Hibbard Judith
Health Policy Research Group, University of Oregon.
Stud Health Technol Inform. 2017;240:251-262.
In this paper we define health literacy and patient activation, discuss how each construct is measured, and review the evidence linking each construct to outcomes. Studies indicate that health literacy and patient activation are separate concepts that are only moderately correlated with each other. The studies indicate that patient activation and health literacy can each make independent contributions to outcomes. This is important, as it indicates the need to attend to both health literacy and patient activation in the design of interventions. This means that interventions that are successful in increasing health literacy will not necessarily also influence patient activation, and interventions that are successful in increasing patient activation will not necessarily also influence health literacy. Both are likely necessary. The studies show that patient activation is often a stronger predictor of behaviors and health outcomes than is health literacy, however, health literacy is sometimes a stronger predictor of understanding and using information for choice. Some of the differences observed in these studies reflect the fact that health literacy is primarily a skills based concept, and patient activation includes skills, but also includes confidence, beliefs, and role expectations. These differences suggest different pathways for effectively intervening to improve outcomes. The implications for interventions and research directions are discussed.
在本文中，我们定义了健康素养和患者激活度，讨论了每种结构的测量方法，并回顾了将每种结构与结果联系起来的证据。研究表明，健康素养和患者激活度是相互独立的概念，彼此之间仅有中等程度的相关性。研究表明，患者激活度和健康素养均可对结果做出独立贡献。这一点很重要，因为它表明在设计干预措施时需要同时关注健康素养和患者激活度。这意味着，成功提高健康素养的干预措施不一定也会影响患者激活度，而成功提高患者激活度的干预措施也不一定会影响健康素养。两者可能都是必要的。研究表明，患者激活度通常比健康素养更能有力地预测行为和健康结果，然而，健康素养有时在理解和运用信息进行选择方面是更强的预测因素。这些研究中观察到的一些差异反映了这样一个事实，即健康素养主要是一个基于技能的概念，而患者激活度包括技能，但也包括信心、信念和角色期望。这些差异表明了有效干预以改善结果的不同途径。本文还讨论了对干预措施和研究方向的启示。
