Meier Clément, Vilpert Sarah, Wieczorek Maud, Borrat-Besson Carmen, Jox Ralf J, Maurer Jürgen
Faculty of Business and Economics (HEC), University of Lausanne, Lausanne, Switzerland.
Faculty of Biology and Medicine (FBM), University of Lausanne, Lausanne, Switzerland.
PLoS One. 2023 Oct 13;18(10):e0292367. doi: 10.1371/journal.pone.0292367. eCollection 2023.
Personal health literacy is the ability of an individual to find, understand, and use information and services to inform health-related decisions and actions for oneself and others. The end of life is commonly characterized by the occurrence of one or several diseases, the use of many different types of healthcare services, and a need to make complex medical decisions that may involve challenging tradeoffs, such as choices between quality and length of life. Although end-of-life care issues concern most people at some point in life, individuals' competencies to deal with those questions have rarely been explored. This study aims to introduce, develop, and validate an instrument to measure individuals' self-assessed competencies to deal with end-of-life medical situations, the Subjective End-Of-Life Health Literacy Scale (S-EOL-HLS), in a sample of older adults aged 50+ living in Switzerland who participated in wave 8 (2019/2020) of the Survey of Health, Ageing, and Retirement in Europe. The S-EOL-HLS uses a series of questions on self-rated difficulties in understanding end-of-life medical jargon, defining in advance which end-of-life medical treatments to receive or refuse, and communicating related choices. Aside from conducting exploratory and confirmatory factor analysis to evaluate the construct validity, we compared measurements from the S-EOL-HLS to respondents' general health literacy measured with the European Health Literacy Survey questionnaire. We obtained a three-factor model with acceptable fit properties (CFI = 0.993, TLI = 0.992, RMSEA = 0.083, SRMR = 0.061) and high reliability (α = 0.93). The partial associations between the health literacy scores from the two scales and respondents' sociodemographic characteristics were similar; however, individuals with higher end-of-life health literacy scores appeared to have more positive attitudes towards end-of-life care planning outcomes. The S-EOL-HLS demonstrates reliable and consistent results, making the instrument suitable for older adults in population surveys.
个人健康素养是指个人寻找、理解和使用信息及服务，以便为自己和他人做出与健康相关的决策并采取行动的能力。生命末期通常表现为出现一种或多种疾病，使用多种不同类型的医疗服务，以及需要做出可能涉及具有挑战性的权衡取舍的复杂医疗决策，例如在生活质量和寿命之间进行选择。尽管生命末期护理问题在人生的某个阶段会困扰大多数人，但很少有人探讨个体应对这些问题的能力。本研究旨在引入、开发并验证一种工具，以测量个体应对生命末期医疗状况的自我评估能力，即主观生命末期健康素养量表（S-EOL-HLS），该研究的样本为居住在瑞士的50岁及以上老年人，他们参与了欧洲健康、老龄化和退休调查的第8轮（2019/2020年）。S-EOL-HLS使用了一系列关于自我评定在理解生命末期医学术语、预先确定接受或拒绝哪些生命末期医疗治疗以及传达相关选择方面的困难程度的问题。除了进行探索性和验证性因素分析以评估结构效度外，我们还将S-EOL-HLS的测量结果与通过欧洲健康素养调查问卷测量的受访者的一般健康素养进行了比较。我们得到了一个具有可接受拟合特性的三因素模型（CFI = 0.993，TLI = 0.992，RMSEA = 0.083，SRMR = 0.061）和高信度（α = 0.93）。两个量表的健康素养得分与受访者社会人口学特征之间的部分关联相似；然而，生命末期健康素养得分较高的个体似乎对生命末期护理规划结果持更积极的态度。S-EOL-HLS显示出可靠且一致的结果，这使得该工具适用于人群调查中的老年人。
