Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, United Kingdom.
PLoS One. 2013 Sep 4;8(9):e74373. doi: 10.1371/journal.pone.0074373. eCollection 2013.
There is ongoing debate on whether health literacy represents a skill-based construct for health self-management, or if it also more broadly captures personal 'activation' or motivation to manage health. This research examines 1) the association between patient activation and health literacy as they are most commonly measured and 2) the independent and combined associations of patient activation and health literacy skills with physical and mental health.
A secondary analysis of baseline cross-sectional data from the LitCog cohort of older adults was used. Participants (n = 697) were recruited from multiple US-based health centers. During structured face-to-face interviews, participants completed the Test of Functional Health Literacy in Adults (TOFHLA), the Patient Activation Measure (PAM), the SF-36 physical health summary subscale, and Patient Reported Outcomes Measurement Information Service (PROMIS) short form subscales for depression and anxiety.
The relationship between health literacy and patient activation was weak, but significant (r = 0.11, p<0.01). In models adjusted for participant characteristics, lower health literacy was associated with worse physical health (β = 0.13, p<0.001) and depression (β = -0.16, p<0.001). Lower patient activation was associated with worse physical health (β = 0.19, p<0.001), depression (β = -0.27, p<0.001) and anxiety (β-0.24, p<0.001).
The most common measures of health literacy and patient activation are weakly correlated with each other, but also independently correlated with health outcomes. This suggests health literacy represents a distinct skill-based construct, supporting the Institute of Medicine's definition. Deficits in either construct could be useful targets for behavioral intervention.
健康素养是否代表健康自我管理的技能基础结构，或者它是否更广泛地捕捉个人“激活”或管理健康的动机，这一直存在争议。本研究检验了 1）最常测量的患者激活和健康素养之间的关联，以及 2）患者激活和健康素养技能与身心健康的独立和综合关联。
使用来自老年人群体 LitCog 队列的基线横断面数据进行二次分析。参与者（n=697）从美国多个健康中心招募。在结构化的面对面访谈中，参与者完成了成人功能性健康素养测试（TOFHLA）、患者激活量表（PAM）、SF-36 身体健康综合量表和患者报告的结果测量信息服务（PROMIS）简短形式子量表，用于评估抑郁和焦虑。
健康素养和患者激活之间的关系虽然较弱，但具有统计学意义（r=0.11，p<0.01）。在调整参与者特征的模型中，较低的健康素养与较差的身体健康（β=0.13，p<0.001）和抑郁（β=-0.16，p<0.001）相关。较低的患者激活与较差的身体健康（β=0.19，p<0.001）、抑郁（β=-0.27，p<0.001）和焦虑（β=-0.24，p<0.001）相关。
最常用的健康素养和患者激活测量方法彼此之间相关性较弱，但也与健康结果独立相关。这表明健康素养代表一种独特的技能基础结构，支持医学研究所的定义。这两种结构的缺陷都可能成为行为干预的有用目标。
