大學生網路健康素養量表建構及其與健康行為之關係研究

Development and Validation of the E-health Literacy Scale and Investigation of the Relationships between E-health Literacy and Healthy Behavior among Undergraduate Students in Taiwan

10.30074/FJMH.201509_28(3).0002

江佳勳(Chia-Hsun Chiang)；楊淑晴(Shu-Ching Yang)；許琬甄(Wan-Chen Hsu)

大學生 ； 網路健康素養 ； 健康行為 ； undergraduate students ； e-health literacy ； healthy behavior

中華心理衛生學刊

28卷3期（2015 / 09 / 01）

389 - 420

繁體中文

研究目的：本研究旨在建構網路健康素養量表，並進一步探討網路健康素養與健康行為之關係。研究方法：本研究採取分層叢集抽樣的方式，資料蒐集時間自2014年3月至5月，正式樣本來自臺灣地區13所大專院校共455位大學生。研究結果：經預試分析後，網路健康素養量表可區分為「互動性」、「功能性」及「批判性」三層面，各層面Cronbach α信度介於.70至.83之間，全量表信度為.84，可解釋總變異量為61.10%。接著以正式樣本進行驗證性因素分析，結果顯示量表個別項目的信度介於.36至.74之間；標準化因素負荷量介於.60至.86（p＜.001）；而潛在變項的組合信度為.75至.84之間；平均變異抽取量為.50至.52之間。測量模式的各項指標顯示基本適配度良好，整體模式適配度指標數值相當理想，而內在適配度亦大致符合。此外，大學生在網路健康素養與健康行為各層面的得分均呈現顯著差異，其次，不同「性別」、「就讀科系」、「健康關注程度」的大學生在網路健康素養或健康行為之得分呈現顯著差異，而網路健康素養與健康行為之間具有顯著的正向關係，「較重視健康」、「網路批判性健康素養」可以正向預測健康行為。研究結論：本研究所建構之網路健康素養量表可區分為「互動性」、「功能性」與「批判性」等三層面，且具有不錯的信效度，此外，網路批判性健康素養越佳者，越會採取飲食、運動及睡眠等健康行為。

Purpose: The purpose of this study was to construct an e-health literacy scale(EHLS) and to investigate the relationship between e-health literacy and healthy behavior among undergraduate students in Taiwan. Methods: A nationally representative sample of college students was surveyed, and 455 valid responses obtained in formal study. Results: In the pilot study (N=148), items loaded on 3 dimensions in the exploratory factor analysis: functional, interactive, and critical e-health literacy. The Cronbach α was between .70 and .83. The Cronbach α of the EHLS was .84, and total variance was 61.10%. In the formal study (N=455), we used structural equation modeling to examine the measurement model. The reliability of the individual EHLS items ranged from .36 to .74. Standardized factor loading ranged from .60 to .86 (p＜.001). Composite reliability ranged from .75 to .84, and the average variance extracted for each dimension ranged from .50 to .52. The indicators demonstrated a good fit for the measurement model. We identified significant differences for each dimension of e-healthy literacy and healthy behavior. E-health literacy and health behavior were positively correlated. We found that significant differences in e-health literacy or healthy behavior from undergraduate students with different majors, genders, and degree of health concern. Specifically, we found that undergraduate students who demonstrated strong concern for health and had higher critical e-health literacy were more likely to engage in healthy behaviors. Conclusions: The EHLS is a reliable and valid measure of functional, interactive and critical e-health literacy. In addition, those who demonstrated higher critical e-health literacy tended to adopt a healthier lifestyle with respect to diet, exercise, and sleep behaviors.

