生活保護ケースワーカーによる受給者の健康支援に関する研究 : 都市部福祉事務所における質問紙調査の分析

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  • セイカツ ホゴ ケースワーカー ニ ヨル ジュキュウシャ ノ ケンコウ シエン ニ カンスル ケンキュウ : トシブ フクシ ジムショ ニ オケル シツモンシ チョウサ ノ ブンセキ
  • Health Support of Recipients by Welfare Caseworkers : Analysis of a Questionnaire Implemented at Urban Welfare Offices

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【目的】生活保護受給者の自立支援の基礎となるのは健康への支援である。生活保護ケースワーカー（以下、CW）による受給者の健康支援を促進する要因と健康支援に関連する認識を明らかにすることを研究目的とした。【方法】3都市10福祉事務所のCW212人に質問紙を配布し、有効回答178人分を分析対象とした。作成した尺度に基づき健康支援得点を算出し、それを目的変数として関連要因を明らかにするために重回帰分析を行った。また、健康支援得点で2群（高群、低群）に分け、重要と考える健康課題、健康支援方策および職場環境整備の必要性についてCWの認識を比較した。【結果】健康支援得点には、CWとしての受給者への姿勢、高い仕事のやりがい感、職場における事例検討が有意に関連していた。重要と考える健康支援の課題は、精神保健と母子保健の領域の課題をあげるものが多く、健康支援得点の高群は低群に比し、児童虐待をあげる割合が有意に高かった。また、健康支援得点の高群は、健康支援方策では保健医療専門職との連携、栄養教室の開催、患者会や当事者グループ等の活用をあげる割合が有意に高く、職場環境の整備では、職場内での助け合い、他部署との友好な連携、支援策の相談と助言、保健医療専門職の配置などの項目すべてでかなり必要であると答える割合が高かった。【結論】CWによる健康支援を促進するには、CWの志気の高さとそれを支える職場内の取り組みが重要である。受給者の健康課題は、精神保健や母子保健の領域に多く認められた。健康支援に積極的に取り組んでいるCWは、健康支援方策についてより多くの方策が必要と考えており、また、職場環境整備の必要性についての意識もより積極的であった。受給者の健康支援では、世帯を担当するCWが受給者の健康状態への気づきやアセスメント力を高め、医療専門職との協働・連携につなげていける職場環境や体制づくりが重要である。

[Purpose] Health support is fundamental of various supports for public welfare recipients. This study aimed to clarify promotion factors and awareness related to health support for recipients among welfare caseworkers (CWs). [Methods] Questionnaires were distributed to a total of 212 CWs at ten welfare offices in three different cities, and analysis was conducted on valid answers from 178 respondents. Health support scores were calculated based on a scale created for the study; using the score as the dependent variable, multiple regression analysis was conducted to clarify related factors. In addition, according to the health support score respondents were divided into two groups (the high score group and low score group), and CWs' awareness of the importance of health issues, health support measures, and improvement of workplace environment were compared. [Results] A significant relationship was found between the health support score and the attitudes of CWs toward recipients, a strong sense of the work being worth doing, and case study meetings in the workplace. The health issues that the CWs considered important were those that involved mental health and maternal and child health, and the rate of child abuse being considered important in the high score group was significantly higher than in the low score group. Regarding health support measures, significantly higher rates were shown in the high score group than low score group in terms of cooperation with health professionals, holding nutrition classes, and cooperation with self-help groups. As improvement of workplace environment, the high score group showed higher rates in all of the items, such as helping others within the workplace, favorable cooperation with other sections, consultations and advice for support measures, and placement of health professionals. [Conclusions] For the promotion of health support by CWs, high levels of morale among the CWs themselves and supporting initiatives within the workplace are essential. Many health issues were identified in the areas of mental health and mother and child health. CWs who proactively make efforts for health support thought that larger numbers of health support measures were necessary, and they also had a stronger awareness of the necessity of workplace environment improvement. To promote health support of welfare recipients, it is necessary to enhance CWs' assessment skills toward recipients health need, and workplace environment that assure cooperation with health professions is also important.

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