38卷4期

• Link 政策論壇 Policy Forum
• 我們從台灣上一波自殺死亡率高峰學到甚麼？What have we learned from the last surge of suicide mortality in Taiwan?
• 廖士程
  Shih-Cheng Liao
• 無
  none
• 無
  none
• 329-334
• 10.6288/TJPH.201908_38(4).PF04

• Link 公衛論壇 Public Health Forum
• 我國電子煙管理及其閘門效應防制政策之省思Rethinking the management policy for prevention and control of the gateway effect of the electronic cigarette in Taiwan
• 陳再晉、鐘珮純、陳冠文、林廷育
  Tzay-Jinn Chen, Pei-Chun Chung, Kuan-Wen Chen, Ting-Yu Lin
• 無
  none
• 無
  none
• 335-337
• 10.6288/TJPH.201908_38(4).108015

• Link 公衛論壇 Public Health Forum
• 政策、能源與健康：從哥斯大黎加的健康環境權談起Policy, energy and health: the right to a healthy and ecologically balanced environment in Costa Rica
• 張弘潔、Edgar Zavala-Pelayo
  Hung-Chieh Chang, Edgar Zavala-Pelayo
• 無
  none
• 無
  none
• 338-341
• 10.6288/TJPH.201908_38(4).107126

• Link 綜論 Review Article
• 健康資訊功能整合的國際趨勢Progress toward functional integration in health informatics: an international perspective
• 楊瓊瓔、陳慈純、徐尚為、李卓倫
  Chiung-Ying Yang, Tzu-Chun Chen, Shang-Wei Hsu, Jwo-Leun Lee
• 資訊通訊技術、健康服務、功能整合、整合照顧
  information and communication technology, health service, functional integration, integrated care
• 在老年社會慢性疾病整合照顧的概念中，與資訊通訊技術相關的「功能整合」至為重要，跨國分析比較顯示整體功能性整合成功的案例並不多見，但透過資訊通訊科技系統整合成功的個別案例正逐漸累積。本文之目的在蒐集分析各國為了促進健康照顧與長期照顧疾病管理所開發之資訊通訊科技產品，以及這些產品與服務的運作情形。全文依據資訊通訊技術的種類大致區分為「遠距醫療與穿戴裝置」、「應用程式與數位治療」、「智慧手機與人工智慧」三大類別，透過期刊、其他定期與非定期出版之文獻、各國政府出版品、和各新科技開發之官方網頁，搜集資料後，將各國比較明顯的成功案例、廠商、技術產品、功能列表簡介，希望讀者可以藉由本文連結資訊通訊技術的最新進展。本文的最後以資訊及通訊科技介入健康服務在視訊、簡訊、健康監測三方面的貢獻，並以其中發展最迅速的居家照護進展，以及它對於台灣長照2.0政策的階段性含義作為結論與建議。
  Studies on functional integration in information and communication technology (ICT) for integrated care of older adults with chronic diseases are needed but rarely conducted. Therefore, this study gathered and analyzed information on the operational situation and expiration of ICT developed in various countries for disease management in health care and long-term care. This paper has three sections, each focusing on one ICT—telemedicine and wearable devices, applications and digital therapy, and smartphones and artificial intelligence. By reviewing journal articles, periodicals, government and international organization reports, and ICT product websites, this paper compares (using tables) success cases, ICT firms, and products and their functional introduction to update readers on the latest progress in ICT applications. This paper concludes by summarizing the contribution of ICT in the use of video, publication of newsletters, and health monitoring, focusing especially on the development of ICT in domiciliary care and its policy implications for long-term care in Taiwan.
• 342-354
• 10.6288/TJPH.201908_38(4).108034

• Link 綜論 Review Article
• 從國際經驗省思全民健保地區預算之分配方法Geographical allocation of the healthcare budget in the National Health Insurance program: what can we learn from other countries?
