Using the PRECEDE Model to Assess Injuries in a Selected Community

目標：運用PRECEDE模式，評估台北市某一社區事故傷害狀況，以作為該社區之安全社區計畫推動最適介入策略之參考。方法：針對台北市某一社區，蒐集該社區事故傷害資料，包括事故傷害死亡率、醫院急診事故傷害個案、警察局交通事故。將事故傷害資料統計後，提供社區領袖票選優先議題及其影響因素之重要度及可改變度。參照PRECEDE模式，依序進行流行病學診斷，行為和環境診斷，及教育和生態診斷，完成該社區事故傷害問題之評估。結果：在流行病學診斷方面，該社區與事故傷害有關之議題以「跌倒墜落」及「交通事故」為優先；跌倒墜落的高危險群為10歲以下小孩及70歲老人以上；交通事故的高危險群為20-29歲機車騎士。在行為和環境診斷方面，老人跌倒之行為因素為精神不佳，環境因素為居家地面的濕滑；小孩跌倒之行為因素為沒有大人陪伴或大人沒注意，環境因素為居家或浴室的地面濕滑。機車交通事故之行為因素為違反交通規則，環境因素為天候光線不佳。在教育和生態診斷方面，所有前置因素、增強因素及促成因素，分析其重要度及可改善度之後，找出應優先改善之項目為：老人居家跌倒為浴室沒有把手或防滑墊未固定；小孩跌倒為主要照顧者防跌知識及警覺性不足；機車交通事故傷害為警覺性不夠及安全認知不足。結論：藉由PRECEDE模式進行社區事故傷害評估，透過社區事故傷害監測客觀數據蒐集，及社區領袖評量問題重要度及可改善度，評估結果可應用於該社區推動事故傷害防制計畫之參考。Objectives: To use the PRECEDE model to assess injuries in a selected community in Taipei City. The assessment results form the basis for a program of community safety. Methods: Injury data, including injury mortality, emergency room cases, and cases involved in traffic accidents, were collected from a selected district in Taipei City. Data were analyzed so that community leaders might prioritize the subtypes of injury and related factors by importance and improvability. Injuries in the community were assessed by following each phase of the PRECEDE model in terms of epidemiological, behavioral and environmental, and educational and ecological diagnoses. Finally, we completed a community assessment of the problem of injuries. Results: The epidemiological diagnosis revealed that motor vehicle injuries (MVI) and falls were priority issues. Children under age 10 and elders over 70 were the high-risk groups for injuries due to falls, as were motorcycle riders aged 20-29 years for MVI. The behavioral and environmental diagnosis showed that the elderly fell either at a low-spirited status or due to a wet floor at home; children fell due either to adults’ absence or negligence or due to a wet floor at home or in a bathroom; factors underlying motorcycle injuries were violation of traffic rules and a dim weather. For the education and ecological diagnosis, the importance and improvability of the predisposing, reinforcing, and enabling factors were examined. Priorities were identified: for the elderly, a grasp bar or fixation of a skid-proof mat in the bathroom; for children, provision of fall prevention knowledge and awareness for caregivers; for motorcycle riders, training in vigilance and safety concerns. Conclusions: The PRECEDE model was used to assess injuries in a designated community. The results of the assessment in combination with community injury surveillance data and local leaders' acknowledgement of the importance and improvability of various injuries, can be utilized to promote injury prevention and control programs in a community