隨著高齡化時代的來臨，老化議題成為全世界共同關注的問題。世界衛生組織於2002年提出活躍老化政策，將「使健康」、「社會參與」和「安全」列為三大支柱，其中提及老年人之社會參與將可使其被賦權於這個社會，而參與政治決策和自主性的建立可使他們做出最利己的健康尋求行為，進而達到促進健康的結果。
本研究使用安德森行為模式理論探討我國老年人其社會參與和健康尋求行為的關聯，有鑑於過去我國學者甚少將社會面向作為健康行為之前趨因素，且較少於使用一手資料套用該理論之調查，本研究具體研究目的有三：描述長者各類社會參與活動現況、觀察我國長者健康尋求行為、及比較長者社會活動參與對健康尋求行為的影響。
研究採量性橫斷式研究設計，以結構式問卷電話訪查大臺南37區65歲以上之長者。依行政區人口分層隨機抽樣，共867位成功完訪，平均年齡為73.14(SD:6.83)歲。研究資料使用SPSS 17.0統計套裝軟體，進行卡方檢定、獨立T檢定及邏輯斯回歸分析檢定人口特徵、社會參與和健康尋求行為之相關性分析。研究結果顯示，台南地區老年人有48.3%比例未參與社會活動，而參與比例最高的為休閒參與(55.2%)，最低的則是學習參與(11%)。當患有慢性疾病(95.74%)、急性疾病(感冒、腹瀉)(87.56%)、急性症狀(關節、肌肉扭傷)(70.97%)時，其健康尋求行為皆以選擇西醫醫療服務之比例為最高。整體而言，人口特徵中以「居住地區」和「罹患疾病總數」和健康尋求行為之相關性最顯著；「政治參與」則為多項醫療服務種類選擇之預測因子。而人口特徵中，當經濟狀況較穩定者、自覺生活費足夠、且生活費用為12,000元以上者；社會參與部分有休閒、政治或工作參與者其複向求醫情形比例亦較高。
本研究為廣泛性調查大台南地區65歲以上民眾之基本人口特徵、社會參與和健康尋求行為情形，研究結果有實質上的參考效益，是以期望研究結果能給予當前環境作一些檢視，提供政府增進老年人社會資源的相關福利政策。

Summary
This study used the cross-sectional design to explore the relationship between population characteristic, social participation and utilization of health seeking behavior among older adults in Tainan. A structured questionnaire based on Anderson behavior model was developed with acceptable reliability and validity. A total of 867 participated through telephone interview. Subjects’ average age was 73.1±6.83 years old, and there was 48.3% elderly not even participating at any activities. The western medical services was the most common utilized health seeking behavior among various health situations. The “living area” and “the total number of disease” in population characteristics and “political participation”in social participatonwere the most frequent factors predicting health seeking behavior. Subjects with higher income and participated in leisure activites, political activities, and work activities also had higher tendency of pluralistic health seeking behavior.

Key words: Social participation, Anderson behavior model, Utilization of heath seeking behavior

INTRODUCTION
The World Health Organization proposed the Active Aging Policy in 2002, taking "health", "social participation" and "security" as the three pillars to realize this goal which masked social participation the key to be empowered and healthy. This study based on the conceptual framework rooted in the Anderson behavioral model, and aims to explore the association between social participation and health seeking behavior patterns of the elderly.

METHODS
This study conducted in a cross-sectional study, and stratified random sampling by administrative area in Tainan. The subjects were dwelling elderly lived in 37 districts through random digit dialing, but excluded who had communication problem. The research instrument was self-developed based on Anderson behavior model with acceptable validity and reliability. A total of 867 completed the telephone interview. Chi-squares test, independent t-test, and multivariate logistic regression were used to analyse the association between population characteristics, social participation and health seeking behavior.

