醫師健康識能專業知能指標建構與評估工具發展之研究

研究背景及目的：本研究立基於健康識能之觀點，建構醫師健康識能專業知能之概念、內涵與指標，發展專業知能評估工具，以促進醫療資源提供者適時關注、掌握與因應病人健康識能，從而進行良好的醫病溝通，協助病人有效運用醫療資源，促進醫療品質。研究方法：本研究彙整文獻制訂訪談要點後，進行包括醫師、醫學生與病友等三組共21人之三場次焦點團體訪談，與由13位專家協助進行之修正型德菲法三回合調查，完成醫師健康識能專業知能指標制訂；再依據指標對應發展問卷，經專家內容效度檢驗分析，預試後立意取樣國內三所醫學院醫學系學生為對象，利用網路問卷收集資料後進行探索性因素分析(N=127)與驗證性因素分析(N=203)，完成醫師健康識能專業知能評估量表之編製。研究結果：經由焦點團體訪談與修正型德菲法調查後，將醫師健康識能專業知能區分為「概念與評估」、「接納與尊重」、「溝通與互動」及「醫療資訊與決策」等四面向、13次面向、44項指標，再依據相關指標對應制訂問卷47題，進行專家內容效度檢驗研析後題目全數保留，問卷採取預試與正式施測等二階段收案，經項目分析與相關係數分析顯示內部一致性良好，探索性因素分析刪除15題，驗證性因素分析刪除5題，最後完成「醫師健康識能專業知能量表」編製。研究結論：本研究建構之醫師健康識能專業知能指標與量表可作為未來規劃醫師與醫學生健康識能專業知能相關職前與在職教育訓練課程之依據，藉此評估與深化醫療資源提供者個人知識、態度與技能程度，以利醫師扮演健康識能評估者、接納者、規畫者及導引者之角色，並據以發展醫學教育創意教學模組，深化醫師健康識能專業知能。

關鍵字

健康識能；醫師；醫學生；醫病關係；醫療資源；焦點團體；修正型德菲法

並列摘要

Background and objectives: This study was based on health literacy perspectives. The concept, content, and indicators of the physician’s professional competence in health literacy were constructed, and a professional competence assessment tool was developed. This study aimed to enhance healthcare providers’ attentiveness, understanding, and response toward patients’ health literacy. This would improve physician-patient communication and facilitate the effective use of medical resources by patients, thereby promoting medical care quality. Methods: A literature review was conducted to help formulate key points for the interviews. Subsequently, 3 focus group interviews involving 21 physicians, medical students, and patients were conducted. Using the modified Delphi method, 3 rounds of surveys were completed by 13 experts, and the indicators for the physician’s professional competence on health literacy were formulated. Next, a questionnaire based on the corresponding indicators was developed, and the experts analyzed the content validity. Following pretesting, a sample of medical students from 3 national medical schools in Taiwan was selected. Data were collected using an online questionnaire. Exploratory factor analysis (N=127) and confirmatory factor analysis (N=203) were performed to complete the development of the physician’s professional competence on health literacy assessment scale. Results: Following the focus group interviews and the modified Delphi rounds, the physician’s professional competence on health literacy were categorized into 4 aspects, 13 sub-aspects, and 44 indicators. Specifically, the 4 aspects were “concept and evaluation,” “acceptance and respect,” “communication and interaction,” and “medical information and decision-making.” A 47-item questionnaire was created based on the corresponding indicators. All questions were retained after the content validity was analyzed by experts. The questionnaire was tested in 2 stages—pretesting and formal testing. Item analysis and correlation analysis revealed good internal consistency of the questionnaire. About 15 questions were removed after exploratory factor analysis, and 5 questions were removed after confirmatory factor analysis. Finally, the “Physician’s Professional Competence on Health Literacy Scale” was established. Conclusions: The indicators and scale for evaluating the physician’s professional competence on health literacy established in this study can be used as a foundation for developing relevant pre-employment and on-the-job training programs for physicians and medical students. They may be used to assess and enhance healthcare providers’ knowledge, attitudes, and skills. This will be beneficial to physicians as they evaluate, accept, plan, and guide health literacy matters. Furthermore, the established indicators and scale may serve as a basis for the development of creative teaching modules for use in medical education to increase the physicians’ professional competence in health literacy.