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研究生: 王桂芸
論文名稱: 氣喘病人健康素養與健康結果之因果模式驗證
Validation of the Causal Model Linking Health Literacy to Health Outcomes of Asthma Patients
指導教授: 賴香如
學位類別: 博士
Doctor
系所名稱: 健康促進與衛生教育學系
Department of Health Promotion and Health Education
論文出版年: 2010
畢業學年度: 98
語文別: 中文
論文頁數: 177
中文關鍵詞: 氣喘病人健康素養健康結果因果模式
英文關鍵詞: asthma patients, health literacy, health outcomes, causal model
論文種類: 學術論文
相關次數: 點閱:750下載:45
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  • 背景及研究目的
    全球氣喘協會 (Global Initiative for Asthma) 於2004年預估,到2025年世界人口中罹患氣喘人數將增加45-59%,故氣喘將成為全球一項重要健康議題。目前國內尚未見氣喘病人健康素養之資料,而相關研究顯示氣喘病人的健康素養與健康結果有關,但並未證實兩者的因果關係,故本研究之目的是驗證健康素養與健康結果的因果模式。
    研究方法
    本研究為一橫斷式調查研究(Cross-sectional survey research),以至北部三所醫學中心及一所區域教學醫院胸腔內科門診就診之20歲以上氣喘病人為對象,共收案300人。以問卷收集社會人口學、疾病特性、健康素養、醫療決策、氣喘知識、態度和自我效能、接受健康照護經驗,以及健康結果 (MDI使用技能、醫療資源利用及自我管理行為) 等資料,再採SPSS 15.0 版之結構方程式驗證健康素養對健康結果之直接效應及中介效應因果模式,並以P< .05為統計上的顯著水準。

    結果
    健康素養之平均值為80.43(滿分120),其中不足者佔13.67%、邊緣者13.33%、而足夠者佔73%。健康素養與健康結果的直接效應模式不成立,但加入社會人口學及疾病特性變項後,健康素養對健康結果之MDI使用技能具直接效果。另,不論是否加入社會人口學及疾病特性變項,健康素養會經由中介變項對健康結果產生間接效果。
    結論
    本研究顯示,研究對象的健康素養與健康結果間有因果關係,包括直接效應及間接效應模式,但解釋力不高,顯示可能尚有具影響力之變項未置入模式中,值得未來繼續探究。然本研究為驗證兩者因果模式之第一項研究,故可作為相關研究設計和介入措施成效評價之參考。

    Background and Research Purposes
    The Global Initiative for Asthma (GINA) estimated that by 2025 the number of people with asthma will have grown by 45-59% and asthma will become as an important health issue globally. Although the relationship between health literacy and health outcome has been identified in the literature, the health literacy of asthma sufferers in Taiwan and the causal models linking health literacy and health outcomes have yet been adequately explored. This study was to examine the causal model linking health literacy and health outcome.
    Research Methodology
    This study was a cross-sectional survey. Using purposive sampling, we identified and invited potential participants from the thoracic medicine outpatient clinics of three medical centers and one district teaching hospital located in northern Taiwan. Qualified participants were aged 20 or over with a diagnosis of asthma. A total of 300 agreed to participate and were enrolled as subjects. A self-administered questionnaire was used to collect socio-demographics, disease characteristics, knowledge, attitudes and self-efficacy of asthma, medical decision-making, healthcare experience, and health outcome including MDI usage proficiency, medical utilization and self-management behavior. Data was analyzed using SPSS 15.0 software and a structured equation model (SEM) was used to validate the direct and mediating effects of health literacy on health outcomes. Statistical significance was defined as P< .05.
    Results
    The mean value for health literacy was 80.43 (total score = 120) with 13.67%, 13.33% and 73% categorized as “inadequate”, “borderline” or “adequate”, respectively. The direct effect of health literacy on health outcome was not supported. However, after considering socio-demographics and disease characteristics, the direct effect of health literacy on MDI usage proficiency was supported. Regardless of socio-demographic and disease characteristics, health literacy was found to have an indirect effect via mediated variables on the health outcomes of MDI usage proficiency, medical utilization and self-management behavior.
