筛检问题有助于预测有限的健康知能


  January 12, 2009 — 根据1/2月家庭医学年监中的一篇研究结果,简单的筛检问题有助于预测有限的健康知能(health literacy)。
  
  俄亥俄州立大学医学院的Kelly Marvin Jeppesen医师等人写道,越来越多人认为有限的健康知能是接受适当照护的障碍。确认哪里些病患因为有限的健康知能而造成不佳健康结果之风险,是医师们目前的责任。我们的目标是确认哪里些筛检问题与人口统计项目可以独立预测有限的健康知能,因而有助于医师为个别病患提供教育。
  
  这是一个大型研究的一部份,于2006年8月到2007年7月间,在一个学院初级照护诊接受治疗的225名糖尿病患者,被问及数个有关阅读能力的问题。回覆率为57%。为了确认这些问题和人口统计变项之独立预测性质,研究者建立一个逻辑回归模式来预测有限的健康知能。
  
  评估作为有限健康知能的潜在预测因素,包括自我评估的阅读能力、最高学历、单项素养筛检(Single-Item Literacy Screener,SILS)结果、享受阅读乐趣、年纪、性别和种族。
  
  有限之健康知能的定义为,成人功能性健康知能测验简短版(S-TOFHLA)分数小于23,总共有15.1%的病患属之。五个造成有限健康知能的独立因素包括自我评估阅读能力不佳 (在该模式中每增加1分的胜算比(odds ratio [OR] )为3.37; 95%信心区间[CI]为1.71 – 6.63)、阅读书面健康资料时经常需要帮助(以SILS测量; OR为2.03; 95% CI为1.26 – 3.26)、教育程度低(OR为1.89; 95% CI为1.12 – 3.18)、男性(OR为4.46; 95% CI为1.53 – 12.99)以及白人以外种族(OR为3.73; 95% CI为1.04 – 13.40)。
  
  年纪与其无关。接受器操作特性曲线的曲线下面积为0.9212。
  
  研究限制包括缺乏该机构之糖尿病患以外的一般性、参与此研究的病患比拒绝参加者年轻、使用S-TOFHLA作为健康知能的参考标准、可能有病患对于一些素养方面的问题有困难。
  
  研究作者写道,自我评估的阅读能力、SILS结果、最高学历、性别与种族可独立预测病患是否属于有限的健康知能;医师应对这些关联有所警觉,且对高风险病患提出问题。
  
  俄亥俄州立大学Crisafi-Monte心肺初级照护捐赠基金以及隶属国家健康研究中心的国家研究资源中心资助本研究。作者之一担任辉瑞药厂的发言人。

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.

    



回上一页




回上一页