本研究之目的在發展臺灣地區高中職學生用藥素養評量工具，並調查臺灣高中職學生的用藥素養、用藥行為的現況，以及探討用藥素養對用藥行為之預測情形。本研究採先質性後量性研究的方式進行。第一階段以焦點團體訪談方法蒐集高中職學生之用藥相關資訊，做為發展用藥素養評量題組之依據，以104學年度第二學期全國高中職學生研究對象，立意選取5所北部地區高中職學校，計43 名學生參與焦點團體訪談。第二階段量性研究主要在調查高中職學生之用藥素養及正確用藥行為現況，採自填結構式網路調查問卷進行調查，以105學年度第一學期全國高中職學生為研究對象，採等比機率抽樣，全國共26 所高中職學校，計2,250 名學生完成問卷填寫。以多元邏輯斯迴歸分析探討探討個人背景因素、用藥素養對正確用藥行為之預測。本研究發展出具有良好信度與效度，以生活情境運用藥袋、藥盒、說明書（仿單）及藥品廣告單等輔助評量之高中職學生用藥素養評量工具。高中職學生用藥素養調查發現，有67.77%的學生處於邊緣或不足素養程度，以評量工具而言，學生在藥盒及說明書（仿單）使用的素養是最差的，若以素養層面而言，學生的批判性用藥素養層面最不好。用藥行為調查結果發現，竟有約半數的學生不會留意居家附近的診所、藥局的位置及電話，約二成的學生曾以不當方式購藥，約一成的學生用藥前不會閱讀使用說明，且約二成的學生曾自行增加藥量且超過說明書的建議。以多元邏輯斯迴歸分析結果發現，用藥素養、學制、性別、年級及家庭經濟狀況等因素與高中職學生之正確用藥行為有顯著相關。因此建議學校能以本研究發展之評量工具檢測學生之用藥素養程度，再依照學生用藥素養程度授以適合的正確用藥教育課程，達到最好的教育成效。

The objectives of this study were to develop the medication literacy assessment instrument and survey of medication literacy and behavior of medication use among the high school students in Taiwan. In addition, we also investigated the association of medication literacy with the behavior of appropriate medication use was investigated among high school students.
In this study, qualitative and quantitative research methods were used. The focus group interview was used to collect the issue about medication use among high school students, as the reference for the development of medication literacy assessment instrument. After the medication literacy assessment tool has been developed, the medication literacy and behavior of appropriate medication use among high school students were surveyed by the questionnaire. There were 43students from 5 Senior/Vocational high schools in the Greater Taipei who were be purposively sampled to conduct the focus group interview in 2015. The online questionnaire was used and there were 2250 students from 26 Senior/Vocational high schools completed the survey in 2016. Multiple logistic regression analysis was used to examine factors related to the behavior of appropriate medication use.
The main findings in this study were as follows. First, a real-life medication literacy assessment tool was been developed, and the reliability and validity were good. Second, 67.77% high school students had inadequate and marginally adequate medication literacy. Generally, the literacy to use the information in the medication package/label and literacy of medication advertisement and the critical medication literacy were inadequate among high school students. Third, the behavior to appropriate use of non-prescription drugs should be enhanced. Fourth, medication literacy, school type, gender, grade, household income were the predictive variable of the behavior of appropriate medication use among high school students.
It is suggested that medication literacy of students should be assessed by this assessment instrument and the education programs should be practiced according to the level of medication literacy among students.