• 陳珮青、楊銘欽、陳宛琪、郭年真
  Pei-Ching Chen, Ming-Chin Yang, Wan-Chi Chen, Raymond N. Kuo
• 總額支付制度、地區預算、醫療資源分配、風險校正、健康不平等
  global budget, resource allocation, risk adjustment, health inequity
• 全民健保自1998年陸續實施牙醫門診、中醫、西醫基層、醫院等部門之總額支付制度，在此制度下將預算分配到健保署各業務分組，以促進各地區醫療資源之有效自主管理。然而目前總額部門之地區預算分配方式互異，雖遭致許多批評但應如何修訂迄今仍難凝聚各方共識。部分醫界代表及專家學者認為，除了現行地區預算分配方式中納入的分配參數，也應將各地區醫療需求程度差異、人口風險因子、醫療服務提供者之執業成本、醫療服務供給等因素納入考量。因此本研究經由文獻探討，瞭解實施總額支付制度或醫療先進之國家，其地區醫療預算分配方式、參考因素、發展趨勢與經驗，以提出臺灣全民健保總額支付制度下地區預算分配方式之改善方向及具體建議，提供主管機關作為未來政策修訂之參考。 本研究經由文獻探討發現，英國、澳洲、紐西蘭等國有進行地區醫療預算之分配，且均採用「以人口為基礎」（population-based）、或稱為「以需求為基礎」（need-based）之預算分配方法。分配預算的參考因素或校正因子除了基本的年齡、性別組成，多數國家也納入民眾罹病狀態、社經特性以反映不同地區民眾對醫療需求的差異；有些國家亦將供給面的成本差異或未被滿足的醫療需求等因素納入分配預算的條件。各國預算分配機制除了反映醫療需求的差異，也期望透過地區預算的分配降低地區間的醫療資源分配不公平。本研究建議於未來的地區預算分配機制中，納入罹病狀態與社經特性等參考因子，並建議發展本土化、共通性的社經特性測量工具，並進行調查研究以瞭解現況下民眾有多少未被滿足的醫療需求。
  In 1998, the National Health Insurance program of Taiwan implemented a global budget payment system for dental outpatient services, followed by traditional Chinese medicine, primary care, and hospitals. Under this scheme, the annual healthcare budget is distributed among six regional service areas for enhancing self-management within each area. However, the formulas used in the allocation of the annual budgets differ across sectors. This situation has drawn criticism from healthcare providers, and stakeholders have yet to reach a consensus regarding the types of revisions that should be implemented. For the formulation of healthcare budgets, many medical professionals and researchers are demanding the inclusion of factors such as the variations in healthcare needs, personal risk factors, costs involved in the healthcare service provision, and distribution of healthcare providers in the region. In this study, we review the methods employed in other countries for the distribution of budgets as well as the factors included in their formulas, trends in the development of the budget allocation systems, and their experiences following implementation. Our literature review revealed that the United Kingdom, Australia, and New Zealand allocate healthcare funds according to population-based (also referred to as “needs-based”) distribution formulas. These formulas include factors pertaining to age and gender, morbidity, and socioeconomic status. Some of these formulas also account for differences in the supply-side costs and “unmet needs” in the healthcare provision. The methods in question are ostensibly highly effective in accounting for regional healthcare variations and also aim to reduce inequity in healthcare resource distribution. We suggest that morbidity and socioeconomic status should be included in the resource allocation formula in the future. According to the literature review findings, the government should develop localized measures of socioeconomic status that can be applied across Taiwan. The government should also investigate the status quo in relation to “unmet needs” in Taiwan.