RESULTS
The results showed that the average age was 73.1±6.83 years old. The main findings included there were 48.3% elderly not even enhanced any activities, while the highest participation rates was leisure activities (55.2%), and the lowest one was learning activities (11%). The western medical services was the most frequently used health seeking behavior in the case of suffering from chronic diseases (95.74%), acute illness (colds, diarrhea) (87.56%), or acute symptoms (joint, muscle sprain) (70.97%). “Living area” and “the total number of disease” which belong to population characteristics, and “political participation” belong to social participation were the frequent predictorsfor multi-utilized medical services. Among the population characteristics, the elderly who had stable economic situation, perceived having adequate living expenses, and the living expenses was over NTD 12,000 had the higher rate to having the pluralistic medical utilization. Those participated in leisure activites, political activities, and work activities also were higher propotion to practice pluralistic health seeking behavior.

CONCLUSION
In this study, we used Aderson behavior model and widely stratified investigated the elderly over 65 years old, and living in the area of Tainan city, using the first-hand information to explore the relationship of population characteristics, social participation and utilization of health seeking behavior. The results were mostly consistent with the Taiwan Longitudinal Study on Aging Survey Report conducted by Ministry of Health and Welfare. Results indicated that “living area” and “the total number of disease” were the most frequent predictors of various health seeking behaivors. And compare to others, the higher-income elderly were more tend to have the plurastic medical utilization behavior.
Due to the cross-sectional study design, this study results can’t make the causal effect speculation. This study also suffered from using self-report data that might cause the higher estimation of the relationship among population characteristics, social participation and the utilization of health seeking behavior. While mention about almost 50% older people not participated in any social activities, we suugested that relevant units could design the diversity activities and combined with the local features. To develop such as creative, independent, or even productive social activities.Thus might improve the participance of the elderly, and to creat a better later life.

Andersen, R. M. (1995). Revisiting the behavioral model and access to medical care: does it matter? Journal of health and social behavior, 1-10.
ANDERSEN, R. M. (1995). Revisiting the Behavioral Model and Access to Medical Care: Does It Matter? Journal of health and social behavior, 36, 1-10.
Astell-Burt, T., Feng, X., & Kolt, G. S. (2013). Mental health benefits of neighbourhood green space are stronger among physically active adults in middle-to-older age: evidence from 260,061 Australians. Prev Med, 57(5), 601-606. doi: 10.1016/j.ypmed.2013.08.017
Babitsch, B., Gohl, D., & von Lengerke, T. (2011). Re-revisiting Andersen's Behavioral Model of Health Services Use: a systematic review of studies from 1998-2011. Psycho-social medicine, 9, Doc11-Doc11.
Bassuk, S. S., Glass, T. A., & Berkman, L. F. (1999). Social disengagement and incident cognitive decline in community-dwelling elderly persons. Annals of internal medicine, 131(3), 165-173.
Bradley, E. H., McGraw, S. A., Curry, L., Buckser, A., King, K. L., Kasl, S. V., & Andersen, R. (2002). Expanding the Andersen Model: The Role of Psychosocial Factors in Long‐Term Care Use. Health services research, 37(5), 1221-1242.
Chen, Y. J., & Chen, C. Y. (2012). Living Arrangement Preferences of Elderly People in Taiwan as Affected by Family Resources and Social Participation. Journal of Family History, 37(4), 381-394. doi: 10.1177/0363199012440948
Chiao, C.-Y., Lee, S.-H., Liao, W.-C., Yen, C.-H., Lin, Y.-J., Li, C.-R., . . . Lee, M.-C. (2013). Social Participation and Life Expectancy—The Case of Older Adults in Taiwan from 1996 to 2003. International Journal of Gerontology, 7(2), 97-101. doi: 10.1016/j.ijge.2012.07.001
Danson, M., & Gilmore, K. (2012). Employability and flexible retirement: Variations in academia in an age of austerity. Geoforum, 43(6), 1323-1332. doi: 10.1016/j.geoforum.2012.06.005
Das, A., & Nairn, S. (2013). Race Differentials in Partnering Patterns among Older U.S. Men: Influence of Androgens or Religious Participation? Archives of Sexual Behavior, 42(7), 1119-1130. doi: 10.1007/s10508-013-0096-y
Derksen, B. J., Duff, M. C., Weldon, K., Zhang, J., Zamba, K. D., Tranel, D., & Denburg, N. L. (2015). Older adults catch up to younger adults on a learning and memory task that involves collaborative social interaction. Memory, 23(4), 612-624. doi: 10.1080/09658211.2014.915974
Dewhurst, S., Nelson, N., Dougall, P. K., & Bampouras, T. M. (2014). Scottish country dance: benefits to functional ability in older women. J Aging Phys Act, 22(1), 146-153. doi: 10.1123/japa.2012-0234
Dhillon, P., & Ladusingh, L. (2013). Working life gain from gain in old age life expectancy in India. Demographic Research, 28, 733-762. doi: 10.4054/DemRes.2013.28.26
Dominic Julien, L. G., Lucie Richard, Yan Kestens, and Helene Patette. (2013). The Role of Social Participation and Walking in Depression among Older Adults: Results from the VoisiNuAge Study.
