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。

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.

一、中文部分
王英偉、魏米秀、張美娟（2017）。健康識能與醫病共享決策。醫療品質雜誌，11(4)，42-49。
王亭惠等（2017）。角色扮演：醫病溝通工作坊。物理治療，42(2)，155-156。
朱正一、曾稼志（2011）。骨科手術病人之健康知能、知覺同理心、術前資訊理解程度與術前焦慮之探討。醫務管理期刊，12(3)，177-190。
朱宗信（2009）。ACGME六大核心能力於一般醫學教育。醫療品質雜誌，3(3)，75-78。
行政院衛生署（1992）。衛署醫字第8156514號函釋。取自https://www.legis-pedia.com/dictionary/75。
行政院衛生福利部（2017）。105年全民健康保險醫療統計。台北市：行政院衛生福利部。
行政院衛生福利部（2019）。108年衛生福利部新聞。取自https://www.mohw.gov.tw/cp-4251-50316-1.html。
余民寧、李仁豪（2008）。調查方式與議題熟悉度對問卷回收率與內容的影響，教育學刊，30，101-140。
李守義、蔡慈儀、蔡憶文、郭耿南（2012）。「中文健康識能評估量表」簡式量表的發展與效度檢測。台灣公共衛生雜誌，31(2)，184-194。
李明濱、謝博生（1999）。醫學生之醫療態度教育。醫學教育，3(1)，1-2。
李宜致、吳偉立、李佳珂、林陽助（2012）。大學生健康知能與健康行為之研究。清雲學報，32(3)，51-63。
李錦虹、邱浩彰、陳亭君（2015）。臨床醫師的醫病溝通技巧之質性分析。台灣醫學，19(6)：569-580。
李懿倫（2008）。慢性病病人之成人健康知能程度與醫療資源利用相關性之研究(未出版之碩士在職專班學位論文)。高雄醫學大學醫務管理學研究所，高雄市。
周怡伶、陳鈺如、李彩緣（2010）。降低住院期間醫病溝通之訊息傳遞不正確率。中山醫學雜誌，21(4)，435-446。
周迺寬、王水深、周玲玲、陳宜君、林明燦、李伯皇、侯勝茂（2004）。門診醫病關係初探—醫學生在「醫師與人文」課程之問題導向學習。醫學教育，8(2)，159-167。
邱雅純、陳膺嵩、蔡敏玲（2013）。健康照護矩陣在臨床教學之實作。The Journal of Taiwan Pharmacy，29(4)，16-21。
林慧如、林育志、賴春生、王心運（2011）。健康照護矩陣與病人安全。Journal of Crisis Management，8(2)，33-36。
孫嘉慧、林秋菊（2014）。運用健康知能概念促進慢性腎臟病患者自我管理。護理雜誌，61(1)，105-110。
郭年真、江東亮、賴美淑（2014）。二代健保改革。台灣醫學，18(1)，43-52。
郭峰淵、曾繁絹、劉家儀（2006）。從社會認知觀點探討醫師專業知識分享。圖書資訊學刊，4(1/2)，97-114。
張美娟（2018a）。健康識能之概念發展與實務應用。行政院國民健康署專案研究計畫成果報告。台北市，國立臺灣師範大學。
張美娟（2018b）。健康識能友善教材指標。社團法人臺灣健康醫學會：2018年健康促進醫院輔導工作坊，台北市。
張苙雲（2014）。全民健保的組織社會學。台灣醫學，18(1)，85-91。
張偉豪（2011）。SEM論文寫作不求人（第一版）。高雄：鼎茂圖書出版股份有限公司。
章美英、許麗齡（2006）。質性研究-焦點團體訪談法之簡介與應用。護理雜誌，53(2)，67-72。
陳偉德（2011）。健康照護矩陣（Healthcare matrix）簡介。醫療品質雜誌，5(2)，76-80。
陳麗琴（2018）。倫理教師之教育工作坊。高雄市立大同醫院：教育工作坊，高雄市。
許維邦、張瑞月、呂美君、周明智、蕭培靜（2015）。共同決策於臨床醫學之應用。澄清醫護管理雜誌，11，24-29。
黃朝新、陳秋文、余昆宏、林旭志（2016）。健康照護矩陣應用於跨領域照護團隊運作之經驗。醫院，49(2)，40-49。
黃煌雄、沈美真、劉興善(2012)。全民健保總體檢。臺北市：五南。
趙康邑、王實之、黃遵誠、翁林仲、李光申、璩大成、朱昭美、劉嘉仁、黃勝堅（2017）。北市聯醫推廣健康識能之現況。北市醫學雜誌，14(2)，96-105。
趙康邑、朱昭美、黃勝堅、翁林仲、李光申、璩大成、劉嘉仁、黃遵誠（2018）。當代國際健康識能發展趨勢。北市醫學雜誌，15(SP)，78-87。
葉蓉慧、連吉時（2011）。由台灣民眾的就醫經驗探討病患如何減低不確定感。傳播與社會學刊，2011(17)，61-85。
劉潔心、廖梨伶、施淑芳、張子超、紀雪雲、Richard H Osborn（2014）。台灣學童健康素養測驗之發展與測量。台灣衛誌，33(3)，251-270。
蔡慈儀、李守義、蔡憶文、郭耿南（2010）。中文健康識能評估表的發展與測試。醫學教育，14(2)，122-136。
賴香如（2018）。青少年健康素養：理論、研究與學校實務。國立臺灣師範大學出版中心。
魏米秀、王英偉、張美娟、謝至鎠（2017）。中文多面向健康識能量表（MMHLQ）之發展。台灣公共衛生雜誌，36(6)，556-570。
蘇哲能等（2008）。台灣健康知能量表之初探性研究。台灣醫學，12(5)，525- 536。

二、英文部分
Bagozzi, R. P., & Yi, Y. (1988). On the evaluation of structural equation models.
