臺灣博碩士論文加值系統

糖尿病人的健康素養是衛教師在衛教糖尿病病人常見的挑戰，其影響衛教的成效、自我管理進而可能影響疾病本身的控制，本研究旨在探究糖尿病患者之健康素養相關因素探討，其健康素養程度影響糖尿病指標及遵從率。研究目的有三，首先探討糖尿病病人健康素養程度及健康素養相關因素之探討，歸納研究結果，提出結?與建議供糖尿病衛教之?考，以達到提昇??病人照護品質。
本研究針對某地區醫院門診個案管?中??病病人為研究對象，針對門診衛教病歷紀錄中個案評估資?包括社會人口學特質 (性別、年齡、教育程度、BMI)、疾病史（罹病年數、家族史、治療方式）、學習經驗(衛教來源、參加病友支持團體)及健康素養程度（血糖管理、運動注意事項、足部照顧、血糖監測、糖尿病認識與照護、糖尿病生活管理、糖尿病計數知能七構面）與糖尿病指標(急性併發症、慢性併發症及糖化血色素、空腹血糖)、遵從率(服藥遵從率、糖化血色素遵從率)等變項，以SPSS 18.0中文版軟體進?敘述性及推?性統計資?分析。使用之研究方法包括敘述性統計分析（次?分配、平均?、標準差、百分比）、獨?樣本t檢定、變??分析(ANOVA)分析。
結果顯示糖尿病人普遍健康素養偏低，分題之健康素養描述性分析中共有11題低於平均值，佔46%；探討其構面，以「足部照顧」得分最低(1.8分)，顯示糖尿病人在足部照顧的健康素養多為差或非常差，最差的單題為「傷口的處理」，有97.6%的病人不知如何傷口處理的知識和技巧；有76.3%的糖尿病人不知自我檢查的重要性及方法，在臨床上為足為參考。構面較差的其次為「糖尿病計數知能」得分僅2.1分，尤以「胰島素的種類、外觀、效能及劑量」此項健康素養差者佔81.3%，顯示糖尿病人不知胰島素的知識及使用技巧。另血糖監測方面的得分為2.4分，有65%~66.3%的病人對於驗血糖的時間及次數及居家自我血糖監測方式的素養不足，此點實為堪慮，可為臨床衛教指引參考。

This study aims to investigate the health literacy of patients with diabetes-related factors. The research has three purposes, first to explore the related factors in diabetic patients the degree of health literacy and health literacy of, summarized the findings, conclusions and recommendations for diabetes care management reference.
To join the "diabetes common care plan" out-patient cases Management of diabetes patients for a local hospital the object of study for out-patient health education medical records case assessment of capital data include basic information (gender, age, educational attainment), life patterns (BMI, drinking history, smoking history), morbidity status (number of years of morbidity, family history, history of related diseases, treatment (medication adherence, glycosylated hemoglobin rate of compliance) and the learning experience (education, experience, and to participate in the patient group to participate in activities of patients) and health literacy levels (blood glucose management, exercise precautions, foot care, blood glucose monitoring, diabetes awareness and care, diabetes life management, diabetes count knowledge of seven dimensions), to explore its impact, hoping Based on the results , analyzed and summarized to make a proposal to provide community-based hospital executive diabetes disease wei to teach management reference use to enhance the quality of diabetes patient care.
In this study, SPSS 18.0 Chinese version of the software to conduct descriptive and inferential statistical data analysis. The research methods used include descriptive statistics (frequency distribution, mean, standard deviation, percentage), the chi-square test, independent sample t test, analysis of variance (ANOVA), Pearson correlation analysis.

