台灣學童健康素養測驗之發展與測量

Development and Implementation of Taiwan's Child Health Literacy Test

10.6288/TJPH201433102105

劉潔心(Chieh-Hsing Liu)；廖梨伶(Li-Ling Liao)；施淑芳(Shu-Fang Shih)；張子超(Tzu-Chau Chang)；紀雪雲(Hsueh-Yun Chi)；Richard H Osborne

健康素養 ； 學童 ； 課程本位 ； health literacy ； student children ； curriculum-based

台灣公共衛生雜誌

33卷3期（2014 / 06 / 15）

251 - 270

繁體中文

目標：本研究目的在於以國小六年級學童為對象，發展台灣學童健康素養測驗及進行全國性的調查，以呈現台灣學童健康素養之現況，以及瞭解健康素養、健康行為與健康狀態之相關性。方法：本研究所發展的學童健康素養測驗乃經由釐清學童健康素養的概念、建立測驗架構、經由實務教師觀點與學童焦點團體訪談發展測量題目、進行預試分析，並經正式測試後確認定稿。在正式測試中，全國共2,235所學校參與填答（83.3%），共計162,609位學童（56.9%）；在該調查中也同時收集學童的出生日、BMI（身高、體重）、自我健康認知與健康行為表現。結果：本測驗經共計32題，依據試題反應理論，其鑑別度介於0.55~1.89，而難度則介於-1.7~0.41，內部一致性信度Cronbach’s α值為0.87，適合用於測量學童基本健康素養能力之表現與篩檢，此外，全國六年級學童健康素養平均分數為23.97分（滿分32分），答對率為74.9%。有“好”的自我健康認知的學童具有較好的健康素養，其得分（M = 24.94）都顯著高於其他自我健康認知低的學童，且健康素養與良好健康行為有顯著正相關（r = .25，p ＜ .05），與不良健康行為則有顯著負相關（r = -.28，p ＜ .05）。結論：本研究為全國首創以教師與學童觀點為依據之課程本位學童健康素養測驗，透過嚴謹的程序發展，其全國性的調查結果可提供國家健康教育之決策單位做參考。

Objectives: The aims of this study were to develop Taiwan’s Child Health Literacy Test and to undertake a nation-wide survey in order to determine the current status of Taiwanese sixth graders’ health literacy, and to understand the association between health literacy, healthy behavior, and health status. Methods: Taiwan’s Child Health Literacy Test was developed through the process of concept clarification, a qualitative pilot, a development pilot, and a field test. In the field test, 162,609 sixth graders (56.9%) from 2,235 schools (83.3%) nationwide completed the questionnaire. We also collected the students’ dates of birth, BMIs, self-reported health and healthy behaviors. Results: The final test consisted of 32 questions with item discrimination of 0.55~1.89 and item difficulty of -1.7~0.41 according to IRT; Cronbach’s α was 0.87. Based on this information, the test was deemed appropriate for basic health literacy screening among children. Nation-wide, the average score for sixth graders’ health literacy was 23.97 points (total score 32 points), with a correct rate of 74.9%. Those who were ＂good＂ in self-reported health scored highest in health literacy (M = 24.29). Health literacy was significantly positively related to healthy behavior (r = .25, p ＜ .05), and negatively to risky behavior (r = -.28, p ＜ .05). Conclusions: This study was the first curriculum-based child health literacy test developed from the viewpoints of both teachers and pupils in Taiwan through a rigorous procedure. The nationwide survey results may serve as a reference for decision-makers at the national health education level.

