健康識能與初診斷糖尿病病人照護成效初探

Health Literacy and the Care Outcome of Newly Diagnosed Diabetic Patients: A Preliminary Exploration

劉依亭(I-Ting Liu) ； 黃如薏(Ru-Yi Huang) ； 林友菁(Yu-King Lin) ； 洪暐傑(Wei-Chieh Hung) ； 林季緯(Chi-Wei Lin)

《台灣家庭醫學雜誌》 27卷4期 (2017/12) Pp. 201-212

https://doi.org/10.3966/168232812017122704002

摘要

目的：糖尿病是現代社會常見的慢性疾病，其發生及預後可能與病患的健康信念與行為息息相關。而依據歐盟的定義，健康識能代表的是一種閱讀、過濾和理解健康資訊，以形成完善決斷的能力，本研究擬探討糖尿病患健康識能的高低，是否會影響對其自身疾病的照護成效。方法：本研究針對南台灣某大型區域醫院初診斷糖尿病病人進行收案，調查此族群健康識能現況，並分析其六個月後的糖化血色素照護情況是否與其健康識能相關。結果：本研究於2015年1月至12月共收案78人，扣除資料不全、檢驗數據缺漏、失去聯繫未回診追蹤，最後共有52人進行最後研究分析。此族群平均健康識能為33.1分，有限制的健康識能者佔55.8%，其六年以下教育者比例較高，但與年齡、性別、身體質量指數及初始糖化血色素無顯著相關。六個月後追蹤其糖化血色素是否達標(HbA1c≤7%)，發現其與健康識能總分與其次領域分數並無顯著關係，僅與其初始糖化血色素是否達標相關。結論：本研究結果顯示，具多重慢性疾病與健康識能有顯著負向關聯，另外受過六年以上教育以及目前具婚姻關係者與健康適能有顯著正相關，但健康識能與糖尿病照護成效則未能於半年內追蹤中顯示明確相關，仍有待未來進一步研究探討。

關鍵字

健康識能 ； 糖尿病 ； 糖化血色素

並列摘要

Purpose: Diabetes mellitus is one of the most common chronic diseases in modern society, and the occurrence and prognosis of this disease is correlated with patients' health belief and behavior. Since health literacy is defined as ＂the ability to read, filter and understand health information in order to form sound judgments＂ by EU, it may also play an important role in the care of diabetic patients. Methods: This research collected a cohort of newly diagnosed diabetic patients at a large teaching hospital in Southern Taiwan, evaluated the health literacy status in this population, and analyzed the relationship between the diabetes care outcome and the patients' health literacy. Results: There were 52 patients eligible for final analysis with an average score of 33 points in terms of health literacy. Patients with limited health literacy appeared to be less educated, while their health literacy scores showed no significant correlation to initial HbA1c. Satisfactory 6-month diabetic control (HbA1c ≤7%) was found related to satisfactory initial diabetes control (HbA1c ≤7%) but not to age, obesity, education, marriage, multiple disease, and health literacy score. Conclusion: Health literacy may influence the knowledge of the disease and self-care ability of the diabetic patients, but there is still no solid evidence indicating a relationship between health literacy and HbA1C control outcome in our research.

並列關鍵字

diabetes mellitus ； HbA1c ； health literacy

參考文獻

Chang CH, Shau WY, Jiang YD, et al: Type 2 diabetes prevalence and incidence among adults in Taiwan during 1999-2004: a national health insurance data set study. Diabetic Med 2010; 27: 636-43.

Westerberg DP: Diabetic ketoacidosis: evaluation and treatment. Am Fam Physician 2013; 87: 337-46.

Stoner GD: Hyperosmolar hyperglycemic state. Am Fam Physician 2005; 71: 1723-30.

Denmark D: Patient-physician partnering to improve chronic disease care. Fam Pract Manag 2004; 11(5): 55-6.

黃儀、鄭惠美、沈德昌：門診糖尿病 患對糖尿病知識、態度、行為與糖尿病衛 教需求之研究。健康促進暨衛生教育雜誌 1998；18：25-35。