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。臺灣衛誌，31(2)，184-194。
   連結：
2. 林純雯(2010)。Newest Vital Sign健康素養量表中文版之信校度檢驗與應用－以幼兒職前教師為例。健康促進與衛生教育學報，34，1-31。
   連結：
3. 邱史珊、劉俊昌(2008)。大學生的睡眠與學校生活型態、環境間之關係研究－以中部地區某國立師資培育大學學生為例。學校衛生，52，1-11。
   連結：
4. 張淑紅(2005)。社會階層、社會心理因素對大學生運動行為之影響。臺灣衛誌，24(4)，325-334。
   連結：
5. 許琬甄、陳素鳳、何青蓉(2011)。大學生網路健康資訊使用經驗之初探－健康素養的觀點。健康促進與衛生教育學報，35，1-22。
   連結：
6. 陳美娟、楊志良(2008)。大學生睡眠品質及其相關因素之研究－以中部某私立大學為例。學校衛生，53，35-55。
   連結：
7. 黃有慶、吳侖謹、陳青浩、隋安莉(2009)。南部大專生的睡眠習慣與睡眠品質。嘉南學報，35，572-581。
   連結：
8. 黃明月(2012)。網路健康資訊之批判思考技能發展之方案規畫研究。課程與教學，15(4)，217-240。
   連結：
9. 黃淑貞、洪文綺、劉翠薇、李秋娓(2005)。青少女運動行為探討－焦點團體訪談法之應用。衛生教育學報，23，39-68。
   連結：
10. 劉美媛、呂昌明(2006)。大一學生健康行為現況及其相關因素之研究－以北部某大學學生為例。學校衛生，48，19-37。
    連結：
11. Fox, S. (2006). Online health search 2006: Most Internet users start at a search engine when looking for health information online. Very few check the source and date of the information they find. Retrieved December 10, 2012, from http://www.pewinternet.org/2006/10/29/online-health-search-2006/.
12. 教育部統計處（2013）：〈大專院校校別學生數〉。2013年1月12日，取自https://stats.moe.gov.tw/files/detail/101/101_student.xls。
13. 衛生福利部中央健康保險署（2013）：〈全民健康保險慢性病範圍〉。2013年1月10日，取自http://www.nhi.gov.tw/webdata/webdata.aspx?menu=18&menu_id=683&webdata_id=444。
14. Anderson, J. C.,Gerbing, D. W.(1988).Structural equation modeling in practice: A review and recommended two-step approach.Psychological Bulletin,103(3),411-423.
15. Bagozzi, R. P.,Yi, Y.(1988).On the evaluation of structural equation models.Academy of Marketing Science Journal,16(1),74-94.
16. Baker, L.,Wagner, T. H.,Singer, S.,Bundorf, M. K.(2003).Use of the Internet and e-mail for health care information: Results from a national survey.Journal of American Medical Association,289(18),2400-2406.
17. Bentler, P. M.,Bonnett, D. G.(1980).Significant tests and goodness of fit in the analysis of covariance structure.Psychological Bulletin,88(3),588-606.
18. Bodie, G. D.,Dutta, M. J.(2008).Understanding health literacy for strategic health marketing: eHealth literacy, health disparities, and the digital divide.Health Marketing Quarterly,25(1-2),175-203.
19. Chinn, D.,McCarthy, C.(2013).All aspects of health literacy scale (AAHLS): Developing a tool to measure functional, communicative and critical health literacy in primary healthcare settings.Patient Education and Counseling,90(2),247-253.
20. Cho, Y. I.,Lee, S. Y. D.,Arozullah, A. M.,Crittenden, K. S.(2008).Effects of health literacy on health status and health service utilization amongst the elderly.Social Science & Medicine,66(8),1809-1816.
21. Creswell, J. W.(2008).Education research: Planning, conducting, and evaluating quantitative and qualitative research.New Jersey:Pearson Education.
22. Cutilli, C. C.,Bennett, I. M.(2009).Understanding the health literacy of America: Results of the national assessment of adult literacy.Orthopaedic Nursing,28(1),27-34.
23. Eng, T. R.(2001).The e-health landscape: A terrain map of emerging information and communication technologies in health and health care.New Jersey:The Robert Wood Johnson Foundation.
24. Escoffery, C.,Miner, K. R.,Adame, D. D.,Butler, S.,McCormick, L.,Mendell, E.(2005).Internet use for health information among college students.Journal of American College Health,53(4),183-188.
25. Eysenbach, G.,Köhler, C.(2002).How do consumers search for and appraise health information on the world wide web? Qualitative study using focus groups, usability tests, and in-depth interviews.British Medical Journal,324(7337),573-577.
26. Fornell, C.,Larcker, D. F.(1981).Evaluating structural equation models with unobservable variables and measurement error.Journal of Marketing Research,18(1),39-50.
27. Fox, S.,Rainie, L.(2000).,未出版
28. Gorsuch, R. L.(1983).Factor analysis.New Jersey:Lawrence Erlbaum.
29. Greenberg, D.(2001).A critical look at health literacy.Adult Basic Education,11(2),67-79.
30. Harris, D. M.,Guten, S.(1979).Health-protective behavior: An exploratory study.Journal of Health and Social and Behavior,20(3),17-29.
31. Hooper, D.,Coughlan, J.,Mullen, M.(2008).Structural equation modelling: guidelines for determining model fit.Electronic Journal of Business Research Methods,6(1),53-60.
