健康識能的概念發展與實務應用

Health Literacy: Conceptual Development and Practical Application

健康識能的概念誕生於1970年代，而於近年來越來越受到重視，包括世界衛生組織、美國醫學會、歐盟等都曾為其做出解釋與定義。在健康識能的評估方面，國際上常用的有英文版的The Rapid Estimate of Adult Literacy in Medicine (REALM)、Test of Functional Health Literacy in Adults (TOFHLA)，以及依據其衍生出的短版與其他語言版本等；而European Health Literacy Survey Questionnaire (HLS-EU-Q) 則是另外一種由歐洲發展出，和前述施測概念較為不同的自評問卷。在臨床照護上，健康識能被認為與醫病溝通、慢性疾病照護等常見健康照護議題有舉足輕重的關係。但於實務領域中，除了提升民眾健康識能外，建立健康識能友善環境也是醫療院所與衛生機關可以共同努力的方向。健康識能於社區、醫療院所、教育機構、媒體等場域情境中，都各自有需重視的議題與可行的具體運作方式。台灣於近年來也開始重視此議題，陸續有學者自創或翻譯國外相關問卷作為為台灣民眾施測的工具。將健康識能概念與評估應用於家庭醫學的核心領域，將有助於對病人的就醫與尋求健康行為有更完整的了解，並落實以病人為中心的整體照護。

The term “health literacy,” first introduced in the 1970s, has received increasing attention as the World Health Organization, American Medical Association and European Union have all made efforts to define and elaborate the term. To assess health literacy, the English versions of the Rapid Estimate of Adult Literacy in Medicine (REALM) and the Test of Functional Health Literacy in Adults (TOFHLA) have been in extensive use. The short-form and non-English versions of the two questionnaires have also been developed and used globally. The European Health Literacy Survey Questionnaire (HLS-EU-Q) is another self-assessed questionnaire designed by the EU based on concepts slightly different from those adopted by the two aforementioned assessment tools. In clinical care, health literacy has been considered related closely to common health issues such as doctor-patient communication and the treatment and care of chronic diseases. In actual practice, in addition to promoting the public awareness of health literacy, medical institutions and public health departments should strive to make their healthcare facilities more literacy-friendly. Overall, discussions related to health literacy focus on its influence and action plans to be implemented in communities, medical facilities, educational institutions, and mass media. In response to the growing interest in health literacy, scholars and researchers in Taiwan have started in recent years to introduce health literacy assessment tools both through translation and self-development. Integrating the concepts of health literacy with the core principles of family medicine can be expected to facilitate a more comprehensive understanding of patients’ health-seeking behaviors and to better implement patient-centered care.