    Conclusions
    There was a causal relationship between between health literacy and health outcomes, both direct and indirect, but the variance explained was not high. The findings suggest that some variables with potentially explanative effects on health outcomes might not include and need to explore. Furthermore, this study was the first validation study to consider this issue. It is hoped that our findings and suggestions may be incorporated into the design of research and the evaluation of intervention effectiveness in the future.

    中文摘要 I 英文摘要 III 誌謝 V 目次 VI 表次 XI 圖次 XV 第一章 緒論 1 第一節 研究動機及重要性 1 第二節 研究目的 5 第三節 待答問題 6 第四節 研究假設 7 第五節 名詞界定 7 第六節 研究限制 10 第二章 文獻探討 11 第一節 氣喘之相關概念 11 第二節 健康素養之相關概念 14 第三節 健康素養相關因素研究 18 第三章 研究方法 34 第一節 研究設計與架構 34 第二節 研究場所及對象 36 第三節 研究工具 37 第四節 實施步驟 45 第五節 資料處理與統計分析 46 第六節 倫理考量 53 第四章 結果 54 第一節 各類變項之分佈情形 54 第二節 社會人口學變項及疾病特性與健康素養之相關分析 57 第三節 健康素養與醫療決策程度、氣喘知識、氣喘態度、氣喘自我效能或接受健康照護之經驗之相關分析 63 第四節 醫療決策、氣喘知識、態度和自我效能、接受健康照護之經驗與健康結果之相關分析 64 第五節 健康素養與健康結果之關係 69 第六節 健康素養與健康結果假定之直接效應模式驗證分析 70 第七節 健康素養與健康結果之中介效應模式驗證分析 78 第五章 討論 107 第一節 健康素養之現況 107 第二節 社會人口學變項與健康素養 107 第三節 疾病特性與健康素養 108 第四節 健康素養與醫療決策、氣喘知識、氣喘態度、氣喘自我效能、接受健康照護之經驗 109 第五節 醫療決策、氣喘知識、氣喘態度、氣喘自我效能或接受健康照護之經驗與健康結果 110 第六節 健康素養與健康結果 111 第七節 健康素養與健康結果的直接效應模式 112 第八節 健康素養與健康結果的中介效應模式 113 第六章 結論與建議 118 第一節 結論 118 第二節 建議 120 參考資料 124 附錄一、初步因素分析結果 137 附錄二、因素分析後保留之題項 139 附錄三、最後因素分析之結果 140 附錄四、健康素養對健康結果假定之直接效應模式 142 附錄五、 加入人口學變項及疾病特性後健康素養對健康結果假定之直接效應模式 143 附錄六、第一次模式修正圖 144 附錄七、第二次模式修正圖 145 附錄八、第三次模式修正圖(最終模式) 146 附錄九、健康素養與健康結果假定之中介效應模式 147 附錄十、第一次模式修正圖 148 附錄十一、第二次模式修正圖 149 附錄十二、第三次模式修正圖 150 附錄十三、第四次模式修正圖 151 附錄十四、第五次模式修正圖 152 附錄十五、第六次模式修正圖 153 附錄十六、第七次模式修正圖 154 附錄十七、第八次模式修正圖 155 附錄十八、第九次模式修正圖 156 附錄十九、第十次模式修正圖 157 附錄二十、第十一次模式修正圖 158 附錄二十一、第十二次模式修正圖 159 附錄二十二、第十三次模式修正圖(最終模式) 160 