背景及研究目的
全球氣喘協會 (Global Initiative for Asthma) 於2004年預估，到2025年世界人口中罹患氣喘人數將增加45-59%，故氣喘將成為全球一項重要健康議題。目前國內尚未見氣喘病人健康素養之資料，而相關研究顯示氣喘病人的健康素養與健康結果有關，但並未證實兩者的因果關係，故本研究之目的是驗證健康素養與健康結果的因果模式。
研究方法
本研究為一橫斷式調查研究（Cross-sectional survey research），以至北部三所醫學中心及一所區域教學醫院胸腔內科門診就診之20歲以上氣喘病人為對象，共收案300人。以問卷收集社會人口學、疾病特性、健康素養、醫療決策、氣喘知識、態度和自我效能、接受健康照護經驗，以及健康結果 (MDI使用技能、醫療資源利用及自我管理行為) 等資料，再採SPSS 15.0 版之結構方程式驗證健康素養對健康結果之直接效應及中介效應因果模式，並以P< .05為統計上的顯著水準。

結果
健康素養之平均值為80.43（滿分120），其中不足者佔13.67%、邊緣者13.33%、而足夠者佔73%。健康素養與健康結果的直接效應模式不成立，但加入社會人口學及疾病特性變項後，健康素養對健康結果之MDI使用技能具直接效果。另，不論是否加入社會人口學及疾病特性變項，健康素養會經由中介變項對健康結果產生間接效果。
結論
本研究顯示，研究對象的健康素養與健康結果間有因果關係，包括直接效應及間接效應模式，但解釋力不高，顯示可能尚有具影響力之變項未置入模式中，值得未來繼續探究。然本研究為驗證兩者因果模式之第一項研究，故可作為相關研究設計和介入措施成效評價之參考。

Background and Research Purposes
The Global Initiative for Asthma (GINA) estimated that by 2025 the number of people with asthma will have grown by 45-59% and asthma will become as an important health issue globally. Although the relationship between health literacy and health outcome has been identified in the literature, the health literacy of asthma sufferers in Taiwan and the causal models linking health literacy and health outcomes have yet been adequately explored. This study was to examine the causal model linking health literacy and health outcome.
Research Methodology
This study was a cross-sectional survey. Using purposive sampling, we identified and invited potential participants from the thoracic medicine outpatient clinics of three medical centers and one district teaching hospital located in northern Taiwan. Qualified participants were aged 20 or over with a diagnosis of asthma. A total of 300 agreed to participate and were enrolled as subjects. A self-administered questionnaire was used to collect socio-demographics, disease characteristics, knowledge, attitudes and self-efficacy of asthma, medical decision-making, healthcare experience, and health outcome including MDI usage proficiency, medical utilization and self-management behavior. Data was analyzed using SPSS 15.0 software and a structured equation model (SEM) was used to validate the direct and mediating effects of health literacy on health outcomes. Statistical significance was defined as P< .05.
Results
The mean value for health literacy was 80.43 (total score = 120) with 13.67%, 13.33% and 73% categorized as “inadequate”, “borderline” or “adequate”, respectively. The direct effect of health literacy on health outcome was not supported. However, after considering socio-demographics and disease characteristics, the direct effect of health literacy on MDI usage proficiency was supported. Regardless of socio-demographic and disease characteristics, health literacy was found to have an indirect effect via mediated variables on the health outcomes of MDI usage proficiency, medical utilization and self-management behavior.
Conclusions
There was a causal relationship between between health literacy and health outcomes, both direct and indirect, but the variance explained was not high. The findings suggest that some variables with potentially explanative effects on health outcomes might not include and need to explore. Furthermore, this study was the first validation study to consider this issue. It is hoped that our findings and suggestions may be incorporated into the design of research and the evaluation of intervention effectiveness in the future.

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