Listening to Indigenous Elders: An Evaluation of the Cultural Health Stations in Taiwan.

The Council of Indigenous Peoples in Taiwan has established tribal-based Cultural Health Stations offering basic health services and social activities for Indigenous communities. However, little is known about the factors influencing participation. This pilot study examined the reasons for attendance among older adults from five Paiwan communities in eastern Taiwan. A structured questionnaire, informed by Andersen's Behavioral Model of Health Services Use and shaped through community consensus, was administered to 211 elders, 77 of whom were attending Cultural Health Stations. Participants who attended were generally older, female, living alone, not engaged in paid work or farming, and reported positive perceptions of the activities. Common reasons for non-attendance included time constraints, preference for alternative social settings, and dissatisfaction with the programs. Multivariable logistic regression analysis revealed that being aged 75 years or older, living alone, and reporting a higher self-rated ability to manage health issues were positively associated with attendance. In contrast, having paid employment was negatively associated. Findings from the open-ended questions suggested attendees appreciated services and activities but requested more cultural content. Non-attendees expressed that activities should be inclusive of different age groups and ability levels, culturally connected to local communities, and mindful that many elders still need to work. These findings highlight the importance of incorporating elders' perspectives in the planning and evaluation of community-based services and may inform policy improvements for Indigenous elder care in Taiwan. However, it is also necessary to consider the economic circumstances of elders, design culturally centered activities, and respond to their interest in courses related to cultural transmission to ensure services are both accessible and meaningful.