臺灣博碩士論文加值系統

研究背景：功能性消化不良(FD)在社區中的全球盛行率為5%～11%，功能性消化不良病人由於就醫、服藥、請病假，所造成的社會成本與醫療費用甚高。過去研究指出健康識能不足會提高健康狀況不良及增加醫療利用的風險等，但尚未有文獻探討功能性消化不良與健康識能的相關性研究。
研究目的：本研究主要探討功能性消化不良病人之健康識能和情緒狀態（焦慮、憂鬱）之間的關係，主要希望透過此研究結果提供醫療從業人員新增或修訂適合的衛教單張、衛教方式之參考，進而提高功能性消化不良病人的健康識能，改善病人的就醫習慣並提升病人自我照護能力，以及有效利用醫療資源，以促進民眾的健康。
研究方法：採用橫斷性研究，使用「中文健康識能評估量表」簡式量表(s-MHLS)，以及醫院焦慮與憂鬱量表(HADS)中文量表之結構性問卷，調查2016年02月18日至2016年5月18日期間，在北部一所醫學中心消化內科門診就診病人中符合羅馬Ⅲ診斷準則為功能性消化不良之病人，共收案66名，扣除1名未完成所有問卷，僅65名列入統計分析。自變項為「健康識能程度」，依變項為情緒狀態「焦慮程度、憂鬱程度」，控制變項為基本人口學屬性變項，運用描述性統計（次數分配、百分比、卡方檢定、費雪精確性檢定、四象限的散佈圖）探討功能性消化不良病人其健康識能程度和焦慮程度、憂鬱程度之間的分佈狀況以及人口學變項、焦慮程度、憂鬱程度在不同健康識能程度之間的差異性；推論性統計則以邏輯斯迴歸分析各人口學變項與健康識能程度之間的相關性，以及健康識能程度在焦慮程度、憂鬱程度之間的相關性。
研究結果：功能性消化不良病人以女性佔多數(86.2%)、年齡大多在51歲以上(73.8%)、婚姻以已婚/鰥寡佔多數(86.2%)、職業類別以家管/退休/農林漁牧較多(50.8%)、教育程度大多在高中/高職以上(61.5%)、經濟狀況不夠用/恰好夠用較多(60%)、有長期失眠狀況較多(58.5%)、焦慮程度以疑似/確定焦慮居多(63.1%)、憂鬱程度則以無憂鬱居多(70.8%)。無長期失眠狀況者相較於有長期失眠狀況者比較不容易有焦慮情況(P < .05)。
在不同健康識能程度的比較部分，結果顯示年齡(P = .026)、職業類別(P = .001)、教育程度(P < .001)、經濟狀況(P = .017)、憂鬱程度(P = .004)在健康識能較好者及健康識能較不佳者兩組別中皆有顯著差異(P < .05)。而且，不論在調整其他變項前後，職業類別及教育程度均具有統計上顯著差異(P < .05)，家管/退休/農林漁牧者相較於軍公教工商服務業者較容易有健康識能較不佳的情況(Adjusted OR = 8.34, 95% CI = 1.19-58.29)；國中以下者相較於高中/高職以上者較容易有健康識能較不佳的情況(Adjusted OR = 6.01, 95% CI = 1.27-28.45)。
經調整人口學變項後，健康識能較好者相較於健康識能較不佳者比較不容易有焦慮情況(OR = 0.29, 95% CI = 0.06-1.44 )、及憂鬱情況(OR = 0.18,95% CI = 0.03-1.03)。
研究結論：功能性消化不良病人其健康識能程度較高者較不容易產生焦慮及憂鬱情況。要改善功能性消化不良疾病症狀，或許可以先從提升功能性消化不良病人的健康識能著手，健康識能程度提升後，病人較不容易產生焦慮及憂鬱情況，進而對其疾病有所改善。因此，本研究結果可提供醫療從業人員新增或修訂適合的衛教單張、衛教方式之參考。

