受到人口快速老化和家庭結構變遷的影響，高齡者健康照護服務已開始受到各界重視；其中，提供高齡者照護服務之機構 (以下簡稱安養機構)，其需求量更是逐年增加。因此，安養機構如何提供優質的照護服務實為與許多社會機構值得關切的議題。良好的飲食服務不僅能提供營養，更能讓人們獲得愉悅的感受。先前研究指出，顧客參與對服務品質的評價和滿意度有正面影響。另外，也有文獻證實知覺自主性會影響顧客對於服務滿意度的感受。再者，服務品質之優劣亦是影響顧客滿意度的關鍵因素。基此，本研究旨在探討安養機構高齡者「顧客參與」、「知覺自主性」和「用餐服務品質」對「顧客滿意度」之影響。

首先，本研究第一階段研究調查以觀察法調查台北市兩家安養機構 [安養機構A (民營)、安養機構B (公營)] 用餐服務現況，建構服務藍圖詳加了解服務流程。其次，藉由安養機構用餐服務品質量表對80名高齡者進行服務品質評估 (40名/安養機構A；40名/安養機構B)；接著，透過服務品質屬性重要性-滿意度分析法，本研究發掘出4項需要優先改善和9項次要改善的用餐服務品質要項，分別屬於服務品質缺口1到缺口4。基此，本研究提出2項用餐服務設計提案：「活動導向」設計和「系統導向」設計。然後，本研究以問卷調查法進行第二階段設計驗證並針對52名高齡者/安養機構A進行預測。本研究發現「系統導向」設計較為受測者所滿意，並以此為後續正式施測之刺激物。在正式施測時，本研究針對32名高齡者進行問卷調查，以了解高齡者顧客參與和知覺自主性對用餐服務品質和顧客滿意度之影響。本研究主要發現有：1) 不同「顧客參與群」會對「顧客滿意度」造成影響，以及2) 高顧客參與群對「顧客滿意度」有較佳的滿意表現。最後，希冀本研究成果能做為未來高齡者照護機構發展用餐服務時的參考依據。

Health care for old adults has become a central issue in many countries due to the rapidly aging population and the changing family structure. Especially, the demand for institutional care for old adults is constantly increasing. Thus, how to provide better health care services for old adults is a critical issue that many societies currently face. As we all know, a decent meal can not only provide people necessary nutrition, but also give a sense of pleasure. Previous studies have indicated that customer participation has the positive consequences of service quality and customer satisfaction. There is some evidence that perceived autonomy has the effect on customer satisfaction. Moreover, service quality also has a critical effect on customer satisfaction. Therefore, as an example of health care meal services for old adults, this study aimed to explore how the effects of customer participation, perceived autonomy and meal service quality on customer satisfaction.

At the primary phase, the study first blueprinted the meal service processes of two long-term care facilities (Facility A: private-owned; Facility B, public-owned) in Taipei through the non-participant observation. Then, the study used a meal service questionnaire to investigate the current meal service quality of 80 older adults who live in long-term care facility (Facility A: 40; Facility B: 40). After conducting the service quality attribute importance-performance analysis, the study found that 4 primary attributes and 9 secondary attributes of hearth care meal services need to be improved. Furthermore, all of 13 attributes were classified into four different service gaps. To fill the service gaps, this study proposed two types of meal services: activity-driven design and system-driven design. At the secondary phase, as a pilot test, the study further examined 52 older adults who live in Facility A and found that the type of the system-driven design was more satisfied with the older adults than the type of the activity-driven design on the meal services. Moreover, the study conducted a survey with 32 older adults in Facility A to discover how various levels of customer participation and perceived autonomy can affect meal service quality and customer satisfaction. Finally, three main findings of the study are: 1) customer participation had an impact on customer satisfaction at a significant level; 2) one older adult with a higher level of participation was more satisfied than with a lower level of participation. Finally, it is hoped that the findings of this study could be treated as a reference for the development of meal service design of institutional care in the future.

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