Journal of the Academy of Marketing Science, 16 (1), 74-94.
Batterham, R.W., et al. (2016). Health literacy: applying current concepts to
improve health services and reduce health inequalities. Public health, 132, 3-12.
Bentler, P. M., & Bonett, D. G. Bonett, D. G. (1980). Significance tests and goodness of fit in the analysis of covariance structures. Psychological Bulletin, 88 (3), 588.
Blank, P.K. (1993). Developing a system of education indicators: Selecting, implementing, and reporting indicator. Educational Evaluation and Policy Analysis,15 (1),65-80.
Chu, C., et al. (2018). ISQUA18-2405 Sharing Decision Making (SDM) Approach Applicable to Whole Hospital-A Medical Center in Northern Taiwan. International Journal for Quality in Health Care, 30 (suppl_2), 23-24.
Cliffford A. Coleman, Amber Fromer (2015). A Health Literacy Training Intervention for Physicians and Other Health professionals. Family Medicine, 47 (5), 388-392.
Clifford A. Coleman, Shannon Appy (2012). Health Literacy Teaching in US Medical Schools 2010. Family Medicine , 44 (7), 504-507.
Clifford A. Coleman, Sylvia Peterson-Perry, Tracy Bumsted (2016). Long-Term Effects of a Health Literacy Curriculum for Medical Students. Family Medicine ,48 (1), 49-53.
Cohen, R. J., Swerdlik, M. E., & Phillips, S. M. (2005). Psychological testing and assessment: An introduction to tests and measurement (6ed.). Mayfield Publishing Co.
Coleman, C.A. & A. Fromer (2015). A health literacy training intervention for physicians and other health professionals. Fam Med, 47 (5), 388-92.
Coleman, C.A. & S. Appy (2012). Health literacy teaching in US medical schools, 2010. Fam Med, 44 (7), 504-7.
Coleman, C.A., S. Hudson, & L.L. Maine (2013).Health literacy practices and educational competencies for health professionals: a consensus study. Journal of health communication, 18 (sup1), 82-102.
Coleman, C.A., S. Peterson-Perry, & T. Bumsted (2016). Long-term effects of a health literacy curriculum for medical students. Family medicine, 48 (1), 49-53.
Comery, AL., & Lee, H. B. (2013). A first course in factor analysis. Psychology Press.
Costello, A., & Osborne, J. (2005). Best practices in exploratory factor analysis: Four recommendations for getting the most from your analysis. Pract Asses,Res Eval.Practical Assessment, Research & Evaluation, 10 (7), 1-9.
De Neufville, J. I., & Innes, J. E. (1975). Social indicators and public policy: Interactive processes of design and application. Amsterdam; New York: Elsevier
Scientific Publishing Company.
DeVellis, R. F. (2016). Scale development: Theory and applications (Vol.26).Thousand Oaks, CA: Sage publications.
DeWalt, D.A. & A. Hink (2009). Health literacy and child health outcomes: a systematic review of the literature. Pediatrics, 124 (Supplement 3), S265-S274.
DeWalt, D.A., et al. (2010). Health literacy universal precautions toolkit. Rockville, MD: Agency for Healthcare Research and Quality, 1-227.
Dickens, C., et al. (2013). Nurse overestimation of patients' health literacy. Journal of health communication, 2013. 18 (sup1): 62-69.
Duong, V.T. et al. (2015). Health literacy in Taiwan: a population-based study. Asia Pacific Journal of Public Health, 27 (8), 871-880.
Fornell, C., & Larcker, D. F. (1981). Evaluating structural equation models with unobservable variables and measurement error. Journal of Marketing Research,18 (1), 39-50.
Freedman, D.A., et al. (2009). Public health literacy defined. American journal of preventive medicine, 2009. 36 (5): 446-451.
Hair, J. F., Black, W. C., Babin, B. J., & Anderson, R. E. (2009). Multivariate data Analysis (7th ed.). Harlow, United Kingdom: Pearson Education Limited.
Hair, J. F., Black, W. C., Babin, B. J., & Anderson, R. E. & Tatham, R. L. (2006).