Escolar Chua, R. L., & de Guzman, A. B. (2014). Effects of Third Age Learning Programs on the Life Satisfaction, Self-Esteem, and Depression Level among a Select Group of Community Dwelling Filipino Elderly. Educational Gerontology, 40(2), 77-90. doi: 10.1080/03601277.2012.701157
Gelberg, L., Andersen, R. M., & Leake, B. D. (2000). The Behavioral Model for Vulnerable Populations: application to medical care use and outcomes for homeless people. Health services research, 34(6), 1273.
Gong, Y., Gallacher, J., Palmer, S., & Fone, D. (2014). Neighbourhood green space, physical function and participation in physical activities among elderly men. International Journal of Behavioral Nutrition and Physical Activity, 11(40).
Goodwin, J., & O'CONNOR, H. (2012). Notions of fantasy and reality in the adjustment to retirement. Ageing and Society, 1-21.
Garces, I. C., Scarinci, I. C., & Harrison, L. (2006). An examination of sociocultural factors associated with health and health care seeking among Latina immigrants. J Immigr Minor Health, 8(4), 377-385. doi: 10.1007/s10903-006-9008-8
Hsu, H. (2007). Does social participation by the elderly reduce mortality and cognitive impairment? Aging & mental health, 11(6), 699-707.
Hung, J.-Y., & Lu, K.-S. (2014). Research on the Healthy Lifestyle Model, Active Ageing, and Loneliness of Senior Learners. Educational Gerontology, 40(5), 353-362. doi: 10.1080/03601277.2013.822200
Ju-hyun Kim, M. K., and Joongbaeck Kim. (2013). Social Activities and Health of Korean Elderly Women by Age Groups. Educational Gerontology, 39, 640-654.
Julien, D., Gauvin, L., Richard, L., Kestens, Y., & Payette, H. (2013). The Role of Social Participation and Walking in Depression among Older Adults: Results from the VoisiNuAge Study. Canadian Journal on Aging / La Revue canadienne du vieillissement, 32(01), 1-12. doi: 10.1017/s071498081300007x
Kalache, A., & Gatti, A. (2002). Active ageing: a policy framework. Advances in gerontology= Uspekhi gerontologii/Rossiiskaia akademiia nauk, Gerontologicheskoe obshchestvo, 11, 7-18.
Kang, S. (2013). The elderly population and community engagement in the Republic of Korea: The role of community storytelling network. Asian Journal of Communication, 23(3), 302-321. doi: 10.1080/01292986.2012.725176
Kim, J.H., Kim, M., & Kim, J. (2013). Social Activities and Health of Korean Elderly Women by Age Groups. Educational Gerontology, 39(9), 640-654. doi: 10.1080/03601277.2012.730454
Kim, J. H. (2013). Productive activity and life satisfaction in Korean elderly women. J Women Aging, 25(1), 80-96. doi: 10.1080/08952841.2012.717850
Kleiber, D. A., & Linde, B. D. (2014). The Case for Leisure Education in Preparation for the Retirement Transition. Journal of Park and Recreation Administration, 32(1).
Kehoe, Jerard (1995). Basic item analysis for multiple-choice tests. Practical Assessment, Research & Evaluation, 4(10).
MacKian, S. (2003). A review of health seeking behaviour: problems and prospects. Health Systems Development. University of Manchester, Manchester, UK.