• 355-371
• 10.6288/TJPH.201908_38(4).107094

• Link 原著 Original Article
• 台灣與西太平洋五國非傳染性疾病防治現況Non-communicable diseases prevention and control: the current status in Taiwan and 5 Western Pacific Countries
• 林宛禛、曾育慧、林宜靜、林峻吉
  Wan-Chen Lin, Yu-Hwei Tseng, Yi-Jing Lin, Chun-Ji Lin
• 非傳染性疾病、過早死亡、健康促進政策
  non-communicable diseases, premature death, health promotion policy
• 目標：非傳染性疾病（non-communicable diseases, NCD）為導致全球死亡及失能最主要原因之一，約68%的死亡與罹患NCD有關，因此降低NCD的負擔，已成為各國永續發展的首要任務。本文旨在探討我國與5個西太平洋國家NCD監測指標趨勢，探究其國家社經環境背景或健康促進政策發展情形，據以呼籲我國應積極參與全球行動，及提出未來國家政策制定的參考建議。方法：運用聯合國全球永續發展指標資料庫及世界衛生組織全球衛生觀察站資料取得各國從2000年至2015年每5年NCD監測指標資料，如NCD過早死亡機率、酒精消費量、目前吸菸率、過重與肥胖率等，我國則以國家監測或運用國家調查資料計算取得。結果：隨著NCD過早死亡機率降低趨勢，各國平均餘命亦隨之增長，並以日本及韓國的NCD過早死亡機率相對較低。在危害行為表現上，韓國酒精消費量相對較高，中國及越南的消費趨勢有上升；各國目前吸菸率均呈現降低趨勢，其中男性目前吸菸率以台灣相對較低。各國過重與肥胖率仍呈現上升趨勢，其中馬來西亞及台灣男性相對較高，且兩國之身體活動不足率亦相對較高。結論：我國NCD防治仍有待改善，未來應持續重視國家整體NCD防治政策，及建置監測指標蒐集平台，以 評估政策進展並與國際接軌。
  Objectives: Non-communicable diseases (NCD) are one of the leading causes for global deaths and disabilities, accounting for approximately 68% of deaths. International communities have made it a top priority to reduce the burden of NCD as part of the effort to achieve sustainable development. The study intends to provide policy implications for Taiwan by investigating the trends of premature NCD mortality and risk factors in Taiwan and five other countries in the Western Pacific Region. Methods: The paper retrieved 2000-2015 data for five countries from the UN Global SDG Indicators Database and WHO Global Health Observatory Data Repository, including premature NCD deaths, alcohol consumption per capita, prevalence of current tobacco use, and prevalence of overweight and obesity. Data for Taiwan were obtained from databases of national surveillance and surveys. Results: Increase in life expectancy was accompanied by a decreasing trend of premature NCD mortality in each country. In Japan and South Korea, premature NCD mortality was relatively low, compared to other countries. In terms of behavioral risk factors, South Korea’s alcohol consumption per capita was higher, while China and Vietnam experienced a rising trend. Prevalence of current tobacco use in all countries was decreasing, with the lowest male smoking rate in Taiwan. However, trend of overweight and obesity was on the rise in all countries. Malaysians and Taiwanese males had higher prevalence than other populations. Similarly, physical inactivity rate was higher in these two countries. Conclusions: NCD prevention and control in Taiwan need to be strengthened. We suggest that a comprehensive NCD prevention framework be implemented, including development of a surveillance system conducive to monitoring, evaluation and international comparison.