32. Ishikawa, H.,Nomura, K.,Sato, M.,Yano, E.(2008).Developing a measure of commu-nicative and critical health literacy: A pilot study of Japanese office workers.Health Promotion International,23(2),269-274.
33. Ishikawa, H.,Takeuchi, T.,Yano, E.(2008).Measuring functional, communicative, and critical health literacy among diabetic patients.Diabetes Care,31(5),874-879.
34. Jöreskog, K. G.,Sörbom, D.(1993).LISREL8: Structural equation modeling with SIM-PLIS command language.Illinois:Scientific Software International.
35. Kasl, S. V.,Cobb, S.(1966).Health behavior, illness behavior, and sick role behavior. I. Health and illness behavior.Archives of Environmental Health,12(2),246-266.
36. Kerka, S.(2003).,Washington, DC.:Office of Educational Research and Improvement (ED).
37. Lai, A. Y.,Ishikawa, H.,Kiuchi, T.,Mooppil, N.,Griva, K.(2013).Communicative and critical health literacy and self-management behaviors in end-stage renal disease pa-tients with diabetes on hemodialysis.Patient Education and Counseling,91(2),221-227.
38. Longo, D.(2005).Understanding health information, communication, and information seek-ing of patients and consumers: A comprehensive and integrated model.Health Expec-tations,8(3),189-194.
39. Mitsutake, S.,Shibata, A.,Ishii, K.,Oka, K.(2012).Association of eHealth literacy with colorectal cancer knowledge and screening practice among internet users in Japan.Journal of Medical Internet Research,14(6),e153.
40. Mitsutake, S.,Shibata, A.,Ishii, K.,Okazaki, K.,Oka, K.(2011).Developing Japanese version of the eHealth Literacy Scale (eHEALS).Japanese Journal of Public Health,58(5),361-371.
41. Nielsen-Bohlman, L.,Panzer, A. M.,Kinging, D. A.(2004).Health literacy: Prescription to end confusion.District of Columbia:National Academies Press.
42. Norman, C. D.,Skinner, H. A.(2006).eHealth literacy: Essential skills for consumer health in a networked world.Journal of Medical Internet Research,8(2),e9.
43. Norman, C. D.,Skinner, H. A.(2006).eHEALS: The eHealth literacy scale.Journal of Medical Internet Research,8(4),e27.
44. Nutbeam, D.(2008).The evolving concept of health literacy.Social Science & Medicine,67(12),2072-2078.
45. Nutbeam, D.,Kickbusch, I.(2000).Advancing health literacy: A global challenges for the 21st century.Health Promotion International,15(3),183-184.
46. Parker, R.,Moore, B. N.(2001).Critical thinking.Mountain View, CA:Mayfield.
47. Sharma, S.(1996).Applied multivariate techniques.New York:John Wiley & Sons.
48. van der Vaart, R.,Drossaert, C. H.,Taal, E.,ten Klooster, P. M.,Hilderink- Koertshuis, R. T.,Klaase, J. M.,van de Laar, M. A.(2012).Validation of the Dutch functional, com-municative and critical health literacy scales.Patient Education and Counseling,89(1),82-88.
49. van der Vaart, R.,van Deursen, A. J.,Drossaert, C. H .C.,Taal, E.,van Dijk, J. A. M. G.,van de Laar, M. A. F. J.(2011).Does the eHealth literacy scale (eHeals) measure what it intends to measure? Validation of a Dutch version of the eHeals in two adult populations.Journal of Medical Internet Research,13(4),e86.
50. Wagner, C. V.,Knight, K.,Steptoe, A.,Wardle, J.(2007).Functional health literacy and health-promoting behaviour in a national sample of British adults.Journal of Epidemiology and Community Health,61(12),1086-1090.
51. Zahnd, W. E.,Scaife, S. L.,Francis, M. L.(2009).Health literacy skills in rural and urban populations.American Journal of Health Behavior,33(5),550-557.
52. Zaichkowsky, J. L.(1985).Measuring the involvement construct.Journal of Consumer Research,12(3),341-352.
53. Zorn, M.,Allen, M. P.,Horowitz, A. M.(2004).Understanding health literacy and its barriers.Bethesda, MD:National Library of Medicine.
54. 李茂能(2006)。結構方程模式軟體Amos之簡介及其在測驗編製上之應用－Graph-ics & Basic。臺北:心理出版社。
55. 周其宏(2003)。碩士論文(碩士論文)。國立臺灣大學醫療機構管理研究所。
56. 邱皓政(2010)。量化研究與統計分析SPSS/PASW中文視窗版資料分析例解析。臺北:五南出版社。
57. 財團法人資訊工業策進會(2011)。,臺北:資策會。
58. 陳政昌、程炳林(1998)。SPSS、SAS、BMDP統計軟體在多變量統計上的應用。臺北:五南出版社。
59. 陳政昌、程炳林、陳新豐、劉子鍵(2005)。多變量分析方法－統計軟體應用。臺北:五南出版社。
60. 游智雯(2000)。碩士論文(碩士論文)。國立中正大學電訊傳播研究所。
61. 黃芳銘(2004)。結構方程模式－在教育資料應用之研究。臺北:五南出版社。
62. 黃冠英(2006)。碩士論文(碩士論文)。國立中山大學醫務管理研究所。
63. 楊逸菊、吳欣霓、王雅琦、莊昭華、王拔群、洪焜隆(2009)。參與社區活動民眾之健康行為調查及分析－以臺北市大安區為例。家醫研究，7(2)，54-79。
64. 楊裕隆、莊仲仁(1998)。臺大學生運動行為之研究－合理行動理論之應用。臺大體育學報，2，189-210。

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