運用德菲法建構醫師健康識能專業知能指標之研究

Study of constructing indicators of physician's professional competence on health literacy by Delphi method

10.6288/TJPH.202006_39(3).108130

劉峻正(Chun-Cheng Liu)；張家臻(Chia-Chen Chang)；賴香如(Hsiang-Ru Lai)；蔡兆勳(Jaw-Shiun Tsai)；明金蓮(Jin-Lain Ming)；董貞吟(Chen-Yin Tung)

健康識能 ； 德菲法 ； 醫師 ； 醫病關係 ； 醫療資源 ； health literacy ； Delphi method ； physicians ； doctor-patient relations ； medical resources

台灣公共衛生雜誌

39卷3期（2020 / 06 / 15）

292 - 310

繁體中文

目標：本研究旨在建構醫師健康識能專業知能指標，以促醫療提供者關注、掌握與因應病人健康識能、進行良好醫病溝通，並協助病人有效運用醫療資源。方法：本研究採德菲法，進行三回合調查，以凝聚13名專家之共識。根據文獻與焦點團體訪談結果，界定醫師健康識能專業知能之內涵與面向，並擬定指標初稿。在每回合調查歷程中，針對各項指標的適切性與一致性進行分析，依據專家意見修正與增刪指標。結果：建構「概念與評估」、「接納與尊重」、「溝通與互動」及「醫療資訊與決策」等四面向、13次面向、44項指標，以利醫師扮演健康識能評估者、接納者、規劃者及導引者之角色。結論：本研究建構之健康識能專業知能指標可作為未來規劃醫師健康識能專業知能相關職前與在職教育課程，以及研發相關測量工具之參考。

Objectives: This study aims to construct indicators of physicians' professional competence on health literacy in order to motivate healthcare providers to pay attention to master, and respond to patients' health literacy; conduct good doctor-patient communication; and assist patients in effectively using medical resources. Methods: The Delphi method was applied, and three rounds of investigation were conducted to gather the consensus of 13 experts. According to the literature and results of focus group interviews, the connotations and dimensions of physicians' professional competence on health literacy were defined, and the first draft of indicators was drawn up. In the course of each round of investigation, the suitability and consistency of various indicators were analyzed, and indicators were revised, added, or deleted according to the experts' opinions. Results: Four dimensions, namely ＂concept and evaluation＂, ＂acceptance and respect＂, ＂communication and interaction＂, and ＂medical information and decision-making＂; and 13 sub-dimensions and 44 indicators were constructed to help physicians play the roles of health literacy evaluators, receivers, planners, and guides. Conclusions: The indicators of physicians' professional competence on health literacy constructed in this study can be used as a reference for future planning of pre-service and on-the-job education courses related to physicians' professional competence on health literacy, as well as development of related measurement tools.