• 372-385
• 10.6288/TJPH.201908_38(4).108018

• Link 評論 Commentary
• 評論：台灣與西太平洋五國非傳染性疾病防治現況Commentary: non-communicable diseases prevention and control: the current status in Taiwan and 5 Western Pacific Countries
• 江東亮
  Tung-liang Chiang
• 無
  none
• 無
  none
• 386
• 10.6288/TJPH.201908_38(4).10801801

• Link 原著 Original Article
• 姙娠糖尿病篩檢策略之成本效果分析Cost-effectiveness analysis of screening strategies for gestational diabetes mellitus
• 周盈邑、董鈺琪
  Ying-Yi Chou, Yu-Chi Tung
• 娠糖尿病、全面篩檢、高風險族群篩檢、成本效果、遞增成本效果比
  gestational diabetes mellitus, universal screening, targeted screening, cost-effective, incremental cost-effectiveness ratio
• 目標：?娠糖尿病（gestational diabetes mellitus, GDM）與孕婦及新生兒發生第二型糖尿病與不良結果有關。篩檢是辨識孕婦是否罹患?娠糖尿病的重要方法，全面篩檢與高風險族群篩檢係重要的篩檢策略，但目前對於合適的篩檢策略尚缺乏共識。因此，本研究目的為從第三付費者觀點，探討?娠糖尿病篩檢策略之成本效果。方法：本研究以決策樹模型評估三種?娠糖尿病篩檢策略之成本以及健康生活品質校正生命年（quality-adjusted life years, QALYs）：全面篩檢、高風險族群篩檢、未篩檢。本研究使用全民健康保險研究資料庫資料與文獻回顧估計模型參數，及敏感度分析評估研究結果的穩健度。結果：相較於未篩檢，全面篩檢與高風險族群篩檢皆具備成本效果，與高風險族群篩檢及未篩檢相比，全面篩檢能減少?娠糖尿病併發症發生風險，全面篩檢相較高風險族群篩檢的遞增成本效果比，每增加一個健康生活品質校正生命年需增加928元成本，敏感度分析結果一致。結論：全面篩檢係有成本效果之?娠糖尿病篩檢策略，並能改善孕婦及新生兒照護結果。
  Objectives: Gestational diabetes mellitus (GDM) is associated with type 2 diabetes mellitus and adverse outcomes for both mothers and infants. Screening is a valuable method for identifying women at risk for GDM, and universal screening along with targeted screening is a key strategy for such identification. However, consensus is lacking regarding which GDM screening strategy is appropriate for pregnant women. Hence, the objective of this study was to compare the costeffectiveness of GDM screening strategies from the third payer perspective. Methods: A decision tree model was used to assess the costs and quality-adjusted life years (QALYs) for three GDM screening strategies: universal screening, targeted screening, and no screening. The Taiwan National Health Insurance Research Database and a literature review were used to estimate the model parameters. Sensitivity analysis was performed to evaluate the robustness of assessment. Results: Compared with the no screening strategy, universal screening and targeted screening were cost-effective. Universal screening was a cost-effective approach for decreasing the risks of GDM complications compared with targeted screening or no screening. Relative to targeted screening, universal screening generated an incremental cost-effectiveness ratio of $928/QALY gained. Sensitivity analysis provided similar results. Conclusions: Universal screening is a costeffective approach for improving maternal and neonatal outcomes.
• 387-399
• 10.6288/TJPH.201908_38(4).108012

• Link 原著 Original Article
• 建立全民健保職業工會財務異常管理機制之研究Establishment of a financial anomaly management mechanism of National Health Insurance for craft unions
• 蘇宜貞、莊美惠、許綉華、簡文娜、洪品妤、王琳斐
  Pin-Yu Hong, Ling-Pei Wang
• 全民健康保險、職業工會、財務實地訪查
  National Health Insurance, craft union, onsite financial inspection
• 目標：職業工會健保費採「集體預收、分期彙繳」模式，潛藏極大已收未繳風險，本研究旨在找出財務異常關鍵指標，提出工會財務異常管理機制之建議。方法：本研究結合質性與量化方法，與勞保局實地訪談，並就中彰投勞政主管機關及303家曾受健保實地訪查工會，進行問卷調查，再就2012-2016年間，工會健保財務訪查缺失實績值及欠費紀錄，進行健保資料探勘及統計檢定分析，最後以三角驗證法交叉檢驗。結果：勞保局透過罰則以「補助款撥付權」為「工會財務監控手段」，且85%工會財務查核項目與健保署相同。中彰投勞政主管機關在異常工會管理具勞健保跨域合作意願；有24.8%工會內控不足無財務管理辦法，87.6%工會基層支持外部財務稽查，並建議嚴查健保費是否被挪用。經綜整實地訪談、問卷調查、卡方檢定及羅吉斯迴歸分析，確立4項工會財務異常（欠費）關鍵指標，包括：「健保費未設立專戶儲存」、「專戶存儲之保險費移作他用」、「健保費專戶未2人以上共同開戶及管理」、「健保費存款餘額不足」。結論：健保署、勞保局及縣市政府工會財務查核之共同項目，可作為跨機關聯合監控基礎。本研究結合4項財務異常關鍵指標及現行27項健保工會訪視紀錄表查核項目，將訪查缺失影響程度分為：重大、中度、輕微3級，綜整研究結果及健保署中區業務組執行現況，建構全民健保職業工會財務異常分級管理模式，並提出具體執行建議。
