门诊患者健康素养对就医体验的影响及机制

doi:10.19723/j.issn.1671-167X.2021.03.020

摘要/Abstract

摘要：

目的: 探究中国门诊患者的健康素养与就医体验之间的关联,分析其具体的影响机制。方法: 以安德森医疗卫生服务利用行为模型和健康素养技能模型为理论依据,构建患者层面的就医体验影响因素理论框架。采用滚雪球抽样法,通过线上电子问卷调查,利用自行设计的患者健康素养量表和北京协和医学院开发的中国门诊患者体验量表,评估门诊患者的健康素养和就医体验,构建结构方程模型探究两者之间的关系。结果: 最终纳入门诊患者2 773名,健康素养总得分的平均值为(90.72±12.90)分,就医体验综合评价的平均分为(3.71±0.74)分。结构方程模型分析结果表明,门诊患者的健康素养对其就医体验的综合评价产生积极影响,健康素养每提升一个标准差,就医体验增加0.275个单位。在就医体验的不同维度上,健康素养对就医体验总效应的标准化路径系数从高到低依次是:信息引导体验0.337,人文关怀体验0.319,诊疗行为体验0.294,流程效率体验0.240,环境设施体验 0.173。结论: 提升个体的健康素养水平,对于门诊患者的就医体验有显著促进作用,其中信息引导体验和人文关怀体验受健康素养影响最大。

关键词: 健康素养, 就医体验, 门诊患者, 结构方程模型

Abstract:

Objective: To understand the relationship between health literacy and patient experience of outpatients in China, and to explore its mechanism. Methods: The conceptual framework was developed based on Andersen’s behavioral model of health services use and health literacy skills framework. An online cross-sectional survey was conducted with snowball sampling method, while the health literacy was measured by self-designed patient health literacy scale, and the patient experience was measured by the Chinese patient experience questionnaire for ambulatory care developed by Peking Union Medical College. And a structural equation model was built to explore the relationship between them and test the mechanism of health literacy influencing patient experience. Results: A total of 2 773 subjects were investigated. The average score of health literacy was (90.72±12.90) points, accounting for 78.89% of the full score, and the dimension of seeking social support had the lowest score. The average score of overall rating of patient experience was (3.71±0.74) points, and the scores of each dimension of patient experience were between 3.56 and 3.80. The model fit indices of structural equation model for overall rating of patient experience among the outpatients were χ²/df=9.29 (χ²=4 107.27, df=442), root mean square error of approximation (RMSEA)=0.055 (<0.06), comparative fit index (CFI)=0.926 (>0.90), Tucker-Lewis index (TLI)=0.918 (>0.90), standardized root mean square residual (SRMR)=0.061 (<0.08), the model was acceptable. The variance in patient experience explained by the model was 0.108. The structural equation model analysis results showed that the overall rating of outpatient experience was directly affected by health literacy (β=0.263, P<0.001), also indirectly affected by health literacy (β=0.012, P<0.001). In other words, the overall rating increased by 0.275 units for each standard deviation increase of health literacy. Self-evaluated health status mediated the relationship between health literacy and the overall rating of outpatient experience. In terms of diffe-rent dimensions of patient experience, the standardized path coefficient of the total effect of health literacy on patient experience was as follows: Information guidance 0.337, humanistic care 0.319, communication with doctors 0.294, service efficiency 0.240, and hospital environment 0.173. Conclusion: The patients with higher level of health literacy were more likely to have a better outpatient experience in China, and the information guidance experience and humanistic care experience were most affected by health literacy. And the communication and information utilization ability had the greatest influence on patient experience.

Key words: Health literacy, Patient experience, Outpatients, Structural equation model

中图分类号:

R193

王晓琪,陈美君,云青萍,孙思伟,王熙凯,史宇晖,纪颖,管仲军,常春. 门诊患者健康素养对就医体验的影响及机制[J]. 北京大学学报（医学版）, 2021, 53(3): 560-565.

WANG Xiao-qi,CHEN Mei-jun,YUN Qing-ping,SUN Si-wei,WANG Xi-kai,SHI Yu-hui,JI Ying,GUAN Zhong-jun,CHANG Chun. Impact of health literacy on patient experience of outpatients in China and its mechanism[J]. Journal of Peking University (Health Sciences), 2021, 53(3): 560-565.

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参考文献 17

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Variables	Outpatients, n (%)
Gender
Male	1 010 (36.42)
Female	1 763 (63.58)
Age
18 years-	903 (32.56)
30 years-	587 (21.17)
40 years-	477 (17.20)
50 years-	366 (13.20)
60-80 years	440 (15.87)
Nationality
Han ethnic	2 601 (93.80)
Others	172 (6.20)
Education
Junior high school and below	279 (10.06)
High or technical school	333 (12.01)
University or college	1 609 (58.02)
Graduate or higher	552 (19.91)
Account
Urban	1 996 (71.98)
Rural	777 (28.02)
Marital status
Married	1 818 (65.56)
Single/Widow/Divorced/Separated	955 (34.44)
Annual per capital income
≤5 000 Yuan	148 (5.73)
5 001-10 000 Yuan	228 (8.83)
10 001-20 000 Yuan	419 (16.23)
20 001-30 000 Yuan	281 (10.88)
30 001-50 000 Yuan	601 (23.28)
50 001-100 000 Yuan	611 (23.66)
>100 000 Yuan	294 (11.39)
Health insurance
Self-pay	164 (5.93)
Urban employee basic medical insurance	1 345 (48.62)
Urban resident basic medical insurance	422 (15.26)
Rural cooperative medical insurance	405 (14.64)
Commercial health insurance	47 (1.70)
State medicine	383 (13.85)
Chronic disease
Suffering	1 003 (36.17)
No	1 770 (63.83)

Variables	Dimensions	Number of items	Total score	$\bar{x} \pm s$	Percentage^a
Health literacy	Medical treatment skills	9	45	38.29±6.79	85.09%
	Health improvement willingness	4	20	16.59±2.80	82.95%
	Seeking social support	5	25	16.19±3.73	64.76%
	Communication and information utilization skills	5	25	19.64±3.49	78.56%
	Total	23	115	90.72±12.90	78.89%
Patient experience	Service efficiency	6	5	3.62±0.75	72.40%
	Information guidance	4	5	3.77±0.69	75.40%
	Communication with doctors	3	5	3.71±0.80	74.20%
	Humanistic care	4	5	3.80±0.72	76.00%
	Hospital environment	4	5	3.56±0.75	71.20%
	Overall rating	2	5	3.71±0.74	74.20%

Total effect	Estimator	Product of coefficients			Forest plot of estimator	Bias-corrected bootstrap (5 000 times), 95%CI
Total effect	Estimator	SE	Z	P	Forest plot of estimator	Bias-corrected bootstrap (5 000 times), 95%CI
Health literacy → Overall rating	0.275	0.030	9.308	<0.001		0.216-0.332
Health literacy → Service efficiency	0.240	0.025	9.475	<0.001		0.191-0.291
Health literacy → Information guidance	0.337	0.028	11.899	<0.001		0.280-0.392
Health literacy → Communication with doctors	0.294	0.026	11.206	<0.001		0.244-0.346
Health literacy → Humanistic care	0.319	0.027	11.623	<0.001		0.266-0.372
Health literacy → Hospital environment	0.173	0.029	5.991	<0.001		0.115-0.230