第一章 前言 1
第一節 研究背景與動機 1
第二節 研究目的 3
第二章 文獻探討 4
第一節 糖尿病 4
第二節 健康素養的概念 7
第三節 糖尿病病人健康素養的測量研究 11
第四節 糖尿病病人健康素養的關係影響 16
第三章 研究方法 19
第一節 研究設計 19
第二節 研究架構 20
第三節 操作型定義 21
第四節 研究工具 22
第五節 資料分析與處理 26
第四章 研究結果 27
第一節 基本資料 27
第二節 糖尿病健康素養 30
第三節 糖尿病健康素養相關性分析 34
第五章 結論與討論 41
第一節 結論 41
第二節 研究限制 44
第三節 實務應用與建議 45
參考文獻 46
附錄 51

中文部分
江吉文、李均倩、王仕玲、胡秀蓉、李炳鈺（2008）。糖尿病足病變之評估和處置。長庚藥學學報，15(4)，1-11。
民國99年衛生統計系列（一）死因統計（2011）。行政院衛生署。取自http://www.doh.gov.tw/CHT2006/DM/DM2_2.aspx?now_fod_list_no =11962 &class_no=440&level_no=4
沈宜靜、林建良、許惠恒（2011）。糖尿病與癌症之關聯以及台灣現況探討。內科學誌。22（1），19-30頁。
李哲全、傅振宗、吳篤安（民95）。糖尿病的診斷與治療。慈濟醫學。18(Suppl 1)；1-9頁。
吳淑芳、李玉嬋、張嘉容、Mary Courtney、張月玲（民96）。自我效能諮商技巧訓練於糖尿病衛生教育之運用。護理雜誌，54(1)，70-77頁。
周碧瑟、董道興、李佳琳、莊紹源、林敬恆、楊南屏（2002）。台灣地區糖尿病流行病學。臺灣公共衛生雜誌。21（2），83-96頁。
張美娟、陳月枝、章淑娟（民98）。健康素養的概念分析。護理雜誌。56（5），93-96頁。
林冠品（民93）。與公衛護士互動關係感受、疾病知識、疾病態度與糖尿病自我照顧行為的關係。臺灣公共衛生雜誌23（6），479-486頁。
張媚（民87）。自我效能、社會支持與糖尿病病人居家自我照顧行為相關之探討。護理研究。6(1)，31-43頁。
郭寶蓮、蔡秀鸞、陽琪（民91）。充能訓練對糖尿病患者糖化血色素、自我效能和照護之成效。臺灣醫學。6(6)，848-857頁。
廖嘉音（民98）。成人健康素養教育方案之實施與成效~以糖尿病友為例。取自http://ndltd.ncl.edu.tw/cgi-bin/gs32/gsweb.cgi?o=dnclcdr&s=id=%22097NKNU5142069%22.&searchmode=basic.
???、曲同光、陳玉敏（2002）。??病共同照護與健保給付。台灣醫學。6（4），581－584頁。
蔡慈儀、李守義、?憶文、郭耿南（民99）。中文健康適能評估表的發展與測試。醫學教育。14，122-136頁。
蘇哲能、張淑鳳、陳榮基、潘豐泉、陳清軒、劉偉文（民97）。台灣健康知能量表之初探性研究。台灣醫學。12（5），535－536頁。
學術名詞資訊網（2011）。國家教育研究院。取自http://terms.nict.gov.tw/search_b1.php
英文部分
American Diabetes Association (2011) Standards of Medical Care in Diabetes. Diabetes care. 34(1): 11-61.
American Medical Association Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs.（1999）.Health literacy: Report of the council on scientific affairs. Journal of American Medical Association,281(6),552－557.
American Medical Association Ad Hoc Committee.( 2007) Standards of medical care in diabetes. Diabetes Care 2007;30 (11):4-41.
Cavanaugh, K., Huizinga, M,M., Wallston, K.A., Gebretsadik, T., Shintani, A., Davis, D., Gregory,R,P,, Fuchs, L., Malone, R., Cherrington, A., Pignone, M., DeWalt, D.A.,Elasy, T.A., Rothman, R.L.(2008). Annals of Internal Medicine. Association of numeracy and diabetes control., 148(10), 737–46.
Deane, P.(2004). Literacy redefined. Library journal,49-51.
Dewalt, D. A., Boone, R. S., & Pignone, M. P. (2007). Literacy and its relationship with self-efficacy, trust, and participation in medical decision making. American Journal of Health Behavior, 31, 27-35.
Diamond,J.J.（2007）. Development of a reliable and construct valid measure of nutritional literacy in adults. Nutrition Journal,6(5),1-4.
Funnell, M. M., Brown, T. L., Childs, B. P., Haas, L. B., Hosey, G. M., Jensen, B., et al.(2008). National standards for diabetes self-management ducation. Diabetes Care, 31(11), 97-104.
Guler, N.,Oguz, S.(2011).The spoken knowledge of low literacy in patients with diabetes. Diabetes Research and Clinical Practice, 92(2). 238-243.
Huizinga, M., Carlisle, A. J., Cavanaugh, K. L., Davis, D. L., Gregory, R. P., Schlundt, D.G.,& Rothman, R. L.(2009). Literacy, Numeracy, and Portion-Size Estimation Skills. American Journal of Preventive Medicine, 36(4), 324-328.
Kim, S., Love, F., Quistberg, DA., Shea, JA.(2004).Association of health literacy with self-management behavior in patients with diabetes. Diabetes Care, 27(12), 2980-2982.
Lancet（1998） Group: Intensive blood- glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes. UK Prospective Diabetes Study (UKPDS) ; 352:837-853.
Lin, T., Chou, P., Lai, M. S., Tsai, S. T., & Tai, T. Y. (2001).Direct costs-of-illness of patients with diabetes mellitus in Taiwan. Diabetes Research and Clinical Practice,54(11), 43－46.
