- 學位論文
健康識能在台灣和亞洲的國際研究
HEALTH LITERACY: INTERNATIONAL RESEARCHES IN TAIWAN AND ASIA
摘要
Background: Health literacy (HL) was recognized as an important factor in achieving the health-related Millennium Development Goals (MDGs) and public health goals. It has been emphasized as an essential element in global actions in preventing and controlling non-communicable diseases (NCDs) between 2013 and 2020 as reported by WHO in 2013. Therefore, it is important to understand the health literacy levels, its determinants and consequences in populations in Asia. Which can help with integrating HL into future healthcare agenda to reduce economic burdens from low HL in NCDs. However, there has been short of universal tools for population based survey and comparison. It is interesting to validate the HLS-EU-Qs and use it to assess health literacy in the general populations, and to identify its important associated factors in Asian countries. Methods: A cross-sectional design with multistage sampling method was used to select 10,210 people in six countries, aged 15 and above. The HLS-EU-Qs tool was validated by confirmatory factor analysis in six countries (Indonesia, Kazakhstan, Malaysia, Myanmar, Taiwan, and Vietnam). By multivariate regression analysis, predictors and outcomes of health literacy were identified in five countries (Indonesia, Kazakhstan, Myanmar, Taiwan, and Vietnam). Principle component analysis (PCA) and confirmatory factor analysis (CFA), was used to develop and validate the short-form health literacy questionnaire for use in the general population in six countries. The short-form will be tested in patient samples in national hospital in Taiwan for future clinical assessment. Results: The HLS-EU-Q47 was shown with good construct validity, satisfactory good-fit of the data to the hypothetical model in three health literacy domains, accompanied with high internal consistency, satisfactory item-scale convergent validity, and no floor/ceiling effects. In different countries, there were different socio-demographic and personal factors with different associations with health literacy; e.g., in total sample, HL was influenced by five factors in Indonesia, by nine factors in Kazakhstan, by six factors in Myanmar, eight factors in Taiwan, and by four factors in Vietnam. Among those factors, “ability to pay for medication” and “viewing health related television programs” were strongly associated with HL in different groups in all countries, interaction between education and watching health related TV programs was found. In most countries, higher health literacy was linked to better health status, more exercise, having an accompany to visit doctor, online registration, less long-term illness, less physical limitation, less likely to smoke, and less health service utilizations. There was no association between HL and emergency service use. Health literacy was found to modify the association between age and health status, and between long-term illness and physical limitation. A 12-item short-form questionnaire (HL-SF12) was developed, retaining the conceptual framework. It was shown with adequate psychometric properties in six countries, including satisfied goodness of it indices, high internal consistency reliability, good criterion-related validity, moderate and high level of item-scale convergent validity, and without floor or ceiling effect. Associations between specific socio-demographics with HL measured by the full-form was also noted by the short-form. The HL-SF12 was validated in patients with high internal consistency, moderately correlated with single item SBSQ, with satisfactory item-scale convergent validity without floor/ceiling effect, and with satisfactory goodness-of-fit-indices of three-factor construct model for most of the patients. Results showed that health literacy was not associated with department visited. It was associated with gender, income, health-related TV viewing, and linked to health outcomes, and frequency of doing exercise. Income and watching health related TV programs were found as modifiers of the association between age and health literacy. There was no association observed between HL and healthcare accessibility and utilization in this patient population. Conclusions: This study introduced a comprehensive survey tool to Asian context, and suggested to use the universal tool for international studies. Importantly, findings provided convincing evidences to health care providers, policy makers, and governments to have properly strategies to improve people health literacy, and in turns, more effective performances of healthcare system, and better health outcomes.
並列摘要
Background: Health literacy (HL) was recognized as an important factor in achieving the health-related Millennium Development Goals (MDGs) and public health goals. It has been emphasized as an essential element in global actions in preventing and controlling non-communicable diseases (NCDs) between 2013 and 2020 as reported by WHO in 2013. Therefore, it is important to understand the health literacy levels, its determinants and consequences in populations in Asia. Which can help with integrating HL into future healthcare agenda to reduce economic burdens from low HL in NCDs. However, there has been short of universal tools for population based survey and comparison. It is interesting to validate the HLS-EU-Qs and use it to assess health literacy in the general populations, and to identify its important associated factors in Asian countries. Methods: A cross-sectional design with multistage sampling method was used to select 10,210 people in six countries, aged 15 and above. The HLS-EU-Qs tool was validated by confirmatory factor analysis in six countries (Indonesia, Kazakhstan, Malaysia, Myanmar, Taiwan, and Vietnam). By multivariate regression analysis, predictors and outcomes of health literacy were identified in five countries (Indonesia, Kazakhstan, Myanmar, Taiwan, and Vietnam). Principle component analysis (PCA) and confirmatory factor analysis (CFA), was used to develop and validate the short-form health literacy questionnaire for use in the general population in six countries. The short-form will be tested in patient samples in national hospital in Taiwan for future clinical assessment. Results: The HLS-EU-Q47 was shown with good construct validity, satisfactory good-fit of the data to the hypothetical model in three health literacy domains, accompanied with high internal consistency, satisfactory item-scale convergent validity, and no floor/ceiling effects. In different countries, there were different socio-demographic and personal factors with different associations with health literacy; e.g., in total sample, HL was influenced by five factors in Indonesia, by nine factors in Kazakhstan, by six factors in Myanmar, eight factors in Taiwan, and by four factors in Vietnam. Among those factors, “ability to pay for medication” and “viewing health related television programs” were strongly associated with HL in different groups in all countries, interaction between education and watching health related TV programs was found. In most countries, higher health literacy was linked to better health status, more exercise, having an accompany to visit doctor, online registration, less long-term illness, less physical limitation, less likely to smoke, and less health service utilizations. There was no association between HL and emergency service use. Health literacy was found to modify the association between age and health status, and between long-term illness and physical limitation. A 12-item short-form questionnaire (HL-SF12) was developed, retaining the conceptual framework. It was shown with adequate psychometric properties in six countries, including satisfied goodness of it indices, high internal consistency reliability, good criterion-related validity, moderate and high level of item-scale convergent validity, and without floor or ceiling effect. Associations between specific socio-demographics with HL measured by the full-form was also noted by the short-form. The HL-SF12 was validated in patients with high internal consistency, moderately correlated with single item SBSQ, with satisfactory item-scale convergent validity without floor/ceiling effect, and with satisfactory goodness-of-fit-indices of three-factor construct model for most of the patients. Results showed that health literacy was not associated with department visited. It was associated with gender, income, health-related TV viewing, and linked to health outcomes, and frequency of doing exercise. Income and watching health related TV programs were found as modifiers of the association between age and health literacy. There was no association observed between HL and healthcare accessibility and utilization in this patient population. Conclusions: This study introduced a comprehensive survey tool to Asian context, and suggested to use the universal tool for international studies. Importantly, findings provided convincing evidences to health care providers, policy makers, and governments to have properly strategies to improve people health literacy, and in turns, more effective performances of healthcare system, and better health outcomes.
參考文獻
延伸閱讀
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