1. 蔡慈儀, TI,李守義, SY,蔡憶文, YW,郭耿南, KN(2010)。中文健康識能評估表的發展與測試。醫學教育，14，122-136。
   連結：
2. 魏米秀, MS,王英偉, YW,張美娟, MC,謝至鎠, JG(2017)。中文多面向健康識能量表（MMHLQ）之發展。台灣衛誌，36，556-570。
   連結：
3. Batterham, RW,Hawkins, M,Collins, PA,Buchbinder, R,Osborne, RH(2016).Health literacy: applying current concepts to improve health services and reduce health inequalities.Public Health,132,3-12.
4. Chu, C,Chang, C,Lin, C,Ko, T(2018).ISQUA18-2405 sharing decision making (SDM) approach applicable to whole hospital-a medical center in northern Taiwan.Int J Qual Health Care,30(Suppl 2),23-24.
5. Coleman, CA,Appy, S.(2012).Health literacy teaching in US medical schools.Fam Med,44,504-507.
6. Coleman, CA,Fromer, A(2015).A health literacy training intervention for physicians and other health professionals.Fam Med,47,388-392.
7. Coleman, CA,Hudson, S,Maine, LL(2013).Health literacy practices and educational competencies for health professionals: a consensus study.J Health Commun,18(Suppl 1),82-102.
8. Coleman, CA,Peterson-Perry, S,Bumsted, T(2016).Longterm effects of a health literacy curriculum for medical students.Fam Med,48,49-53.
9. DeWalt, DA,Broucksou, KA,Hawk, V(2010).Health Literacy Universal Precautions Toolkit.Rockville, MD:Agency for Healthcare Research and Quality.
10. DeWalt, DA,Hink, A(2009).Health literacy and child health outcomes: a systematic review of the literature.Pediatrics,124(Suppl 3),S265-S274.
11. Dickens, C,Lambert, BL,Cromwell, T,Piano, MR(2013).Nurse overestimation of patients’ health literacy.J Health Commun,18(Suppl 1),62-69.
12. Duong, VT,Lin, IF,Sorensen, K(2015).Health literacy in Taiwan: a population-based study.Asia Pac J Public Health,27,871-880.
13. Freedman, DA,Bess, KD,Tucker, HA,Boyd, DL,Tuchman, AM,Wallston, KA(2009).Public health literacy defined.Am J Prev Med,36,446-451.
14. Kaper, MS,Reijneveld, SA,van Es, FD(2020).Effectiveness of a comprehensive health literacy consultation skills training for undergraduate medical students: a randomized controlled trial.Int J Environ Res Public Health,17,81.
15. Kickbusch, I,Pelikan, JM,Apfel, F,Tsouros, A(2013).Health Literacy: The Solid Facts.Copenhagen:WHO Regional Office for Europe.
16. Lee, SY,Tsai, TI,Tsai, YW,Kuo, KN(2010).Health literacy, health status, and healthcare utilization of Taiwanese adults: results from a national survey.BMC Public Health,10,614.
17. 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,15,259-267.
18. Osborne, RH,Batterham, RW,Elsworth, GR,Hawkins, M,Buchbinder, R(2013).The grounded psychometric development and initial validation of the Health Literacy Questionnaire (HLQ).BMC Public Health,13,658.
19. Safeer, RS,Keenan, J.(2005).Health literacy: the gap between physicians and patients.Am Fam Physician,72,463-468.
20. Schillinger, D,Piette, J,Grumbach, K(2003).Closing the loop: physician communication with diabetic patients who have low health literacy.Arch Intern Med,163,83-90.
21. Sørensen, K,Van den Broucke, S,Pelikan, JM(2013).Measuring health literacy in populations: illuminating the design and development process of the European Health Literacy Survey Questionnaire (HLS-EU-Q).BMC Public Health,13,948.
22. Stevenson, FA,Kerr, C,Murray, E,Nazareth, I(2007).Information from the Internet and the doctor-patient relationship: the patient perspective -- a qualitative study.BMC Fam Pract,8,47.
23. Sudore, RL,Yaffe, K,Satterfield, S(2006).Limited literacy and mortality in the elderly.J Gen Intern Med,21,806-812.
24. Volandes, AE,Paasche-Orlow, MK(2007).Health literacy, healthin equality and a just healthcare system.Am J Bioeth,7,5-10.
25. Weiner, S,Schwartz, A.(2015).Listening for What Matters: Avoiding Contextual Errors in Health Care.New York, NY:Oxford University Press.
26. Williams, MV,Davis, T,Parker, RM,Weiss, BD(2002).The role of health literacy in patient-physician communication.Fam Med,34,383-389.
27. Zarcadoolas, C,Pleasant, A,Greer, DS.(2009).Advancing Health Literacy: A Framework for Understanding and Action.San Francisco, CA:John Wiley & Sons.
28. 王亭惠, TH,雷繼文, JW,蔡孟潔, MJ,張蕙業, HY,官大紳, TS(2017)。角色扮演：醫病溝通工作坊。物理治療，42，155-156。
29. 朱宗信, TS(2009)。ACGME六大核心能力於一般醫學教育。醫療品質雜誌，3，75-78。
30. 李錦虹, GH,邱浩彰, HC,陳亭君, TJ(2015)。臨床醫師的醫病溝通技巧之質性分析。台灣醫學，19，569-580。
31. 周怡伶, YL,陳鈺如, YJ,李彩緣, CY(2010)。降低住院期間醫病溝通之訊息傳遞不正確率。中山醫學雜誌，21，435-446。
32. 張苙雲, LY(2014)。全民健保的組織社會學。台灣醫學，18，85-91。
33. 黃煌雄, HS,沈美真, MZ,劉興善, HS(2012).全民健保總體檢.台北=Taipei:五南=Wunan.
34. 葉蓉慧, BJH,連吉時, GS(2011)。由台灣民眾的就醫經驗探討病患如何減低不確定感。傳播與社會學刊，17，61-85。
35. 賴香如, HR(2018).青少年健康素養：理論、研究與學校實務.台北=Taipei:國立台灣師範大學出版中心=National Taiwan Normal University Press.
36. 蘇哲能, CL,張淑鳳, SF,陳榮基, RC,潘豐泉, FC,陳清軒, CH,劉偉文, WW(2008)。台灣健康知能量表之初探性研究。台灣醫學，12，525-536。