1. 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。台灣衛誌，31，89-99。
   連結：
2. 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，14，122-36。
   連結：
3. 健康醫學學習網：兒童健康守則「十要十不要」。http://health.edu.tw:8080/teacher/?q=node/2963。引用2013/08/18。Health Medicine Learning Network. Children's health rules: “Ten Do's and Ten Do Nots.” Available at: http://health.edu.tw:8080/teacher/?q=node/2963. Accessed August 18, 2013. [In Chinese]
4. 教育部：第八次全國教育會議。http://140.111.34.54/content.aspx?site_content_sn=21831。引用 2013/08/18。Ministry of Education (Taiwan). 8th National conference on education. Available at: http://140.111.34.54/content.aspx?site_content_sn=21831. Accessed August 18, 2013. [In Chinese]
5. 國民教育社群網：97年國民中小學九年一貫課程綱要。http://teach.eje.edu.tw/9CC2/9cc_97.php。引用2013/08/18。Taiwan Elementary and Secondary Educator Community. 2008 grade 1-9 curriculum guidelines. Available at: http://teach.eje.edu.tw/9CC2/9cc_97.php. Accessed August 18, 2013. [In Chinese]
6. WHO. Why gender and health. Avaliable at: http://www.who.int/gender/genderandhealth/en/. Accessed May 24, 2012
7. Selden CR, Zorn M, Ratzan SC, Parker RM. Current bibliographies in medicine: health literacy. Available at: http://www.nlm.nih.gov/archive/20061214/pubs/cbm/hliteracy.html. Accessed August 18, 2013.
8. 衛生福利部國民健康署：兒童及青少年生長身體質量指數(BMI)建議值。http://obesity.hpa.gov.tw/web/content.aspx?NO=679。引用2014/04/10。Health Promotion Administration, Ministry of Health and Welfare, R.O.C. (Taiwan). Recommended value for children and adolescents growing body mass index (BMI). Available at: http://obesity.hpa.gov.tw/web/content.aspx?NO=679. Accessed April 10. 2014. [In Chinese]
9. Appleton, A,Litchfield, R.(2009).Health literacy and food perceptions: barriers to positive health behaviors among adolescents.J Am Diet Assoc,109,A103.
10. Baker, DW,Gazmararian, JA,Williams, MV(2002).Functional health literacy and the risk of hospital admission among Medicare managed care enrollees.Am J Public Health,92,1278-83.
11. Bloom, BS.(1956).Taxonomy of Educational Objectives.New York, NY:David McKay Co Inc.
12. Borzekowski, DL.(2009).Considering children and health literacy: a theoretical approach.Pediatrics,124(Suppl 3),S282-8.
13. Brown, SL,Teufel, JA,Birch, DA.(2007).Early adolescents perceptions of health and health literacy.J Sch Health,77,7-15.
14. Davis, TC,Wolf, MS,Arnold, CL(2006).Development and validation of the Rapid Estimate of Adolescent Literacy in Medicine (REALM-Teen): a tool to screen adolescents for below-grade reading in health care settings.Pediatrics,118,e1707-14.
15. Gazmararian, JA,Williams, MV,Peel, J,Baker, DW.(2003).Health literacy and knowledge of chronic disease.Patient Educ Couns,51,267-75.
16. Gray, NJ,Klein, JD,Noyce, PR,Sesselberg, TS,Cantrill, JA.(2005).The Internet: a window on adolescent health literacy.J Adolesc Health,37,243.
17. Gray, NJ,Klein, JD,Sesselberg, TS,Cantrill, JA,Noyce, PR.(2003).Adolescents' health literacy and the Internet.J Adolesc Health,32,124.
18. Howard, DH,Gazmararian, J,Parker, RM.(2005).The impact of low health literacy on the medical costs of Medicare managed care enrollees.Am J Med,118,371-7.
19. Jordan, J,Buchbinder, R,Osborne, R..,未出版
20. Jordan, JE,Osborne, RH,Buchbinder, R.(2011).Critical appraisal of health literacy indices revealed variable underlying constructs, narrow content and psychometric weaknesses.J Clin Epidemiol,64,366-79.
21. Kickbusch, I,Wait, S,Maag, D.(2006).Navigating Health: The Role of Health Literacy.London:Alliance for Health and the Future, International Longevity Centre-UK.