Background: The global prevalence of functional dyspepsia in the community is between 5% and 11%. Functional dyspepsia patients due to their medical care, medication, and sick leave result in very high social costs and medical expenses. Past studies indicate that inadequate health literacy can increase the risk of poor health and increased health care utilization, etc., but not literature to date examine the relationship between functional dyspepsia and health literacy.
Aim: This study focused on the relationship between health literacy and emotional state (anxiety and depression) on patients with functional dyspepsia. We hope the results of this study can provide medical professionals for new or amend appropriate health education leaflets, health education mode, and to improve the health literacy of patients with functional dyspepsia. Furthremore, we hope our results could provide some insights to improve the patient's medical care habits and improve patient self-care ability, and the effective use of medical resources, in order to promote people's health.
Methods: In our cross-sectional study, the structured questionnaire use of "short-form Mandarin Health Literacy Scale " (s-MHLS) and "the Hospital Anxiety and Depression Scale " (HADS) Chinese scale. The survey was conducted from February 18, 2016 to May 18, 2016, from the gastroenterology clinic patients fulfilling Rome Ⅲ diagnostic criteria for patients with functional dyspepsia of a medical center in the North. We received a total of 66 cases, and due to a participant was not completed all the questionnaires, only 65 cases were included in the statistical analysis. In our statistical model, independent variable is " healthy literacy level ", and the dependent variable is the emotional state of " anxiety level and depression level". The adjusted models were including variables such as the basic demographic attribute variables. Using descriptive statistics (frequency distribution, percentage, chi-square test, Fisher accuracy test, four-quadrant scatter plot), we explore the distribution of health literacy level, anxiety level, and depression level of patients with functional dyspepsia, and the difference of demography, anxiety level, depression level in among different health literacy level. Inferential statistics were used logistic regression analysis to analysis the correlation between various demographic variables and health literacy level, and correlation between health literacy level among anxiety level, and depression level.
Results: In patients with functional dyspepsia, the majority of them were female (86.2%), mostly in the age above 51 years (73.8%), marriage to married/widowed majority (86.2%), career tube to homemaker/retirement/agriculture, forestry, animal husbandry and fisheries comparing more (50.8%), education level more in high school/vocational above (61.5%), the economic situation is not enough/just enough more (60%), there are more long-term insomnia (58.5%), anxiety level with doubtful/definite anxiety majority (63.1%), and depression level with without depression places the majority (70.8%). No long-term insomnia people were compared with long-term insomnia people are less likely to have anxiety conditions (P <.05).
When we compared different health literacy level, the results showed that age (P = .026), occupational categories (P = .001), educational level (P <.001), economic status (P = .017), depression level (P = .004) in better health literacy group and those in poor health literacy group are significant differences (P <.05).Moreover, regardless of other variables before and after the adjustment, occupational category and educational level are statistically significant difference (P <.05), homemaker/retirement/agriculture, forestry, animal husbandry and fisheries compared to the military and government business and services people are more likely to have poor health literacy situation (Adjusted OR = 8.34, 95% CI = 1.19-58.29); patients with lower educational level (e.g., Junior high) compared to the high school/vocational above were more likely to have poor health literacy situation (Adjusted OR = 6.01, 95% CI = 1.27-28.45).
After adjustment demographic variables, better health literacy of people compared to poor health literacy of people are less likely to have anxiety situation (OR = 0.29, 95% CI = 0.06-1.44), and depression situation (OR = 0.18,95% CI = 0.03-1.03).
Conclusions: Functional dyspepsia patients with higher health literacy levels were less prone to anxiety and depression situation. Our results suggest that to improve functional dyspepsia disease states may be able to upgrade from functional dyspepsia patients' health literacy to proceed, after improve health literacy level, the patient may be less prone to anxiety and depression, the further improvement of their disease. Therefore, the results of our study may provide a medical practitioner for new or amended appropriate health education leaflets, and health education mode for patients with functional dyspepsia.

目錄
中文摘要 I
英文摘要 III
目錄 VII
表目錄 IX
圖目錄 IX
第一章 緒論 1
第一節 研究背景與動機 1
第二節 問題陳述 3
第三節 研究目的及研究問題與假設 4
第四節 研究重要性 4
本章總結 5
第二章 文獻探討 7
第一節 功能性消化不良之概念性定義及診斷 7
第二節 健康識能之概念性定義及測量 11
第三節 憂鬱、焦慮之概念性定義及測量 27
第四節 功能性消化不良與健康識能、情緒狀態之實證研究及相關因素探討 29
文獻總結 49
第三章 研究方法 50
第一節 研究架構 50
第二節 研究設計 52
第三節 研究對象與取樣 53
第四節 研究工具及研究變項之操作型定義 54
第五節 研究資料處理過程 60
第六節 統計分析 61
第七節 研究倫理 62
本章總結 63
第四章 研究結果 64
第一節 研究對象之特性 64
第二節 功能性消化不良病人其社會人口學變項與健康識能程度之相關性 70
第三節 功能性消化不良病人健康識能程度與焦慮程度之相關性 73
第四節 功能性消化不良病人健康識能程度與憂鬱程度之相關性 76
本章總結 79
第五章 討論與建議 82
第一節 研究結果總結和討論 82
第二節 研究之優點、限制及建議 88
第三節 研究結果之應用 91
第四節 研究結論 92
參考文獻 93
中文部份 93
英文部分 95
附錄 104
附錄一 人體研究倫理委員會通過證明函 104
附錄二 問卷內容 105
附錄三 問卷量表授權使用同意書 113

