作者：Laurie Barclay, MD
出處：WebMD醫學新聞
January 12, 2009 — 根據1/2月家庭醫學年鑑中的一篇研究結果，簡單的篩檢問題有助於預測有限的健康知能(health literacy)。
俄亥俄州立大學醫學院的Kelly Marvin Jeppesen醫師等人寫道，越來越多人認為有限的健康知能是接受適當照護的障礙。確認哪些病患因為有限的健康知能而造成不佳健康結果之風險，是醫師們目前的責任。我們的目標是確認哪些篩檢問題與人口統計項目可以獨立預測有限的健康知能，因而有助於醫師為個別病患提供教育。
這是一個大型研究的一部份，於2006年8月到2007年7月間，在一個學院初級照護診接受治療的225名糖尿病患者，被問及數個有關閱讀能力的問題。回覆率為57%。為了確認這些問題和人口統計變項之獨立預測性質，研究者建立一個邏輯回歸模式來預測有限的健康知能。
評估作為有限健康知能的潛在預測因素，包括自我評估的閱讀能力、最高學歷、單項素養篩檢(Single-Item Literacy Screener，SILS)結果、享受閱讀樂趣、年紀、性別和種族。
有限之健康知能的定義為，成人功能性健康知能測驗簡短版(S-TOFHLA)分數小於23，總共有15.1%的病患屬之。五個造成有限健康知能的獨立因素包括自我評估閱讀能力不佳 (在該模式中每增加1分的勝算比(odds ratio [OR] )為3.37; 95%信心區間[CI]為1.71 – 6.63)、閱讀書面健康資料時經常需要幫助(以SILS測量; OR為2.03; 95% CI為1.26 – 3.26)、教育程度低(OR為1.89; 95% CI為1.12 – 3.18)、男性(OR為4.46; 95% CI為1.53 – 12.99)以及白人以外種族(OR為3.73; 95% CI為1.04 – 13.40)。
年紀與其無關。接受器操作特性曲線的曲線下面積為0.9212。
研究限制包括缺乏該機構之糖尿病患以外的一般性、參與此研究的病患比拒絕參加者年輕、使用S-TOFHLA作為健康知能的參考標準、可能有病患對於一些素養方面的問題有困難。
研究作者寫道，自我評估的閱讀能力、SILS結果、最高學歷、性別與種族可獨立預測病患是否屬於有限的健康知能；醫師應對這些關聯有所警覺，且對高風險病患提出問題。
俄亥俄州立大學Crisafi-Monte心肺初級照護捐贈基金以及隸屬國家健康研究中心的國家研究資源中心資助本研究。作者之一擔任輝瑞藥廠的發言人。
Screening Questions May Help Predict Limited Health Literacy
By Laurie Barclay, MD
Medscape Medical News
January 12, 2009 — Simple screening questions may help predict limited health literacy, according to the results of a study in the January/February issue of Annals of Family Medicine.
"Limited health literacy is increasingly recognized as a barrier to receiving adequate health care," write Kelly Marvin Jeppesen, MPH, from the Ohio State University College of Medicine in Columbus, and colleagues. "Identifying patients at risk of poor health outcomes secondary to limited health literacy is currently the responsibility of clinicians. Our objective was to identify which screening questions and demographics independently predict limited health literacy and could thus help clinicians individualize their patient education."
As part of a larger study, 225 patients being treated for diabetes at an academic primary care office between August 2006 and July 2007 were asked several questions regarding their reading ability. Response rate was 57%. To determine the independent predictive properties of these questions and demographic variables, the investigators built a logistic regression model predicting limited health literacy.
Factors evaluated as potential predictors of limited health literacy were self-rated reading ability, highest education level attained, Single-Item Literacy Screener (SILS) result, reading enjoyment, age, sex, and race.
Limited health literacy, defined as a Short Test of Functional Health Literacy in Adults (S-TOFHLA) score of less than 23, was present in 15.1% of the patients. Five factors independently associated with increased odds of having limited health literacy were poorer self-rated reading ability (odds ratio [OR] per point increase in the model, 3.37; 95% confidence interval [CI], 1.71 – 6.63), more often needed help reading written health materials (measured by the SILS; OR, 2.03; 95% CI, 1.26 – 3.26), lower education level (OR, 1.89; 95% CI, 1.12 – 3.18), male sex (OR, 4.46; 95% CI, 1.53 – 12.99), and nonwhite race (OR, 3.73; 95% CI, 1.04 – 13.40).
Age did not confound these associations. Area under the receiver operating characteristic curve was 0.9212.
Study limitations include lack of generalizability beyond patients treated for diabetes at a single academic family practice center, that patients who participated in this study were generally younger than patients who refused to participate, the use of the S-TOFHLA as the reference standard for health literacy, and possible patient embarrassment regarding some of the literacy questions.
"Self-rated reading ability, SILS result, highest education level attained, sex, and race independently predict whether a patient has limited health literacy," the study authors write. "Clinicians should be aware of these associations and ask questions to identify patients at risk."
The Ohio State University Crisafi-Monte Primary Care Cardiopulmonary Endowment and the National Center for Research Resources, a component of the National Institutes of Health, funded this study. One of the authors is on the speaker's bureau for Pfizer Inc.
Ann Fam Med. 2009;7:24–31. |
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