Majaj, L., Nassar, M., & De Allegri, M. (2013). “It’s not easy to acknowledge that I’m ill”: a qualitative investigation into the health seeking behavior of rural Palestinian women. BMC women's health, 13(1), 26.
Nielsen, G., Wikman, J. M., Jensen, C. J., Schmidt, J. F., Gliemann, L., & Andersen, T. R. (2014). Health promotion: the impact of beliefs of health benefits, social relations and enjoyment on exercise continuation. Scand J Med Sci Sports, 24 Suppl 1, 66-75. doi: 10.1111/sms.12275
Paiva, F. S. d., Stralen, C. J. V., & Costa, P. H. A. d. (2014). Participacao social e saude no Brasil: revisao sistematica sobre o tema. Ciência & Saúde Coletiva, 19(2), 487-498. doi: 10.1590/1413-81232014192.10542012
Ra, C. K., & Cho, Y. (2013a). Differentiated effects of social participation components on suicidal ideation across age groups in South Korea. BMC public health, 13(1), 890.
Ra, C. K., & Cho, Y. (2013b). Differentiated effects of social participation components on suicidal ideation across age groups in South Korea. Public Health, 13(890).
Sundquist, J., Hamano, T., Li, X., Kawakami, N., Shiwaku, K., & Sundquist, K. (2014). Neighborhood linking social capital as a predictor of psychiatric medication prescription in the elderly: A Swedish national cohort study. Journal of Psychiatric Research, 55, 44-51. doi: 10.1016/j.jpsychires.2014.04.013
Sundquist, K., Hamano, T., Li, X., Kawakami, N., Shiwaku, K., & Sundquist, J. (2014). Linking social capital and mortality in the elderly: A Swedish national cohort study. Experimental Gerontology, 55, 29-36. doi: 10.1016/j.exger.2014.03.007
Tanaka, M., Ushijima, K., Sung, W., Kawakita, M., Tanaka, S., Mukai, Y., . . . Maruyama, S. (2014). Association between social group participation and perceived health among elderly inhabitants of a previously methylmercury-polluted area. Environmental health and preventive medicine, 19(4), 258-264.
THOMAS, J. E., O’CONNELL, B., & GASKIN, C. J. (2013). Residents’ perceptions and experiences of social interaction and participation in leisure activities in residential aged care. Contemporary Nurse, 45(2), 244-254.
Toepoel, V. (2013). Ageing, Leisure, and Social Connectedness: How could Leisure Help Reduce Social Isolation of Older People? Soc Indic Res, 113(1), 355-372. doi: 10.1007/s11205-012-0097-6
Waltz, C. F., Strickland, O., & Lenz, E. R. (1991). Measurement in nursing research: FA Davis Company.
Wang, H. X., Jin, Y., Hendrie, H. C., Liang, C., Yang, L., Cheng, Y., . . . Gao, S. (2013). Late life leisure activities and risk of cognitive decline. J Gerontol A Biol Sci Med Sci, 68(2), 205-213. doi: 10.1093/gerona/gls153
Yajima, M., Asakawa, Y., & Yamaguchi, H. (2013). Contents and Construct of Subjective Enjoyment of Community-dwelling Elderly People Performing physical activities. J. Phys. Ther. Sci., 25, 207-209.
Zastrow, C., & Kirst-Ashman, K. (2006). Understanding human behavior and the social environment: Cengage Learning.
Wikipedia. from https://en.wikipedia.org/wiki/Social_engagement(2015/06/29)
包正豪. (2013). 選舉競爭, 政治賦權與原住民投票參與: 2008 與 2012 立委選舉的總體資料分析. 台灣原住民族研究季刊, 6(4), 77-117.
史麗珠, 彭佩宜, 高鳳聲, 蘇靖鈞, 鄭蔥君, & 李幸禧. (2000). 北部某大學學生的求醫行為: 中西醫之選擇. 秀傳醫學雜誌, 2(4), 151-159.
吳明隆. (2007). SPSS 操作與應用: 變異數分析實務: 五南圖書出版股份有限公司.