一、中文部分
王惠珀 （2011）。從用藥安全到用藥安全環境建構。藥學雜誌，27（1），2-9。
白淑英、陳育傑、黃莉蓉、鄧新棠 （2008）。基隆市藥師參與社區民眾用藥行為之調查與分析。藥學雜誌，24（4），30-38。
吳肖琪、朱育增、朱婉兒 （2010）。社區藥事照護與推展-兼論醫療團隊之角色。長期照護雜誌，14（1），89-97。
李育姍 （2014）。家長健康素養對學童健康素養及健康行為之影響（未出版碩士論文）。國立臺灣師範大學，臺北市。
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。 doi:10.7049/jcyu.20120701.0051
周雅容 （1997）。焦點團體法在調查研究上的應用。調查研究-方法與應用，3，51-73。
林陳麗蓉、張鳳琴、李景美、紀雪雲（2016）。臺灣某國小學生正確用藥教育介入成效之探討。學校衛生（69），87-111。
紀雪雲 （2012）。安全用藥,從小紮根-用藥安全推廣在校園。醫療品質雜誌，6（2），24-29。
教育部統計處（2016）。各級學校基本資料。臺北市：教育部。取自http://depart.moe.edu.tw/ED4500/News.aspx?n=5A930C32CC6C3818&sms=91B3AAE8C6388B96
國家衛生研究院 （2011）。2009年國民健康訪問暨藥物濫用調查結果報告No.1國民健康訪問調查。苗栗縣：國家衛生研究院。
國家衛生研究院 （2016）。2013年「國民健康訪問調查」結果報告。苗栗縣：國家衛生研究院。
張美娟 （2009）。健康素養與健康照護。志為護理-慈濟護理雜誌，8（3），65-69。
童雅玲 （2008）。慢性病患者之成人健康知能程度與用藥安全認知之探討—以高雄縣某地區醫院為例（未出版碩士論文）。高雄醫學大學，高雄市。
楊俊龍、張鳳琴、紀雪雲、黃莉蓉 （2015）。台灣地區高中職學生正確使用止痛藥知識、態度與行為之研究。台灣公共衛生雜誌，34（1），61-73。 doi:10.6288/tjph201534103081
廖建彰、張祐剛、陳秀熙、呂宗烟、黃鈴雅、宋鴻樟 （2006）。台灣地區民眾抗生素認知與用藥行為。臺灣公共衛生雜誌，25（2），135-142。
廖書涵 （2015）。臺灣地區高中職學生正確使用制酸劑知識、效能及藥袋素養之研究（未出版碩士論文）。國立臺灣師範大學，臺北市。
劉潔心、廖梨伶、施淑芳、張子超、紀雪雲、Osborne, R. H. （2014）。台灣學童健康素養測驗之發展與測量。台灣公共衛生雜誌，33（3），251-270。 doi:10.6288/tjph201433102105
衛生福利部 （2016a）。104年度全民健康保險醫療統計年報。臺北市：衛生福利部編印。
衛生福利部 （2016b）。中華民國105年版衛生福利年報。臺北市：衛生福利部編印。
衛生福利部食品藥物管理署 （2015）。104年度「推廣校園正確用藥教育模式」成果報告。

二、英文部分
Aspden, P., Wolcott, J. A., Bootman, J. L., & Cronenwett, L. R. （2007）. Preventing medication errors: National Acad. Press.
Berkman, N. D., Sheridan, S. L., Donahue, K. E., Halpern, D. J., & Crotty, K. （2011）. Low health literacy and health outcomes: An updated systematic review. Ann Intern Med, 155（2）, 97-107. doi:10.7326/0003-4819-155-2-201107190-00005
Chang, F. C., Chi, H. Y., Huang, L. J., Lee, C. H., Yang, J. L., & Yeh, M. K. （2015）. Developing school-pharmacist partnerships to enhance correct medication use and pain medication literacy in Taiwan. J Am Pharm Assoc （2003）, 55（6）, 595-602. doi:10.1331/JAPhA.2015.15053
Chang, L.C.（2011）. Health literacy, self-reported status and health promoting behaviours for adolescents in Taiwan. Journal of Clinical Nursing, 20（1-2）, 190-196. doi:10.1111/j.1365-2702.2009.03181.x
Chi, H.Y., Chang, F.C., Lin, H.J., Huang, L.J., Chang, J.C., Yeh, M.K., & Kang, J.J. （2014）. Evaluation of a health-promoting school program to enhance correct medication use in Taiwan. Journal of Food and Drug Analysis, 22（2）, 271-278.