  Objectives: Craft unions typically collect the national health insurance premiums from all members at one time and then pay the premiums in instalments. However, this method involves a high risk that the premiums have been collected but not paid. This study identified the key factors for financial anomalies and proposed suggestions for craft unions regarding financial anomaly management mechanisms. Methods: Combining qualitative and quantitative methods, this study conducted onsite interviews on the personnel of the Bureau of Labor Insurance and performed questionnaire survey on the personnel of government authorities on labor affairs as well as 303 craft unions that participated in the national insurance program in Taichung, Changhua, and Nantou, Taiwan. Moreover, data mining and statistical analysis were performed on the actual data missing in the financial inspection on craft unions’ health insurance premiums and the unions’ overdue payment records from 2012 to 2016. Finally, triangulation was conducted for data cross-validation. Results: The Bureau of Labor Insurance facilitated financial monitoring on craft unions by imposing the penalty of terminating grant disbursement. In addition, 85% of the financial audit items used by the unions were consistent with that adopted by the National Health Insurance Administration. Government authorities on labor affairs in Taichung, Changhua, and Nantou were willing to collaborate with health insurance authorities for the management of craft unions with financial anomalies. Moreover, 24% of the craft unions showed insufficient internal control and lacked a financial management mechanism; 87.6% of the union members supported external financial audit and suggested strictly examining whether the insurance premiums were misappropriated. Through onsite interview, questionnaire survey, chi-square analysis, and logistic regression analysis, four key factors for financial anomalies (overdue bills) among craft unions were determined, namely “no exclusive account established for health insurance premiums”, “misappropriation of the premiums saved in the exclusive account”, “the exclusive account for health insurance premiums not opened and managed by more than two people”, and“insufficient balance of the health insurance premium deposit”. Conclusions: The items used in the craft union financial audit that are commonly adopted by the National Health Insurance Administration, Bureau of Labor Insurance, and county and city governments can be used as the basis for collective financial monitoring across agencies. This study combined four key factors for financial anomalies with the current 27 items used in the financial inspections on craft unions’health insurance premiums and divided the level of influence of missing inspection data into strong, moderate, and weak. Finally, this study constructed a health insurance financial anomaly classification management model for craft unions and proposed concrete suggestions according to the research results and the current work status of the Central Division of the National Health Insurance Administration.
