| Summary: | 碩士 === 高雄醫學大學 === 醫務管理學研究所碩士在職專班 === 96 === OBJECTIVES
Health literacy is the ability to read and understand written materials commonly encountered in health care settings. However, functional health literacy indicates the reading and numeracy skills required to fully understand and act on health information. According to the previous studies, health literacy could play an important role in affecting health knowledge, health behavior, refill adherence, understanding prescription list and self-management skills of chronic disease patients. We translate and edit the Short Test of Functional Health Literacy in adults (S-TOFHLA) developed by Baker et.al. in 1999 to Chinese edition. In this study, we use the translated S-TOFHLA Chinese test to examine health literacy level for Taiwanese. Our aim is to research the relationship between health literacy level and medical resource utilization in chronic disease adults. The objectives in our study are: 1.Introduce the popular short test of functional health literacy in adults into Taiwan in Chinese edition. We try to revise the examination to adapt to our culture and society. 2. Survey the percentage and distribution of health literacy adequate, marginal and inadequate levels in chronic disease adults. 3. Discuss the differences of the demographic characters such as gender, age, socioeconomic status, and ethnicity with health literacy level in chronic disease adults. 4. Analyze the relationship between the health literacy level and medical resource utilization in chronic disease adults.
METHODS
This was a retrospective, cross-sectional design study. We used structural questionnaires to collect the information about demography and health literacy of chronic disease patients. Medical resource utilization data was a secondary data from Chi-Shan hospital medical utilization database. Health literacy was examined by the S-TOFHLA and demographic characteristics including gender, age, ethnicity, and socioeconomic status. Study population was sampling with convenience method in Chi-Shan hospital OPD. From 2007 October to 2008 March, there were 355 patients with diagnosis of diabetes, hypertension, heart disease, and benign prostate enlargement enrolled into this study. All the participants needed to sign the informed consent of the survey. Medical resource utilization was defined as the frequency of OPD visit, the frequency of ER visit, the days of admission and the costs of medical resource from 2005-1-1 to 2008-1-1 of the participants.
RESULTS
All 355 patients were eligible and enrolled into this study. There were 221 (62%) male and the other 134(38%) female participants. Mean age at enrollment was 67±11 years, while 214(60%) participants were older than 65 years. Mean education years of patients were 7.6±4.4 years, while 208(59%) cases average education year less than 8 years. All of 216(61%) cases had total annual income of family less than 200 thousand NTD. All cases of 213(60%) were Minnan ethnic population, 112(31%) were Hakka population, and 30(9%) were Mainlander population. Average functional health literacy scores were 59.4±29.6；average numeracy scores were 18.8±9.6；average reading comprehension scores were 40.6±23.1, respectively. There were 184(52%) cases in adequate literacy group (67~100 scores)，37(10%) cases in marginal literacy group (54~66 scores), and the other 134(38%) cases in inadequate literacy group (0~53 scores). Mean scores of health literacy of male were statistic difference than female (62.8±25.0 versus 53.8±35.2, p=0.010). There were significant differences in functional health literacy across age groups, education strata, and annul family income strata (p<0.001) in ANOVA. Across ethnicity groups, no significant differences was found in functional health literacy (p=0.135). Sum of health literacy scores was significantly associated with age and education years. However, sum of health literacy scores was not significantly associated with frequency of OPD visit and costs of OPD visit. In addition, sum of health literacy scores was significant negative association with frequency of ER visits, days of admission, costs of ER, costs of admission, and all medical costs.
CONCLUSION AND SUGGESTION
In this study, the elder patients had less health literacy scores than the younger; while, the more education years, annual family income, the more sum of health literacy scores. Health literacy was not associated with frequency and costs of OPD visit. However, health illiteracy was significant increasing the frequency of ER visit, longer hospital stay, more expensive costs of ER, admission and total medical utilization. Our results implied that health illiteracy would induce medical utilization, especially in ER and hospital stay costs. Health literacy could be an important medical utilization factor in chronic disease patients. We suggested that health education augmentation, health knowledge promotion, healthy behavior enhancement, and self-management reinforcement would be the strategies to improve functional health literacy in chronic disease patients. Improving health literacy of chronic disease adults might mitigate the expenditure of medical utilization and reduce the unnecessary medical waste.
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