Chisolm, D. J., & Buchanan, L. （2007）. Measuring adolescent functional health literacy: a pilot validation of the Test of Functional Health Literacy in Adults. J Adolesc Health, 41（3）, 312-314. doi:10.1016/j.jadohealth.2007.04.015
Darnis, D., Mahe, J., Vrignaud, B., Guen, C. G., Veyrac, G., & Jolliet, P. （2015）. Adverse Drug Reactions in Pediatric Emergency Medicine. Ann Pharmacother, 49（12）, 1298-1304. doi:10.1177/1060028015602904
Davis, T. C., Wolf, M. S., Bass, I. I. I. P. F., Thompson, J. A., Tilson, H. H., Neuberger, M., & Parker, R. M. （2006）. Literacy and Misunderstanding Prescription Drug Labels. Annals of Internal Medicine, 145（12）, 887-894. doi:10.7326/0003-4819-145-12-200612190-00144
DeWalt, D. A., Berkman, N. D., Sheridan, S., Lohr, K. N., & Pignone, M. P. （2004）. Literacy and Health Outcomes. Journal of General Internal Medicine, 19（12）, 1228-1239. doi:10.1111/j.1525-1497.2004.40153.x
DiPiro, J. T., Talbert, R. L., Yee, G. C., Wells, B. G., & Posey, L. M. （2014）. Pharmacotherapy A Pathophysiologic Approach 9/E: McGraw-Hill Education.
Donaldson, M. S., Corrigan, J. M., & Kohn, L. T. （2000）. To err is human: Building a safer health system （Vol. 6）: National Academies Press.
Du, Y., & Knopf, H. （2009）. Self-medication among children and adolescents in Germany: Results of the National Health Survey for Children and Adolescents （KiGGS）. Br J Clin Pharmacol, 68（4）, 599-608. doi:10.1111/j.1365-2125.2009.03477.x
Gualano, M. R., Bert, F., Passi, S., Stillo, M., Galis, V., Manzoli, L., & Siliquini, R. （2015）. Use of self-medication among adolescents: A systematic review and meta-analysis. European Journal of Public Health, 25（3）, 444-450. doi:10.1093/eurpub/cku207
Haun, J. N., Valerio, M. A., McCormack, L. A., Sorensen, K., & Paasche-Orlow, M. K. （2014）. Health literacy measurement: an inventory and descriptive summary of 51 instruments. J Health Commun, 19 Suppl 2, 302-333. doi:10.1080/10810730.2014.936571
Horvat, N., Vidic, L., & Kos, M. （2017）. Development and content validation of Medication Literacy Assessment Questionnaire. Paper presented at the International Journal of Clinical Pharmacy.
Hsiao, F.Y., Lee, J.A., Huang, W.F., Chen, S.M., & Chen, H.-Y. （2006）. Survey of Medication Knowledge and Behaviors Among College Students in Taiwan. Am J Pharm Educ, 70（2）, 30.
Hughes, C. M., McElnay, J. C., & Fleming, G. F. （2001）. Benefits and Risks of Self Medication. Drug Safety, 24（14）, 1027-1037. doi:10.2165/00002018-200124140-00002
Hughes, G. F. （2000）. Drug Abuse and Misuse: A Community Pharmacy Perspective: Queen's University of Belfast.
James, H., Handu, S. S., Al Khaja, K. A., Otoom, S., & Sequeira, R. P. （2006）. Evaluation of the knowledge, attitude and practice of self-medication among first-year medical students. Med Princ Pract, 15（4）, 270-275. doi:10.1159/000092989
James, J. T. （2013）. A new, evidence-based estimate of patient harms associated with hospital care. J Patient Saf, 9（3）, 122-128. doi:10.1097/PTS.0b013e3182948a69
Johnston, L. D., O’Malley, P. M., Bachman, J. G., & Schulenberg, J. E. （2012）. Monitoring the Future national survey results on drug use, 1975-2011. Volume I: Secondary school students.
Jordan, J. E., Osborne, R. H., & Buchbinder, R. （2011）. Critical appraisal of health literacy indices revealed variable underlying constructs, narrow content and psychometric weaknesses. J Clin Epidemiol, 64（4）, 366-379. doi:10.1016/j.jclinepi.2010.04.005
Kanjanarat, P., Winterstein, A. G., Johns, T. E., Hatton, R. C., Gonzalez-Rothi, R., & Segal, R. （2003）. Nature of preventable adverse drug events in hospitals: a literature review. American Journal of Health System Pharmacy, 60（17）, 1750-1759.
