電腦化適性測驗提升病人的健康識能

Computer-Adaptive Testing (CAT) for patients to increase health literacy

傳統上的衛生教育係以衛教單張做單向式的宣導，隨著病人手機的普及，有必要發展一具手機上網互動式的衛生教育模式，以提升病人的健康識能。本研究以皮膚科門診前的病人等候情境，發展一具自評皮膚癌風險的資訊模組，由病人於診間候診時，先行評估再行看診，以達到宣導及防範皮膚癌衛生教育之目的。利用期刊發表的文獻資料，蒐集(1)澳洲國家衛生研究中心於2011 年在Queensland 調查研究皮膚癌風險的31 題題庫，(2)題目的難度參數、及(3) 皮膚癌風險的決斷點為0.88logit，以Rasch 部份給分模式設計一具網頁版本的電腦化適性測驗（CAT）。決斷點提供病人施測後的參考，當大於決斷點，就需主動提示醫師做進一步的檢查與評估。研究發現在診間前貼示一個宣導防範皮膚癌的QR-code，提供皮膚科病人自我評估皮膚癌風險衛教的可能。手機上網及掃描QR-code 即可進行CAT 皮膚癌的風險評估，對於宣導防範皮膚癌的衛生教育，提供新型式的衛教模式，也對其它醫療科的衛生教育提供示範效果，以提升健康識能。

Hygiene education in tradition is a one-way distribution of brochure for patients. As with all forms of Web-based technology, advances in mobile health (mHealth) and health communication technology are rapidly increasing. It is required to develop an interactive mode in hygiene education to increase patients’ health literacy. With a scenario of outpatients waiting for a consultation of dermatology, we developed a mobile CAT survey procedure to practically demonstrate the application in action, rendered to patients increasing hygiene knowledge. Data from published journal papers in Australia’s The QSkin Sun and Health Study (2011) were used to gather (1) a 31-item pool, (2) item difficulties, and (3) a cutoff point of high skin cancer risk. at 0.88 logit. Rasch(1960) partial credit model was performed to design an online CAT module. When CAT score beyond the cut point was recommended to physicians for further follow-up examination and confirmation. We found that it is possible to scan a QR-Code to access the online CAT skin cancer risk assessment as a way of self-response to gain hygiene education. A mobile CAT with a way to educate patients can be generalized to other medical fields to increase health literacy.