• 400-415
• 10.6288/TJPH.201908_38(4).107119

• Link 原著 Original Article
• 影響老年病人就診科別醫師使用電子病歷交換意願因素之初探研究Factors affecting physicians’ intention to use electronic medical record exchange for older patients
• 佘明玲、黃興進、翁儷禎
  Ming-Ling Sher, Hsin-Ginn Hwang, Li-Jen Weng
• 電子病歷交換、電子病歷交換使用意願、科技接受模式（TAM）、健康資訊交換
  EMR exchange, intention to use EMR exchange, Technology Acceptance Model, health information exchang
• 目標：探討影響醫師取用其他醫療機構電子病歷意願的因素。方法：由文獻探討歸納影響醫師使用電子病歷交換意願之因素，經德菲法與文獻再搜集形成正式問卷，藉以對某醫療體系不同層級醫療機構之醫師進行問卷調查。以因素分析探討影響因素之資訊科技與非科技向度，再以階層迴歸探討所得向度對醫師取用其他醫療機構電子病歷意願與不同途徑取用可能性之影響。結果：因素分析後呈現九因素，階層複迴歸分析顯示影響醫師取用電子病歷交換意願的資訊科技因素為「資訊專業完整與知覺有用性」，非科技因素包括「病情需要病歷資訊」、「醫師需有時間取用」、「節省問診時間」、「取用快速可存為依據」四因素。不同診療途徑取用電子病歷之預測因素略有不同。結論：若欲提升醫師取用病人電子病歷交換之意願，宜重視臨床使用經驗，提供所需專業可信完整資訊，方有助於政策目標之達成。
  Objectives: To determine factors that may influence physicians’ intentions of accessing electronic medical records (EMRs) at other institutions. Methods: A literature review was conducted to summarize factors that may affect physicians’ intentions of using EMR exchange. A questionnaire based on the Delphi method and a literature review was administered to physicians at different levels within medical institutions. Health information technique (HIT) and non-HIT factors were extracted through factor analysis and subjected to hierarchical regression analyses to investigate the dimensions potentially affecting physicians’ overall intention of using EMR exchange. The possibility to use EMRs when facing elderly patients at defferent medical services—including in-patient services, out-patient services, emergency health services, and health promotion—was also investigated. Results: Nine factors were extracted after the factor analysis. Then, the hierarchical regression analyses were conducted using these nine factors. The HIT factor“Integrated Professional Data and Perceived Usefulness” was concluded to affect the intention of physicians to use EMR exchange. The influential non-HIT factors included (1) information required regarding patients’ conditions, (2) physicians having time to access relevant information, (3) interrogation time shortening, and (4) quick access and data saving for subsequent use. The factors affecting the likelihood of EMR exchange varied marginally among different types of medical services. Conclusions: To improve physicians’ intentions of using EMR exchange, user experiences in EMR exchange at clinical practices should be emphasized. Providing professional and reliable integrated information is helpful for achieving health care policy objectives.
• 416-430
• 10.6288/TJPH.201908_38(4).108025

• Link 原著 Original Article
• 台灣地區學校護理人員社會支持對其工作壓力與幸福感之中介影響研究The mediating effect of social support on the relationship between working stress and well- being among school nurses in Taiwan
• 楊靜昀、張彩秀、蔡國瑞、劉秀枝、劉潔心
  Ching-Yun Yang, Tsai-Hsiu Chang, Kuo-Jui Tsai, Shiu-Chin Liu, Chieh-Hsing Liu
• 學校護理人員、社會支持、工作壓力、幸福感
  school nurses, social support, work stress, well-being
• 目標：本研究為瞭解學校護理人員社會支持對其工作壓力與幸福感之中介影響。方法：研究母群體以全國高中職及國中小學校之學校護理人員，採隨機分層取樣，以問卷資料收集，進行描述性、相關、中介階層迴歸分析。結果：學校護理人員之社會支持、工作壓力、幸福感得分為中等程度。社會支持、幸福感與工作壓力呈顯著負相關；社會支持與幸福感呈顯著正相關。學校護理人員社會支持在工作壓力與幸福感之關係間具有部分中介效果。結論：學校護理人員的社會支持在工作壓力與幸福感的關聯性上存在著中介效果，提升學校護理人員社會支持有助於減少工作壓力對學校護理人員幸福感之影響。根據研究結果，建議學校主管及機關政策給予行政支持、學校護理人員同儕支持增進工作能力、學校護理專業團體應紮根校護的專業素養教育及工具發展，帶動對學生照護的新視野。
  Objectives: To understand the mediating effect of social support on the relationship between work stress and wellbeing experienced by school nurses. Methods: School nurses from elementary, junior high, high, and vocational schools in Taiwan were selected using stratified random sampling, to whom questionnaires were given to collect the required data. A descriptive analysis, correlation analysis, and hierarchical regression analysis and various mediation methods were performed to examine the mediating effect of social support on the relationship between work stress and wellbeing. Results: School nurses’ social support exerted a mediating effect on the relationship between work stress and well-being. Therefore, increasing school nurses’ social support can reduce the effect of work stress on their well- being. Conclusions: According to the research results, this study recommended that the school and government authorities should provide administrative and policy support for school nurses, and the peer support from other school nurses can enhance school nurses’ work abilities. Professional school nurse organizations should enhance school nurses’ professionalism and facilitate instrument development, promoting a new horizon for student care.