Kann, L., McManus, T., Harris, W. A., Shanklin, S. L., Flint, K. H., Hawkins, J., Queen B, Lowry R, Olsen EO, Chyen D, Whittle L, Thornton J, Lim C, Yamakawa Y, Brener N, & Zaza S. （2016）. Youth Risk Behavior Surveillance - United States, 2015. MMWR Surveill Summ, 65（6）, 1-174. doi:10.15585/mmwr.ss6506a1
Kindig, D. A., Panzer, A. M., & Nielsen-Bohlman, L. （2004）. Health literacy: A prescription to end confusion: National Academies Press.
Kiyingi, K., & Lauwo, J. （1992）. Drugs in the home: Danger and waste. Paper presented at the World health forum.
Kripalani, S., Bengtzen, R., Henderson, L. E., & Jacobson, T. A. （2008）. Clinical research in low-literacy populations: using teach-back to assess comprehension of informed consent and privacy information. Irb, 30（2）, 13-19.
Lee, C. H., Chang, F. C., Hsu, S. D., Chi, H. Y., Huang, L. J., & Yeh, M. K. （2017）. Inappropriate self-medication among adolescents and its association with lower medication literacy and substance use. PLoS One, 12（12）, e0189199. doi:10.1371/journal.pone.0189199
Lee, S.-Y. D., Tsai, T.-I., Tsai, Y.-W., & Kuo, K. N. （2010）. Health literacy, health status, and healthcare utilization of Taiwanese adults: Results from a national survey. BMC Public Health, 10（1）, 614.
Letts, M. （2005）. Always Read the Leaflet: Getting the Best Information with Every Medicine: Stationery Office.
Loke, Y. K., Hinz, I., Wang, X., & Salter, C. （2012）. Systematic review of consistency between adherence to cardiovascular or diabetes medication and health literacy in older adults. Ann Pharmacother, 46（6）, 863-872. doi:10.1345/aph.1Q718
Maniaci, M. J., Heckman, M. G., & Dawson, N. L. （2008）. Functional health literacy and understanding of medications at discharge. Mayo Clin Proc, 83（5）, 554-558. doi:10.4065/83.5.554
Maria Esperanza, R. （2010）. Risks of Self-Medication Practices. Curr Drug Saf, 5（4）, 315-323.
Meadows, M. （2005）. Outreach program to teach safe medicine use to middle school children. FDA consumer, 40（6）, 9-10.
Miech, R. A. J., L. D.; O'Malley, P. M.; Bachman, J. G.; Schulenberg, J. E.; Patrick, M. E. （2017）. Monitoring the Future national survey results on drug use, 1975-2016: Volume I, secondary school students.
Montagne, M. （2013）. Pharmaceutical pictograms: A model for development and testing for comprehension and utility. Res Social Adm Pharm, 9（5）, 609-620. doi:10.1016/j.sapharm.2013.04.003
Montastruc, J., Bagheri, H., Geraud, T., & Lapeyre-Mestre, M. （1996）. Pharmacovigilance of self-medication. Therapie, 52（2）, 105-110.
Murray, M. D., Wu, J., Tu, W., Clark, D. O., Weiner, M., Morrow, D. G., & Brater, D. C. （2004）. Health literacy predicts medication adherence. Clinical Pharmacology & Therapeutics, 75（2）, P76-P76. doi:10.1016/j.clpt.2003.11.288
National Council on Patient Information and Education. （2002）. Attitudes and beliefs about the use of over-the-counter medicines: a dose of reality. Retrieved from NY:
Ngoh, L. N. （2009）. Health literacy: a barrier to pharmacist-patient communication and medication adherence. J Am Pharm Assoc （2003）, 49（5）, e132-146; quiz e147-139. doi:10.1331/JAPhA.2009.07075
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. doi:10.1093/heapro/15.3.259
Nutbeam, D. （2008）. The evolving concept of health literacy. Social Science & Medicine, 67（12）, 2072-2078. doi:https://doi.org/10.1016/j.socscimed.2008.09.050
OECD. （2017）. Health at a Glance 2017: OECD Publishing.
