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

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 nation-wide survey results may serve as a reference for decision-makers at the national health education level.