表目錄
表1健康識能「Health literacy」定義 14
表2國外健康識能測量工具分類表 16
表3國內健康識能評量工具 22
表4功能性消化不良與焦慮、憂鬱之相關實證研究 35
表5健康識能之相關實證研究 44
表6研究變項之操作型定義 58
表7功能性消化不良病人健康識能程度與社會人口學之描述分析 66
表8功能性消化不良病人其社會人口學變項與健康識能程度之相關性 72
表9功能性消化不良病人健康識能程度與焦慮程度之相關性 75
表10功能性消化不良病人健康識能程度與憂鬱程度之相關性 78

圖目錄
圖1研究架構(一) 51
圖2研究架構(二) 51
圖3功能性消化不良病人健康識能程度和焦慮程度散佈圖 69
圖4功能性消化不良病人健康識能程度和憂鬱程度散佈圖 69

中文部份
石崇良、戴玉慈、邱瓊萱、蔡宛芬（2008）‧病人為例之台灣民眾健康知能、健康狀態與病人安全之相關性研究‧衛生福利部2007-2008年委託科技研究計畫（計畫編號DOH96-TD-M-113-031(1/2)、DOH97-TD-M-113-96004）‧衛生福利部，台北市，台灣。
宋佩宜（2008）‧中文版成人功能性健康知能量表之發展及驗證（未發表之碩士論文）‧國防醫學院，台北市，台灣。
李懿倫、張永源（2012）‧慢性病病人成人功能性健康知能程度之相關因素探討‧醫學與健康期刊，1(1)，61-70。
沈立、魏慧如、謝菀婷、林寶秀（2015）‧社區居民的健康意識與健康識能對參與健康活動之探討‧國民教育，55(3)，55-64。
林純雯（2010）‧Newest Vital Sign健康素養量表中文版之信效度檢驗與應用－以幼兒職前教師爲例‧健康促進與衛生教育學報，(34)，1-31。
邱瓊萱、謝邦昌、魏中仁、翁瑄甫（2014）‧糖尿病患者健康識能評量工具之發展與應用評估計畫(103-104年)‧衛生福利部2014年委託科技研究計畫（計畫編號MOHW103-HPA-H-114-112104）‧衛生福利部，台北市，台灣。
徐莞雲、陳筱瑀（2008）‧焦慮的概念分析‧志為護理-慈濟護理雜誌，7(3)，65-70。
財團法人醫院評鑑暨醫療品質策進會（2016）‧使命、願景、核心價值‧取自http://www.jct.org.tw/FrontStage/page.aspx?ID=4AE0AC7B-14C4-4642-BFB8-3FD3FE794E60
陳佩英、史麗珠、王正旭、賴裕和、張獻崑、陳美伶（1999）‧疼痛對癌症病患焦慮與憂鬱之影響‧臺灣醫學，3(4)，373-382。 doi:10.6320/FJM.1999.3(4).02
陳佩英、郭素青、張惠甄、劉亞君、徐子英（2007）‧血液透析病患其控握信念、心理困擾與健康促進行為之初探‧臺灣腎臟護理學會雜誌，6(2)，27-41。
曾旭民（2011）‧健康識能與共同決策：健康識能對癌症病人決策參與感的影響和運用病人決策協助的效益探討‧衛生福利部2010-2011年委託科技研究計畫（計畫編號NSC99-2410-H182-010-MY2）‧衛生福利部，台北市，台灣。
湯澡薰、韓柏檉、張文英、許明照、陳俊榮、沈志陽（2007）‧臺灣地區國民健康知能之調查研究‧衛生福利部2007年委託科技研究計畫（計畫編號DOH96-TD-M-113-030）‧衛生福利部，台北市，台灣。
廖嘉音（2010）‧糖尿病友健康素養教育方案之實施與成效‧中華民國糖尿病衛教學會會訊， 6(2)，40-43。doi:10.6583/TADE.2010.6(2).14
臺北市文山區戶政事務所（2016）‧臺北市文山區15歲以上現住人口數-按性別年齡及教育程度統計表(ods檔案)(民國98年~104年)‧取自http://wshr.gov.taipei/ct.asp?xItem=1014522&ctNode=25305&mp=102151
臺灣憂鬱症防治協會（2009）‧EQ殺手—認識憂鬱‧取自http://www.depression.org.tw/knowledge/know_info_part.asp?paper_id=64
蔡慈儀、李守義、蔡憶文、郭耿南（2010）‧中文健康識能評估表的發展與測試‧醫學教育，14(2)，122-136。
衛生福利部國民健康署健康九九網站（2014）‧103年全國保健會議隆重登場 國民健康署與22縣市共同守護國民健康‧取自http://health99.hpa.gov.tw/TXT/HealthyHeadlineZone/HealthyHeadlineDetai.aspx?TopIcNo=6960
鍾燕宜、郭健隆、賴俊民、楊清容、李麗華（2007）‧全國民眾健康知能調查‧衛生福利部2007年委託科技研究計畫（計畫編號DOH96-TD-M-113-032）‧衛生福利部，台北市，台灣。
蘇哲能、張淑鳳、陳榮基、潘豐泉、陳清軒、劉偉文（2008）‧台灣健康知能量表之初探性研究‧臺灣醫學，12(5)，525-536。 doi:10.6320/FJM.2008.12(5).04