Parker, R., Williams, M. V., Weiss, B. D., Baker, D., Davis, T. C., Doak, C. C., & Dickinson, B. （1999）. Health Literacy: Report of the Council on Scientific Affairs. Jama, 281, 552-557. doi:10.1001/jama.281.6.552
Parker, R. M., Baker, D. W., Williams, M. V., & Nurss, J. R. （1995）. The test of functional health literacy in adults: a new instrument for measuring patients' literacy skills. J Gen Intern Med, 10（10）, 537-541. doi:10.1007/BF02640361
Patel Shrimali, B., Hasenbush, A., Davis, A., Tager, I., & Magzamen, S. （2011）. Medication use patterns among urban youth participating in school-based asthma education. J Urban Health, 88 Suppl 1, 73-84. doi:10.1007/s11524-010-9475-z
Patrick, M. E., Schulenberg, J. E., & O'Malley, P. M. （2016）. High School Substance Use as a Predictor of College Attendance, Completion, and Dropout: A National Multi-cohort Longitudinal Study. Youth Soc, 48（3）, 425-447. doi:10.1177/0044118x13508961
Petersen, P. E., & Kwan, S. （2010）. The 7th WHO Global Conference on Health Promotion-towards integration of oral health （Nairobi, Kenya 2009）. Community Dental Health, 27（Suppl 1）, 129-136.
Raynor, D. （2009）. Addressing medication literacy: a pharmacy practice priority. International Journal of Pharmacy Practice, 17（5）, 257-259. doi:10.1211/ijpp.17.05.0001
Sansom-Daly, U. M., Lin, M., Robertson, E. G., Wakefield, C. E., McGill, B. C., Girgis, A., & Cohn, R. J. （2016）. Health Literacy in Adolescents and Young Adults: An Updated Review. J Adolesc Young Adult Oncol, 5（2）, 106-118. doi:10.1089/jayao.2015.0059
Sauceda, J. A., Loya, A. M., Sias, J. J., Taylor, T., Wiebe, J. S., & Rivera, J. O. （2012）. Medication literacy in Spanish and English: psychometric evaluation of a new assessment tool. J Am Pharm Assoc （2003）, 52（6）, e231-240. doi:10.1331/JAPhA.2012.11264
Schäbitz, W., Berger, C., Knauth, M., Meinck, H., & Steiner, T. （2001）. Hypoxic brain damage after intramuscular self‐injection of diclofenac for acute back pain. European journal of anaesthesiology, 18（11）, 763-765.
Shone, L. P., King, J. P., Doane, C., Wilson, K. M., & Wolf, M. S. （2011）. Misunderstanding and potential unintended misuse of acetaminophen among adolescents and young adults. J Health Commun, 16 Suppl 3, 256-267. doi:10.1080/10810730.2011.604384
Simonds, S. K. （1974）. Health education as social policy. Health Education Monographs, 2（1_suppl）, 1-10.
Speros, C. （2005）. Health literacy: concept analysis. Journal of advanced nursing, 50（6）, 633-640.
Stevenson, R., MacWalter, R., Harmse, J., & Wilson, E. （2001）. Mortality during the Winter Flu Epidemic—Two Cases of Death Associated with Self-Medication. Scottish medical journal, 46（3）, 84-86.
Stilley, C. S., Terhorst, L., Flynn, W. B., Fiore, R. M., & Stimer, E. D. （2014）. MEDICATION HEALTH LITERACY MEASURE: DEVELOPMENT AND PSYCHOMETRIC PROPERTIES. Journal of nursing measurement, 22（2）, 213-222.
Substance Abuse and Mental Health Services Administration （2008）. The NSDUH report: Misuse of over-the-counter cough and cold medications among persons aged 12 to 25.
Wei, M.-H. （2014）. The associations between health literacy, reasons for seeking health information, and information sources utilized by Taiwanese adults. Health Education Journal, 73（4）, 423-434.
World Health Organization. （2000）. Guidelines for the regulatory assessment of Medicinal Products for use in self-medication.
World Health Organization. （2004）. Pharmacovigilance: ensuring the safe use of medicines.
World Health Organization. （2007）. Promoting safety of medicines for children: World Health Organization.
Zheng, F., Ding, S., Luo, A., Zhong, Z., Duan, Y., & Shen, Z. （2017）. Medication literacy status of outpatients in ambulatory care settings in Changsha, China. Journal of International Medical Research, 45（1）, 303-309. doi:10.1177/0300060516676726
Zheng, F., Zhong, Z., Ding, S., Luo, A., & Liu, Z. （2016）. Modification and evaluation of assessment of medication literacy. Zhong nan da xue xue bao. Yi xue ban= Journal of Central South University. Medical sciences, 41（11）, 1226-1231.