附錄二十三、人口學變項、疾病特性、健康素養透過中介變項與健康結果關係假定之中介效應模式 161 附錄二十四、第一次模式修正圖 162 附錄二十五、第二次模式修正圖 163 附錄二十六、第三次模式修正圖 164 附錄二十七、第四次模式修正圖 165 附錄二十八、第五次模式修正圖 166 附錄二十九、第六次模式修正圖 167 附錄三十、第七次模式修正圖 168 附錄三十一、第八次模式修正圖 169 附錄三十二、第九次模式修正圖 170 附錄三十三、第十次模式修正圖 171 附錄三十四、第十一次模式修正圖 172 附錄三十五、第十二次模式修正圖 173 附錄三十六、第十三次模式修正圖 174 附錄三十七、第十四次模式修正圖 175 附錄三十八、第十五次模式修正圖(最終模式) 176 附錄三十九、問卷內容效度專家名單 177 表1 社會人口學變項之分佈 55 表2 疾病特性之分佈 56 表3 知識、態度、自我效能、接受健康照護之經驗及健康結果得分之分佈 58 表4 人口學變項及疾病特性與健康素養之單迴歸分析 59 表 5 社會人口學變項、疾病特性的容忍度及變異數膨脹因素 60 表 6 社會人口學變項、疾病特性的條件指標 61 表 7 人口學變項及疾病特性與健康素養之多元迴歸分析 62 表8 健康素養與醫療決策、氣喘知識、氣喘態度、氣喘自我效能、接受健康照護之經驗之單迴歸分析 64 表9 醫療決策、氣喘知識、氣喘態度、氣喘自我效能、接受健康照護之經驗與MDI使用技能之單迴歸分析 65 表10 醫療決策、氣喘知識、氣喘態度、氣喘自我效能、接受健康照護之經驗與醫療資源利用之單迴歸分析 65 表11 醫療決策、氣喘知識、氣喘態度、氣喘自我效能、接受健康照護之經驗與自我管理行為之單迴歸分析 66 表12 醫療決策、氣喘知識、態度和自我效能、健康照護經驗之容忍度及變異數膨脹因素 67 表13 醫療決策、氣喘知識、態度和自我效能、健康照護經驗之條件指標 67 表14 醫療決策、氣喘知識、氣喘態度、氣喘自我效能、接受健康照護之經驗與MDI使用技能之多元迴歸分析 68 表15 醫療決策、氣喘知識、氣喘態度、氣喘自我效能、接受健康照護之經驗與醫療資源利用之多元迴歸分析 68 表16 醫療決策、氣喘知識、氣喘態度、氣喘自我效能、接受健康照護之經驗與自我管理行為之多元迴歸分析 69 表17 健康素養與健康結果之單迴歸分析 70 表18 健康素養、自我管理行為、醫療資源利用、及MDI使用技能之常態性檢定 71 表19 年齡、教育程度、氣喘患病年數、共病數、健康素養、MDI 使用技能、及自我管理行為之常態性檢定 73 表20 模式修正適配度指標之比較 74 表21 模式修正過程各變項間之非標準化迴歸係數顯著性機率值 75 表22 各變項間之非標準化迴歸係數值 75 表23 各變項間之標準化迴歸係數 76 表24 各變項間之決定係數 76 表25 標準化殘差的共變數矩陣 77 表26 各變項間之直接效果值 77 表27 各變項間之間接效果值 78 表28 各變項間之整體效果值 78 表29 各變項之常態性檢定 79 表30 模式修正適配度指標之比較 83 表31 模式修正過程各變項間之非標準化迴歸係數顯著性機率值 84 表32 各變項間之非標準化迴歸係數值 85 表33 各變項間之標準化迴歸係數 86 表34 變項間之決定係數 87 表35 標準化殘差的共變數矩陣 88 表36 各變項間之直接效果值 89 表37 各變項間之間接效果值 90 表38 各變項間之整體效果值 91 表39 各變項之常態性檢定 92 表40 模式修正適配度指標之比較 97 表41 模式修正過程各變項間之非標準化迴歸係數顯著性 98 表42 各變項間之非標準化迴歸係數值 99 表43 各變項間之標準化迴歸係數 100 表44 各變項間之決定係數 101 表45 標準化殘差的共變數矩陣 102 表46 各變項間之直接效果值 103 表47 各變項間之間接效果值 104 表48 各變項間之整體效果值 105 圖 1 假定之直接效應模式 35 圖 2 假定之中介效應模式 36

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