健康素养和生活方式风险因素对澳大利亚患者健康相关生活质量的影响。
The impact of health literacy and life style risk factors on health-related quality of life of Australian patients.
作者信息
Jayasinghe Upali W, Harris Mark Fort, Parker Sharon M, Litt John, van Driel Mieke, Mazza Danielle, Del Mar Chris, Lloyd Jane, Smith Jane, Zwar Nicholas, Taylor Richard
机构信息
Centre for Primary Health Care and Equity, Level 3 AGSM, University of New South Wales Australia, Sydney, NSW, 2052, Australia.
Discipline of General Pratice, School of Medicine, Flinders University, Adelaide, South Australia, Australia.
出版信息
Health Qual Life Outcomes. 2016 May 4;14:68. doi: 10.1186/s12955-016-0471-1.
BACKGROUND
Limited evidence exists regarding the relationship between health literacy and health-related quality of life (HRQoL) in Australian patients from primary care. The objective of this study was to investigate the impact of health literacy on HRQoL in a large sample of patients without known vascular disease or diabetes and to examine whether the difference in HRQoL between low and high health literacy groups was clinically significant.
METHODS
This was a cross-sectional study of baseline data from a cluster randomised trial. The study included 739 patients from 30 general practices across four Australian states conducted in 2012 and 2013 using the standard Short Form Health Survey (SF-12) version 2. SF-12 physical component score (PCS-12) and mental component score (MCS-12) are derived using the standard US algorithm. Health literacy was measured using the Health Literacy Management Scale (HeLMS). Multilevel regression analysis (patients at level 1 and general practices at level 2) was applied to relate PCS-12 and MCS-12 to patient reported life style risk behaviours including health literacy and demographic factors.
RESULTS
Low health literacy patients were more likely to be smokers (12 % vs 6 %, P = 0.005), do insufficient physical activity (63 % vs 47 %, P < 0.001), be overweight (68 % vs 52 %, P < 0.001), and have lower physical health and lower mental health with large clinically significant effect sizes of 0.56 (B (regression coefficient) = -5.4, P < 0.001) and 0.78(B = -6.4, P < 0.001) respectively after adjustment for confounding factors. Patients with insufficient physical activity were likely to have a lower physical health score (effect size = 0.42, B = -3.1, P < 0.001) and lower mental health (effect size = 0.37, B = -2.6, P < 0.001). Being overweight tended to be related to a lower PCS-12 (effect size = 0.41, B = -1.8, P < 0.05). Less well-educated, unemployed and smoking patients with low health literacy reported worse physical health. Health literacy accounted for 45 and 70 % of the total between patient variance explained in PCS-12 and MCS-12 respectively.
CONCLUSIONS
Addressing health literacy related barriers to preventive care may help reduce some of the disparities in HRQoL. Recognising and tailoring health related communication to those with low health literacy may improve health outcomes including HRQoL in general practice.
背景
关于澳大利亚初级保健患者的健康素养与健康相关生活质量（HRQoL）之间的关系，现有证据有限。本研究的目的是调查健康素养对大量无已知血管疾病或糖尿病患者的HRQoL的影响，并检验低健康素养组和高健康素养组之间HRQoL的差异是否具有临床意义。
方法
这是一项对一项整群随机试验的基线数据进行的横断面研究。该研究纳入了2012年和2013年在澳大利亚四个州的30家普通诊所的739名患者，使用标准的简短健康调查问卷（SF-12）第2版。SF-12身体成分得分（PCS-12）和精神成分得分（MCS-12）采用标准的美国算法得出。使用健康素养管理量表（HeLMS）测量健康素养。应用多水平回归分析（患者为第1水平，普通诊所为第2水平）将PCS-12和MCS-12与患者报告的生活方式风险行为（包括健康素养和人口统计学因素）相关联。
结果
健康素养低的患者更有可能是吸烟者（12%对6%，P = 0.005）、身体活动不足（63%对47%，P < 0.001）、超重（68%对52%，P < 0.001），并且身体健康和心理健康水平较低，在调整混杂因素后，临床显著效应量分别为0.56（回归系数B = -5.4，P < 0.001）和0.78（B = -6.4，P < 0.001）。身体活动不足的患者身体健康得分可能较低（效应量 = 0.42，B = -3.1，P < 0.001），心理健康得分也较低（效应量 = 0.37，B = -2.6，P < 0.001）。超重往往与较低的PCS-12相关（效应量 = 0.41，B = -1.8，P < 0.05）。健康素养低、受教育程度较低、失业且吸烟的患者身体健康状况较差。健康素养分别占PCS-12和MCS-12中患者间总方差解释量的45%和70%。
结论
解决与健康素养相关的预防保健障碍可能有助于减少HRQoL方面的一些差异。认识到健康素养低的人群并为其量身定制与健康相关的沟通方式，可能会改善包括普通医疗中的HRQoL在内的健康结果。
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