健康識能與健康生活品質之關係：以重病醫療可近性、對醫生之信任、認同網路資訊之健康效益為中介變項

研究背景與目的健康識能為健康相關領域近年來的趨勢話題之一，許多學者及單位意識到其對於健康結果的重要性，開始投入研究並嘗試應用於臨床上。過往的研究已針對健康識能與不同的健康結果之關係累積許多文獻，但關於健康識能與健康結果間的過程，是否存在顯著之中介因子仍處於摸索階段。健康生活品質是一綜合性之健康結果，高度的健康生活品質亦為大多數人畢生追求之理想。若健康識能與健康生活品質間存有顯著中介因子，了解其路徑的運作與影響，將能成為日後健康實務上的參考。研究方法本研究採橫斷式研究設計。研究架構以Paasche-Orlow與Wolf所提出「健康識能與健康結果之因果路徑」之理論模型為基礎，採用平行式中介模型。其中，自變項為健康識能，依變項為健康生活品質，中介變項為重病醫療可近性、對醫生之信任與認同網路資訊之健康效益。資料來源使用中央研究院社會學研究所的「社會變遷基本調查計畫」之「健康與醫療照顧」問卷(N=1243)。為檢驗研究假設，以IBM SPSS Statistics(Version 28)以及PROCESS macro for SPSS v4.0進行研究分析，探討各變項間的關係與中介作用之影響。研究結果健康識能與健康生活品質間為顯著正向關係。中介變項方面，唯有「健康識能——重病醫療可近性——健康生活品質」之路徑呈現顯著，因此將重病醫療可近性視為健康識能與健康生活品質間部分中介作用之顯著正向因子。控制變項的部分，性別、教育程度與月收入為顯著：男性較女性有較高的健康生活品質；教育程度愈高，健康生活品質愈低；月收入愈高，健康生活品質愈高。進一步針對重病醫療可近性，進行性別、教育程度與月收入之分層分析結果：性別方面，重病醫療可近性只有在男性樣本中，呈現顯著之中介效果；教育程度方面，重病醫療可近性只有在中低教育程度樣本中，呈現顯著之中介效果；月收入方面，重病醫療可近性在低月收入與中高月收入樣本中，皆呈現顯著之中介效果。結論本研究指出健康識能與健康生活品質間的之關係為顯著正向，且「重病醫療可近性」為健康識能與健康生活品質間部分中介作用之顯著正向因子，因此若能加強健康識能的觀念與技巧，將有助於增加個體之重病醫療可近性，並進一步提升其健康生活品質。其中，須特別留意男性與中低教育程度者的健康識能情形以及其重病醫療可近性之狀況，提供適當的健促方案與相關協助，以提升國人健康生活品質。

關鍵字

健康識能；健康生活品質；重病；醫療可近性；對醫生之信任；網路資訊；中介模型

並列摘要

Background and Objectives Health literacy is one of the trending topics in health-related fields in recent years. Many scholars and institutions have realized its importance on health outcomes and have begun to invest in research and try to apply it in clinical practices. Previous studies have accumulated a lot of literature on the relationship between health literacy and different health outcomes, but whether there are significant mediators between health literacy and health outcomes is still in the exploratory stage. Health-related quality of life is a relatively comprehensive health outcome, and high health-related quality of life is a goal most people pursue throughout their lives. If there are significant mediators between health literacy and health-related quality of life, understanding the operation and impact of its path will become a reference for future health practices. Methods The research framework of this cross-sectional study is based on the theoretical model of causal pathways between health literacy and health outcomes, which Paasche-Orlow and Wolf proposed. The independent variable is health literacy, the dependent variable is health-related quality of life, and the mediators are “accessibility to medical resources for serious illness,” “trust in physicians,” and “perceived health benefits of internet information.” The data was analyzed using the “2021 Taiwan Social Change Survey: Health” questionnaire by the Institute of Sociology, Academia Sinica(N=1243). The research used IBM SPSS Statistics (Version 28) and PROCESS macro for SPSS v4.0 to test the research hypothesis to analyze the relationship between variables and the mediation effects. Results There is a significant positive relationship between health literacy and health-related quality of life. In terms of the mediators, only the path of health literacy - accessibility to medical resources for serious illness - health-related quality of life is completely significant, so “accessibility to medical resources for serious illness” is regarded as a significant positive factor in the partial mediating effect between health literacy and health-related quality of life. For the control variables, gender, education level, and monthly income are significant: men have a higher health-related quality of life than women; the higher the education level, the lower the health-related quality of life; the higher the monthly income, the higher the health-related quality of life. Further stratified analysis results of gender, education level, and monthly income for critical illness medical treatment accessibility: In terms of gender, critical illness medical treatment accessibility has a significant mediating effect only in male samples; in terms of education level, critical illness medical treatment accessibility has a significant mediating effect only in the sample of a lower level of education; in terms of monthly income, critical illness medical treatment accessibility has a significant mediating effect in both the low monthly income and the upper middle monthly income samples. Conclusion This research found that the relationship between health literacy and health-related quality of life was significant and positive. “Accessibility to medical resources for serious illness” was a significant positive factor for the partial mediating effect between health literacy and health-related quality of life. Enhancing health literacy will help increase the level of “accessibility to medical resources for serious illness” and further improve the “health-related quality of life” for the people. Medical organizations and health services can use this achievement to plan health promotion programs and practical applications. Furthermore, it is necessary to pay attention to health literacy and critical illness medical treatment accessibility for men and people with a lower level of education and to provide them with appropriate health promotion programs and related assistance, thus improving the health-related quality of life of every Taiwanese.

並列關鍵字

Health literacy ； Health-related quality of life ； Serious illness ； Medical treatment accessibility ； Trust in physicians ； Internet information ； Mediation model

參考文獻

Nutbeam, D. (2000). Health literacy as a public health goal: A challenge for contemporary health education and communication strategies into the 21st century. Health Promotion International, 15(3), 259–267. https://doi.org/10.1093/heapro/15.3.259

Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs, A. M. A. (1999). Health LiteracyReport of the Council on Scientific Affairs. JAMA, 281(6), 552–557. https://doi.org/10.1001/jama.281.6.552

Google Scholar

Aday, L. A., Andersen, R. (1974). A Framework for the Study of Access to Medical Care. Health Services Research, 9(3), 208–220.

Google Scholar

Ahmad Al-Windi, D. E., Gösta Tibblin, Kurt Svärdsudd. (1999). The influence of sociodemographic characteristics on well-being and symptoms in a Swedish community: Results from a postal questionnaire survey. Scandinavian Journal of Primary Health Care, 17(4), 201–209. https://doi.org/10.1080/028134399750002412

Google Scholar

Akerkar, S. M., Bichile, L. S. (2004). Doctor patient relationship: Changing dynamics in the information age. Journal of Postgraduate Medicine, 50(2), 120.

Google Scholar

主題瀏覽