吳炳輝, 季瑋珠, & 洪其璧. (1997). 蘭嶼雅美人求醫行為之研究. 中華公共衛生雜誌, 16(4), 329-338.
吳重禮, 譚寅寅, & 李世宏. (2003). 賦權理論與選民投票行為: 以 2001 年縣市長與第五屆立法委員選舉為例. 台灣政治學刊, 7(1), 91-156.
李維靈, 施建彬, & 邱翔蘭. (2007). 退休老人休閒活動參與及其幸福感之相關研究. Journal of Humanities and Social Sciences, 3(2), 27-35.
林雁秋, & 顏妙芬. (2005). 慢性腎病患者求醫行為之探討. 實證護理, 1(4), 263-272.
范鈺楨. (2003). 老人生活滿意度之研究. (碩士), 國立中央大學, 桃園縣.
崔曉倩, & 吳重禮. (2011). 年齡與選舉參與: 2008 年總統選舉的實證分析. 調查研究: 方法與應用, 26, 7-44.
張玉萍. (2012). 高齡者社會參與及生活品質關係之研究-以高雄市樂齡學習資源中心為例. (碩士), 國立屏東教育大學, 屏東縣.
張怡. (2003). 影響老人社會參與之相關因素探討.
張尉萱. (2011). 台灣中老年人社會參與對存活情形之影響: 喪偶與有偶之比較. 亞洲大學長期照護研究所學位論文.
陳銘樹, 魏慶國, 黃曉令, 吳潔瑜, & 黃莉蓉. (2006). 利用健康行為模式探討 [社區健康營造] 實施之成效-以桃園地區都市原住民健康營造為例. 健康管理學刊, 4(2), 155-167.
陳嬿先. (2010). 高雄市退休公務員生涯規劃與學習需求關係之研究.
游輝禎, & 徐志宏. (2013). 高齡化社會生活環境發展之研究. 內政部建住研究所自行研究報告.
黃富順, 林麗惠, 梁芷瑄, & 林曉齡. (2008). 我國屆齡退休及高齡者參與學習需求意向調查研究報告. 教育部委託專案報告, 新竹: 玄奘大學教育人力資源與發展學系.
黃耀榮. (2012). 都市地區不同世代之 [在地老化] 住宅空間與設施需求研究-以板橋地區香社里, 香雅里, 社後里等社區為例. 建築學報(80), 1-27.
楊鎧玉. (2003). 臺北市子宮頸抹片檢查陽性個案求醫行為相關因素之探討.
楊爵億(2003)。臺灣中老年人複向求醫之影響因素探討(未出版之碩士論文)。臺中健康暨管理學院健康管理研究所，台灣台中市。
詹典穎. (2008). 都市內高齡者公園休閒活動參與特性之研究－以台南市為例. 成功大學. Available from Airiti AiritiLibrary database. (2008年)
鄔筱婷. (2014). 高雄市退休公教人員志願服務參與動機與參與行為之研究. 高雄醫學大學醫學社會學與社會工作學系碩士班學位論文, 1-157.
蔡承家, & 葉秀菊. 高齡者參與終身學習障礙之研究.
謝美娥. (2012). 老人的社會參與—以活動參與為例:從人力資本和社會參與能力探討研究紀要. 人文與社會科學簡訊, 13(4), 14-21.
顏聖致. (2009). 加入全民健保論值計酬計畫之糖尿病患者接受中西醫療法與照護結果之相關. 中國醫藥大學中國醫學研究所碩士班學位論文, 1-76.
蘇文璽, 劉玲珍, 社會學, 蔡昭民, & 許釗涓. (1992). 高雄市退休老人老年生涯規劃調查: 高雄市社會局.
顧敏盛(2011)。台灣高齡老人之醫療服務使用情形(未出版之碩士論文)。中山醫學大學醫學研究所，台灣台中市。
衛生福利部統計處。取自http://www.mohw.gov.tw/cht/DOS/
內政部統計處。取自http://www.moi.gov.tw/stat/news_list.aspx
老人福利法(民91年6月26日)。
內政部統計處。取自http://www.moi.gov.tw/stat/news_list.aspx
老人福利法(民91年6月26日)。