22. Manganello, JA.(2008).Health literay and adolescents: a framework and agenda for future research.Health Edu Res,23,840-7.
23. Marx, E,Hudson, N,Deal, TB,Pateman, B,Middleton, K.(2007).Promoting health literacy through the health education assessment project.J Sch Health,77,157-63.
24. Monsen, RB.(2007).Child health literacy.J Pediatr Nurs,22,69-70.
25. Morris, C,Liabo, K,Wright, P,Fitzpatrick, R.(2007).Development of the Oxford ankle foot questionnaire: finding out how children are affected by foot and ankle problems.Child Care Health Dev,33,559-68.
26. Murphy, DA,Lam, P,Naar-King, S(2010).Health literacy and antiretroviral adherence among HIV-infected adolescents.Patient Educ Couns,79,25-9.
27. Nielsen-Bohlman, LN(ed.),Panzer, AM(ed.),Kindig, DA(ed.)(2004).Health Literacy: A Prescription to End Confusion.Washington, D.C.:The National Academies Press.
28. Nutbeam, D.(2000).Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century.Health Promot Int,15,259-67.
29. Osborne, RH,Elsworth, GR,Whitfield, K.(2007).The Health Education Impact Questionnaire (heiQ): an outcomes and evaluation measure for patient education and self-management interventions for people with chronic conditions.Patient Educ Couns,66,192-201.
30. Osborne, RH,Norquist, JM,Elsworth, GR(2011).Development and validation of the Influenza Intensity and Impact Questionnaire (FluiiQ™).Value Health,14,687-99.
31. Ratzan, SC.(2001).Health literacy: communication for the public good.Health Promot Int,16,207-14.
32. Ratzan, SC,Parker, RM.(2006).Health literacy-identification and response.J Health Commun,11,713-5.
33. Sanders, LM,Federico, S,Klass, P,Abrams, MA,Dreyer, B.(2009).Literacy and child health: a systematic review.Arch Pediatr Adolesc Med,163,131-40.
34. Scott, TL,Gazmararian, JA,Williams, MV,Baker, DW.(2002).Health literacy and preventive health care use among Medicare enrollees in a managed care organization.Med Care,40,395-404.
35. Sharif, I,Blank, AE.(2010).Relationship between child health literacy and body mass index in overweight children.Patient Educ Couns,79,43-8.
36. Shone, L,Doane, C,Blumkin, AK,Klein, J,Wolf, MS.(2010).Performance of health literacy tools among adolescents and young adults.J Adolesc Health,46,S11-2.
37. Simonds, SK.(1974).Health education as social policy.Health Educ Monogr,2(suppl 1),1-25.
38. St. Leger, L.(2001).Schools, health literacy and public health: possibilities and challenges.Health Promot Int,16,197-205.
39. Telljohann, SK,Symons, CW,Pateman, B.(2006).Health Education-Elementary and Middle School Applications.New York, NY:The McCraw-Hill.
40. WHO(1998).Health Promotion Glossary.Geneva:WHO.
41. Wu, AD,Begoray, DL,MacDonald, M(2010).Developing and evaluating a relevant and feasible instrument for measuring health literacy of Canadian high school students.Health Promot Int,25,444-52.
42. 石崇良(2007)。衛生福利部委託研究計畫衛生福利部委託研究計畫,台北=Taipei:衛生福利部=Ministry of Health and Welfare, R.O.C. (Taiwan)。
43. 吳統雄(1985)。吳統雄：態度與行為之研究的信度與效度。民意學術專刊，101，29-53。
44. 湯澡薰、韓柏檉、張文英(2007)。衛生福利部2007年委託科技研究計畫衛生福利部2007年委託科技研究計畫,台北=Taipei:衛生福利部=Ministry of Health and Welfare, R.O.C. (Taiwan)。
45. 蘇哲能、張淑鳳、陳榮基、潘豐泉、陳清軒、劉偉文(2008)。台灣健康知能量表之初探性研究。台灣醫學，12，525-36。

1. 洪瑞兒,吳枚瑛(2020)。探討高雄市青少年健康知識、態度及行為素養。教育科學研究期刊，65(3)，187-223。
2. 許嘉芬,孫淑慧,吳福森(2022)。以協同教學模式推廣國中學生用藥素養。醫學與健康期刊，11(1)，25-36。
3. 黃如薏、林季緯、何青蓉、王維典(2016)。健康識能的概念發展與實務應用。臺灣家庭醫學雜誌，26(2)，65-76。
4. 龍芝寧、賴香如、黃蕙欣(2017)。素養再見教育教學上之實踐－以身體意象與體重管理素養教學為例。學校衛生，71，1-34。