Multivariate data analysis (6th ed.). New Jersey, US: Prentice-Hall.
Kaiser, H. F. (1974). An index of factorial simplicity. Psychometrika, 39 (1), 31-36.
Jean Hess,et al. (2009). Making health literacy real:aldult literacy and medical students teach each other. J Med Libr Asssoc, 97 (3), 221-224.
Julienne K Kirk, Stephen W Davis, Jade Hairston, Kathryn Melius, & Gail S Marion (2015). Medical Student Health Literacy Perspectives and Experience. J Fam Med Dis Prev ,1(4), 1-5.
Kaper, M.S., et al. (2020). Effectiveness of a Comprehensive Health Literacy Consultation Skills Training for Undergraduate Medical Students: A Randomized Controlled Trial. International Journal of Environmental Research and Public Health, 17 (1), 81.
Kickbusch, I., et al. (2013). Health literacy. WHO Regional Office for Europe.
Lamping, D. L., Schroter, S., Marquis, P., Marrel, A., Duprat-LOmon, I., & Sagnier, P.(2002).The community-acquired pneumonia symptom questionnaire: A new, patient-based outcome measure to evaluate symptoms in patients with community-acquired pneumonia. Chest, 122 (3),920-929.
Lee, S.-Y.D., et al. (2010). Health literacy, health status, and healthcare utilization of Taiwanese adults: results from a national survey. BMC public health,10 (1), 614.
Marsh, H. W., Balla, J. R., & McDonald, R. P. (1988). Goodness-of-fit indexes in confirmatory factor analysis: The effect of sample size. Psychological Bulletin,103 (3), 391-410.
Marsh, H. W., & Hocevar, D. (1985). Application of confirmatory factor analysis to the study of self-concept: First-and higher order factor models and their invariance across groups. Psychological Bulletin, 97 (3),562-582.
Nuttall, D.L.(1990). The functions and limitations of international education indicators. Paper presented at the Annual Meeting of the American educational research Association, Boston.
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.
Odden, A. (1990). Educational indicators in the United States: The need for analysis. Educational Researcher,June-July,24-29.
Organization, W.H. (2013), Health literacy: The solid facts.
Osborne, R.H., et al. (2013). The grounded psychometric development and initial validation of the Health Literacy Questionnaire (HLQ). BMC public health, 13 (1), 658.
Pollard, J. S. (1989). Developing useful educational indicator systems: Insights on educational policy and practice. (EDRS Document Reproduction Service No. ED330056.)
Potery, L. G., Watkins, M. P. (2000). Foundations of clinical research applications to practice. New Jersey, US: Prentice Hall.
Safeer, R.S. & J. Keenan (2005). Health literacy: the gap between physicians and patients. American family physician, 72 (3), 463-468
Schillinger, D., et al. (2003). Closing the loop: physician communication with diabetic patients who have low health literacy. Archives of internal medicine, 163 (1), 83-90.
Sørensen, K., et al. (2013). Measuring health literacy in populations: illuminating the design and development process of the European Health Literacy Survey Questionnaire (HLS-EU-Q). BMC public health, 13 (1), 948.
Stevenson, F.A., et al. (2007). Information from the Internet and the doctor-patient relationship: the patient perspective–a qualitative study. BMC family practice, 8 (1), 47.
Sudore, R.L., et al. (2006). Limited literacy and mortality in the elderly. Journal of general internal medicine, 21 (8), 806-812.
Sunil Kripalani, Kara L. Jacobson, Samatha Brown, Kimberly Manning, Kimberly J. Rask, & Terry A. Jacobson (2006). Development and Implementation of a Health Literacy Training Program for Medical Residents. Medical Education Online, 11 (13), 1-8.
Volandes, A.E. & M.K. Paasche-Orlow (2007). Health literacy, health inequality and adjust healthcare system. The American Journal of Bioethics, 7 (11), 5-10.
Waltz, C. F., Strickland, O., & Lenz, E. R. (2016).Measurement iin nursing and health research (5th ed.). New York, US: Spring Publishing Company.
Weiner, S. & A. Schwartz (2015). Listening for what matters: avoiding contextual errors in health care. Oxford University Press.
William Harper, Sandy Cook, Gregory Makoul (2007). Teaching Medical Students About Health Literacy : 2 Chicago Initiatives. Am J Health Behav. , 31(Suppl 1), S111-S114.
Williams, M.V., et al. (2002). The role of health literacy in patient-physician communication . FAMILY MEDICINE-KANSAS CITY , 34 (5), 383-389.
Yan Zhang, Fan Zhang, Ping Hu, Wenjie Huang, Lu Lu, Rulxue Bai, Manoj Sharma, & Yong Zhao (2016). Exploring Health Literacy in Medical University Students of Chongqing, China: A Cross-Sectional Study. PLOS ONE, 11 (4), 1-10.
Zarcadoolas, C., A. Pleasant, & D.S. Greer (2009). Advancing health literacy: A framework for understanding and action. Vol. 45. 2009: John Wiley & Sons.