Page 42 - 2022-19-中国全科医学

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literacy and its influencing factors among Chinese outpatients，providing a scientific basis for improving patients' health status
and self-management ability，and for medical workers to perform patient education and instruction，disease management and
relevant improvement. Methods A systematic sampling method was used to select 14 secondary or tertiary general hospitals in
eight regions in eastern，central and western China as survey settings，and outpatients（≥ 15 years old）of them during January
to May 2021 were randomly selected and surveyed using the Patient Health Literacy Scale（PHLS）〔those with scores <41 were
deemed unlikely to have health literacy；those with scores ≥ 55 were judged as having high level of health literacy；those with
scores between 41 and 54 were regarded as having moderate level of health literacy〕. The health literacy level of outpatients was
compared by various personal factors. Ordinal and multinomial Logistic regression analyses were used to analyze the influencing
factors of health literacy. Results Altogether，2 808 cases who handed in responsive questionnaires were included for final
analysis. The average score of PHLS in the respondents was（43.38±6.25）. The prevalence of health literacy，and high level
of health literacy was 68.38%（1 920/2 808），and 6.93%（133/2 808），respectively. The level of health literacy varied
obviously by age，education level，occupation，average household monthly income per person，prevalence of a family member
working as a healthcare worker，and prevalence of using the way of acquiring health information（from medical workers，family
members，friends or coworkers，activities conducted by the work unit or the community，listening to the radio，watching
television，reading a newspaper/book，searching the Internet，or other approaches）（P<0.001）. Higher educational level and
average household monthly income per person were associated with higher level of health literacy（P<0.001）. Being a student，
worker of an industrial/mining enterprise，retailer or server was associated with higher level of health literacy（P<0.05）.
Acquiring heath information from healthcare workers and searching the Internet were associated with higher level of health literacy
（P<0.05）. Conclusion On the whole，the health literacy was moderate in outpatients of the 14 general hospitals. To improve
the health literacy level in this population，it is suggested to improve the levels of health education and guidance for them by
strengthening the key role of healthcare workers in health information delivery，giving more concerns to the low educated or low-
income earners，and increasing the ways of acquiring health information.
【Key words】 Health literacy；Outpatients；Hospitals，general；Current situation；Root cause analysis；Health
education

患者健康素养是指患者获取、理解、分析、应用医 开展患者教育工作、采取有效策略以提升患者健康素养
学信息和服务，与医务人员进行有效互动，改善自身治 水平提供科学依据。
疗和康复效果的能力，具备医学科学观念、了解医学 1 对象与方法
常识、掌握基本疾病防治技能、拥有自我效能感、能 1.1 研究对象 根据中国二、三级医院名录，采用系
够认知基本医学信息等均是患者具备健康素养的重要表 统抽样方法选取我国东（北京市、山东省、广东省、江
现 ［1］ 。患者健康素养水平是影响其卫生服务利用状况、 苏省和河北省）、中（山西省）、西（重庆市和甘肃省）
医疗决策参与度，以及医患沟通效果的重要因素 ［2-4］ 。 部 8 省份共 14 家二级或三级综合医院作为调查地点，
既往研究结果也表明，可通过提升患者健康素养，提高 随机抽取 2021 年 1—5 月至 14 家医院门诊就诊的患者
其治愈率和康复率 ［5］ ，降低疾病的复发率、残疾率和 作为调查对象。纳入标准：（1）年龄≥ 15 岁；（2）
死亡率 ［6］ 。近 20 年，国外开展了大量有关患者健康素 病情稳定或处于疾病康复期；（3）知情同意，并自愿
养的研究，开发出多种患者健康素养评价量表，这些量 参与问卷调查。排除标准：（1）急危重症患者；（2）
表目前已在临床上得到广泛应用 ［7-8］ 。在上述量表的基 因存在意识 / 认知障碍或患有精神疾病，无法理解问卷
础上，根据我国实际情况，我国学者也于近年开展了相 内容者；（3）存在视听障碍、偏瘫等不便于参与调查
关研究，并开发出了“患者健康素养测评量表” ［9］ 。 的情况。本研究已通过中国健康教育中心伦理委员会审
我国患者数量庞大，2019 年全国医疗卫生机构诊疗人 批（审批号：2021003）。
次数达 871 987.3 万 ［10］ 。了解我国患者健康素养水平 1.2 调查工具
现状及影响因素，可为改善医患沟通、完善患者治疗和 1.2.1 一般资料调查表 由研究者自行设计，内容包括
康复方案、有针对性地开展患者健康教育提供参考与依 患者的性别、民族、年龄、文化程度、职业、家人从事
据，进而有助于提高患者治疗依从性，改善患者遵医行 医疗卫生行业情况、家庭人均月收入、平时获取医疗信
为和自我管理行为。为此，本研究组利用“患者健康素 息的渠道。
养测评量表”，在全国抽取 14 家综合医院开展了门诊 1.2.2 患者健康素养测评量表 ［9］ 由医学科学观念、
患者健康素养调查工作，旨在为我国综合医院医务人员 医学常识、疾病自我管理技能、自我效能、医学信息