Morris NS, MacLean CD , Chew LD & Littenberg B（2006）. The Single Item Literacy Screener: Evaluation of a brief instrument to identify limited reading ability. BMC Family Practice,7（21）,1-7.
Nath, C.R, Sylvester, S.T, Yasek, V, Gunel, E. (2001).Development and validation of a literacy assessment tool for persons with diabetes. Diabetes Educator, 27(6):857-864.
National Institute for Literacy. (2009). Public law 102-73, the National Literacy Act of 1991. Retrieved July 9, 2009, from http://www.nifl.gov/public-law.html
Nielsen-Bohlman, L., Panzar, A.M.,& Kindig, D.A.(2004). Health literacy: A prescription to end confusion. Washington, DC: National Academies Press.
Ntiri,D W.; STEWART,M.（2009）. Transformative Learning Intervention: Effect on Functional Health Literacy and Diabetes Knowledge in Older African Americans. Gerontology & Geriatrics Education, 30:100–113.
Nutbeam, D.(2000). Health literacy as a public health goal: A challenge for contemporary health education and communication strategies into the 21st century. Health Promotion International.15(3),259-267.
Osborn, C.Y., Cavanaugh,K., Kerri,Ω., Wallston, K.A., White, R.O., Rothman, R.L.(2009). Diabetes Numeracy.Diabetes Care,32(9), 1614-1619
Peek, M.E., Wilson, S.C., Gorawara-Bhat, R., Odoms-Young, A., Quinn, M.T., ＆ Chin, M.H.（2009）. Barriers and Facilitators to Shared Decision-making Among African-Americans with Diabetes. Journal of General Internal Medicine, 24(10):1135–9
Petersen, P.E., ＆ Kwan, S.(2010). The 7th WHO Global Conference on Health Promotion-towards integration of oral health. Community Dent Health. 27(1) ,129-136.
Rothman, R.L., Malone, R., Bryant, B., Wolfe, C., Padgett, P., DeWalt, D.A., Weinberger, M., Pignone, M. (2005). The spoken knowledge in low literacy in diabetes scale: a diabetes knowledge scale for vulnerable patients. Diabetes Education, 31(2), 215–224.
Sarkar, U., Karter, A.J., Liu, J.Y., Moffet, H.H., Adler, N. E., Schillinger, D.（2010）. Hypoglycemia is More Common Among Type 2 Diabetes Patients with Limited Health Literacy: The Diabetes Study of Northern California (DISTANCE). J Gen Intern Med 25(9):962–8.
Schillinger, D., Grumbach, K., Piette, J., Wang, F., Osmond, D., Daher, C., Palacios, J., Sullivan,G.D., Bindman, A.B.(2002).Association of health literacy with diabetes outcomes. JAMA,288(4),475–482.
Schillinger D, Barton LR, Karter AJ, Wang F, Adler N（2006）. Does literacy mediate the relationship between education and health outcomes? A study of a low-income population with diabetes. Public Health Rep.;121(3):245–54.
Schillinger D, Bindman AB, Wang F, Stewart A, Piette J.（2004） Functional health literacy and the quality of physician–patient communication among diabetes patients. Patient Educ Couns. 52(3):315–23.
Shaw, J. E., Sicree, R. A., & Zimmet, P. Z. (2010). Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Research and Clinical Practice, 87(1), 4-14.
Speros,C.(2005). Health literacy: concept analysis. Journal of Advanced Nursing ,50(6),633-640.
Sudore,R.L., Mehta, K.M., Simonsick, E.M., Harris, T.B., Newman, A.B., Satterfield, S., Rosano, C., Rooks, R.N., Rubin, S.M., Ayonayon, H.N., Yaffe, K.（2006）. Limited literacy in older people and disparities in health and healthcare access. J Am Geriatr Soc,54(5),770–776.
Tang Y.H. , Pang S.M.C. , Chan M.F. , Yeung G.S.P. & Yeung V.T.F.(2008) Health literacy, complication awareness, and diabetic control in patients with type 2 diabetes mellitus. Journal of Advanced Nursing 62(1), 74–83
U.S. Department of Health and Human Services,National Institutes of Healyh.（2011）.Clear communication: AN NIH Health Literacy Initiative. Available at: http://www.nih.gov/clearcommunication/healthliteracy.htm. Accessed June 23,2011
United Nations Educational, Scientific and Cultural Organization【UNESCO】. (2006). Understandings of literacy. Education for All Global Monitoring Report. 147-159. Retrieved May 8, 2011,from http://www.unesco.org-education- GMR 2006-full-chapt6_eng.pdf
Wikipedia.(2011).Literacy. Retrieved May 8, 2011, from http://en.wikipedia.org/ wiki/Literacy
World Health Organization. (1998). Health promotion glossary. Retrieved June 23,2011 from http://www.who.int/hpr/NPH/docs/hp_glossary_en.pdf