临床健康素养的特征及其影响因素——一个全国住院病人样本的分析  

Clinical Health Literacy and Its Influencing Factors of Inpatients:A National General Hospital Sample Survey in China

作　　者：洪雅君 叶贝珠 张萍[1] 程瑶[1] 蒋红卫[1] 孙奕[1] 王乔凤[3] 谢小华[4] Zhu Yimei 张乃兴 梁渊[1] HONG Yajun;YE Beizhu;LIANG Yuan(School of Public Health,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,430030,China)

机构地区：[1]华中科技大学同济医学院公共卫生学院,湖北武汉430030 [2]复旦大学附属中山医院厦门医院,福建厦门361010 [3]中山大学第三附属医院岭南院区护理部,广东广州510630 [4]深圳市第二人民医院护理部,广东深圳518037 [5]School of Media,Communication and Sociology,University of Leicester,UK [6]深圳市卫生健康委员会,广东深圳518031

出　　处：《中国社会医学杂志》2020年第1期38-42,共5页Chinese Journal of Social Medicine

基　　金：国家自然科学基金项目(71273098)

摘　　要：目的从临床视角了解住院病人的健康素养状况及其影响因素,为改善病人健康素养提供依据和建议。方法采用分层整群抽样方法,调查全国7个省市、77家综合医院的8238例住院病人。临床健康素养包括病情表述的难度和正确服药的难度;影响因素包括结构因素(性别、年龄、文化程度、婚姻状况、经济状况以及地域分布)和调节因素(家庭成员支持、亲属中从事医护人员的数量和最近三年的住院次数)。结果调查对象病情表述难度“较多/很多”的比例,男性占17.7%,女性占20.6%;正确服药难度“较多/很多”的比例,男性占12.4%,女性占11.6%。Logistic回归分析结果显示,相对大学及以上文化程度的患者而言,小学及以下文化程度的患者在病情表述和正确服药方面的难度均多(OR=1.44,95%CI:1.16~1.80;OR正确服药=2.07,95%CI:1.57~2.73);相对经济状况好的患者而言,经济状况差的患者在病情表述和正确服药方面的难度均多(OR=2.14,95%CI:1.76~2.61;OR正确服药=2.05,95%CI:1.62~2.59);相对住院次数3次及以上的患者,没有住过院的患者对病情表述的难度小(OR=0.66,95%CI:0.56~0.78)。结论病人病情表述上的困难多于正确服药上的困难,影响因素中结构因素(特别是文化程度和经济状况)的作用可能比调节因素(特别是最近三年住院次数)的作用更为重要。Objective To analyze clinical health literacy of inpatients and its’influence factors,and provide recommendation and evidence for improving health literacy of inpatients.Methods Using stratified cluster sampling method,a national cross-sectional survey was performed in 77 hospitals across 7 provinces/metropolis,involving 8238 inpatients.Self-designed questionnaire was used to assess the health literacy of inpatients.Clinical health literacy included disease presentation and medicine-taken correctly.Structural determinants included gender,age,education status,marriage status,economic status and geographical distribution.Intermediary determinants included support from family member,familiar with health professionals and times of hospitalization in the last three years.Results The proportion of low health literacy was 17.7%with male and 20.7%with female for disease presentation,and 12.4%with male and 11.6%with female for medicine-taken correctly.Logistic regression showed that significant influence factors on four dimensions of health literacy were education(OR=1.39,95%CI:1.13~1.71;OR=2.00,95%CI:1.55~2.59)and economic status(OR=1.96,95%CI:1.62~2.36;OR=1.67,95%CI:1.35~2.07).Compared with hospitalization in the last three years more than 3 times,patients with no hospitalization in the last three years had lower health literacy in disease presentation(OR=0.66,95%CI:0.56~0.78).Conclusion The characteristics of the patient's clinical health literacy show that about 20%inpatients have difficulty in disease presentation and 10%inpatients have difficulty in medicine-taken correctly.The role of structural determinants(especially educational level and economic status)may be more important than intermediary determinant(familiar with health professionals and times of hospitalization in the last three years)for the health literacy of inpatients.

关 键 词：健康素养 社会决定因素 结构因素 调节因素 

分 类 号：R181.37[医药卫生—流行病学] R193.3[医药卫生—公共卫生与预防医学]