特定保健指導における未利用の理由の構造—国民健康保険被保険者の未利用者に焦点をあてて

Reasons for Not Using a Specific Health Guidance System: Focusing on Persons Insured by the National Health Insurance Program Who Do Not Use Specific Health Guidance

要旨

　目的：特定保健指導における未利用の理由の構造を明らかにすることである．

　方法：A町の特定保健指導の未利用者10人を対象とし，未利用の理由に関連する3点を質問項目として半構造化面接を行い，KJ法を用いて質的に分析した．

　結果：特定保健指導における未利用の理由の構造は，【“私という領域”がある】【私には“良好な健康”より大切な生きがいがある】【私に限定せずに必要な人への活動を望む】という3つの要素から構成されていた．各要素の関係性として，【“私という領域”がある】は健康観に基づく自己決定の権利を示し，他の要素の基盤となり支持していた．さらに，各要素には，現在の身体状態を健康と捉える健康観が根底にあり，相互に影響することで未利用の理由が強化される関係にあることが示された．

　結論：未利用の解決には，未利用者の健康観を考慮した支援を行うことの重要性が示唆された．

　Purpose: This study sought to elucidate the reasons why a specific health guidance system is not used by some individuals.

　Method: Ten individuals living in an unnamed town were questioned using semi-structured interviews as to why they had not used the specific health guidance system. Three questions were asked regarding the reasons for nonuse, and the interviews were qualitatively analyzed using the KJ method.

　Results: Three factors that constituted reasons for not using the specific health guidance system were clarified: “presence of ‘territory, me,’” “things other than ‘good health’ are important to me,” and “I hope that the activity is provided to people who need it without limiting it to myself.” The factor “presence of ‘territory, me’” represents the right to self-determination with regard to health matters and provides support to the other factors as their basis. In addition, these people generally recognize that good health is a condition in which people may live their everyday lives without difficulty, and such views regarding health formed the basis of the factors. The 3 factors influenced each other, thereby reinforcing the reasons for not using the specific health guidance system.

　Conclusion: The provision of support with consideration of the health-related views of people not using specific health guidance might be important for solving the problem of nonuse.