• 431-444
• 10.6288/TJPH.201908_38(4).107121

• Link 原著 Original Article
• Walk Score®作為台灣地區宜走性環境測量工具之效度檢驗Validation of Walk Score® for estimating neighborhood walkability in Taiwan
• 賴鼎富、林倩宇、黃翊軒、廖邕
  Ting-Fu Lai, Chien-Yu Lin, Yi-Hsuan Huang, Yung Liao
• Walk ScoreR、宜走性環境、地理資訊系統
  Walk ScoreR, neighborhood walkability, geographic information system
• 目標：即使在美國、加拿大、與日本地區，已有研究證實Walk ScoreR作為宜走性環境測量工具之效度，但對於台灣地區仍屬未知，因此本研究檢驗Walk ScoreR與使用地理資訊系統（geographic information system, GIS）所取得之客觀宜走性環境指標之相關性，以驗證Walk ScoreR應用於台灣地區之效度。方法：以台灣地區之65歲以上高齡者為目標族群，進行電腦輔助電訪調查，蒐集自陳資料（社會人口學變項與居住之村里），有效樣本為1,040人；使用GIS計算五項客觀宜走性環境指標（人口密度、十字路口密度、總目的地數、人行道面積與大眾運輸站點密度），接著使用Walk ScoreR網站（https://www.walkscore.com/）取得各村里Walk Score分數，使用皮爾森相關係數（Pearson’s correlation coefficient）檢視Walk Score分數與客觀宜走性環境指標（GIS）的相關程度。結果：統計顯示Walk Score分數與客觀宜走性環境指標具有顯著正相關，其中Walk Score分數與十字路口密度（r = 0.7）及總目的地數量（r = 0.7）之相關性最高。結論：本研究結果與西方國家及日本一致，Walk ScoreR作為宜走性環境測量工具，具有易操作與低成本的特性，且在台灣地區有良好的效度，但該工具在東部及離島的應用須較為謹慎。建議未來政策制定者與公共衛生研究者能利用Walk ScoreR以取得台灣各鄰里之宜走性。
  Objectives: Although some studies have evaluated the concurrent validity of the Walk ScoreR as a measure of neighborhood walkability in the United States, Canada, and Japan, whether the Walk ScoreR is a valid measure in Taiwan has not yet been determined. Accordingly, this study examined how Walk ScoreR is correlated with geographic information system (GIS)-derived characteristics of neighborhood walkability for residential neighborhoods in Taiwan. Methods: A computer-assisted, telephone-based survey was conducted on older Taiwanese adults. Self-reported data (sociodemographic and residential neighborhood) were collected from 1040 Taiwanese residents aged 65 years or older. Five environmental characteristics (population density, intersection density, local destinations, sidewalk availability, and access to public transportation) were calculated for each neighborhood by using a GIS. Consequently, Walk Scores were calculated on the Walk ScoreR website (https://www.walkscore.com/) by inputting residential neighborhood information. The Pearson correlation coefficients between Walk ScoreR data and objective measures of environmental attributes (GIS data) were determined. Results: Significant positive correlations were discovered between the Walk ScoreR data and five GIS-derived environmental characteristics. Walk ScoreR was most strongly associated with intersection density (r = 0.70) and number of local destinations (r = 0.70). Conclusions: Consistent with the results obtained in Western countries and Japan, Walk ScoreR, a simple and low-cost tool, appears to also be a valid measure of neighborhood walkability in Taiwan. However, the tool should be applied with caution in the eastern regions and offshore islands of Taiwan. Walk ScoreR data can enable policy makers and public health practitioners to identify the walkability of local areas in Taiwan.
• 445-452
• 10.6288/TJPH.201908_38(4).108036