向服務人員打聽至付費求諸神媒、超自然力量以獲取某種「指示」等。 5.非專業諮詢及轉介可發揮以下功能: (1)整合周遭社會資源，因應不確定情 境，以解決問題。 (2)使病家知曉周遭醫療照護體系中所有 的解決問題方案，尤其當個人所處網路中 成員異質性較高時更是如此。也因此，某 些個人會在這層層諮詢的過程中開始採 用以往所從未嘗試的另類療法。 (3)有時諮詢者及被諮詢者間的特殊關係 可增進醫病間關係的密切性，而被病家認 為可提升醫療品質。因此，特殊情況下的 非專業轉介事實上也提供多一層保障的 功能(實質上或只是心理上的)。 綜合而言，除了少數由專業人員在執業場 所對病人所做的正式諮詢及轉介之外，其 他由專業人員或一般民眾在非專業機構中 經由尋常社會網路所做的非正式訊息提供 及建議，才是一般民眾求醫訊息之主要來 源。未來，這個極度被忽略的研究領域， 應結合各學科領域，做更實證性的探討。Under the paradigm of social network, a set of concepts have been developed to investigate the way lay persons affect the process of health seeking, among which “lay consultation and referral” is perhaps the most widely discussed. The present study attempts to explore preliminarily the patterns of relations and interactions between individuals’ social networks and persons who provided consultation and/or referral suggestions. Qualitative data for this study came from in-depth interviewings with 60 OPD patients or their families and 3 hospitalized patients in one medical center and a clinic. The major findings are: 1. In modern societies, lay consultation and referral is still prevailing even while the access to information has increasingly institutionalized and relying on technology, and the provision of health services tends to commercialize and apply marketing strategies. It is considered particularly important for individuals to locate a person or persons who can provide advice or guidance while necessary. In general, the greater the uncertainty and the severer the problem are more likely to lead to lay consultation and referral. 2. The role of kinship or primary social network has gradually depleted and networks of the work places and other secondary social networks are becoming of greater importance for help seeking. 3. In general, individuals with the following characteristics tend to be consulted: (1) who are health professionals or who have training in medicine/health-related fields, (2) who are non health professionals but belong to networks in which health professionals are quite commonly seen, (3) who have much experience in seeking help for certain kind of health problems. 4. In addition to the consultations between acquaintants, conferring with strangers can also be made occasionally in certain situations, from asking questions from personnels and other patients in major hospitals to consulting shamans who can communicate with supernatural forces to provide guidance to their clients. 5. Lay consultation and referral has the following functions: (1) To integrate available social resources to cope with uncertainty and solve the problems. (2) To help the clients become aware of as best as possible all solutions which are available our health care system. This is particularly true while the members of one’s social networks are relatively heterogeneous and have diversified experiences in dealing with health problems. As a result, the clients may be motivated to trying “alternative” solutions which had never been used before. (3) The special relations between the one who consult (the client) and who is consulted may be helpful when the patient interacts with recommended healer. The patient and families may consider that a better treatment can be acquired due to relationship between the consulted and the healer. Indeed, in some cases quality of care was deemed assured due to the special triadic relationships between the client, the consulted, and the healer. While only a very limited amount of referrals are made by health professionals within health care organizations, the majority occurred in daily life settings made by non-professionals through social networks. Interdisciplinary, empirical investigations should be encouraged in the future to improve the state-of-the-art of this area which is currently under researched.application/pdf35329 bytesapplication/pdfzh-TW國立臺灣大學公共衛生學院公共衛生學系求醫行為社會網路非專業諮詢與轉介health seeking behaviorsocial networklay consultation and referralreporthttp://ntur.lib.ntu.edu.tw/bitstream/246246/4560/1/872412H002004.pdf