英文部分
Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs, & American Medical Association. (1999). Health literacy: Report of the council on scientific affairs. The Journal of the American Medical Association, 281(6), 552-557. doi: 10.1001/jama.281.6.552
Agréus, L., & Borgquist, L. (2002). The cost of gastro-oesophageal reflux disease, dyspepsia and peptic ulcer disease in Sweden. Pharmacoeconomics, 20(5), 347-355.
Aguirre, A. C., Ebrahim, N., & Shea, J. A. (2005). Performance of the English and Spanish S-TOFHLA among publicly insured Medicaid and Medicare patients. Patient Education and Counseling, 56(3), 332-339.
Aro, P., Talley, N. J., Johansson, S. E., Agreus, L., & Ronkainen, J. (2015). Anxiety Is Linked to New-Onset Dyspepsia in the Swedish Population: A 10-Year Follow-up Study. Gastroenterology, 148(5), 928-937. doi: 10.1053/j.gastro.2015.01.039
Aro, P., Talley, N. J., Ronkainen, J., Storskrubb, T., Vieth, M., Johansson, S. E., . . . Agreus, L. (2009). Anxiety is associated with uninvestigated and functional dyspepsia (Rome III criteria) in a Swedish population-based study. Gastroenterology, 137(1), 94-100. doi: 10.1053/j.gastro.2009.03.039
Baker, D. W. (2006). The meaning and the measure of health literacy. Journal of general internal medicine, 21(8), 878-883. DOI: 10.1111/j.1525-1497.2006.00540.x
Baker, D. W., Williams, M. V., Parker, R. M., Gazmararian, J. A., & Nurss, J. (1999). Development of a brief test to measure functional health literacy. Patient Education and Counseling, 38(1), 33-42.
Berkman, N. D., Sheridan, S. L., Donahue, K. E., Halpern, D. J., & Crotty, K. (2011). Low health literacy and health outcomes: an updated systematic review. Annals of internal medicine, 155(2), 97-107.
Bjelland, I., Dahl, A. A., Haug, T. T., & Neckelmann, D. (2002). The validity of the Hospital Anxiety and Depression Scale: an updated literature review. Journal of psychosomatic research, 52(2), 69-77.
Brewer, N. T., Tzeng, J. P., Lillie, S. E., Edwards, A. S., Peppercorn, J. M., & Rimer, B. K. (2009). Health literacy and cancer risk perception: implications for genomic risk communication. Med Decis Making, 29(2), 157-166. doi: 10.1177/0272989X08327111
Chang, F. Y., Chen, P. H., Wu, T. C., Pan, W. H., Chang, H. Y., Wu, S. J., . . . James, F. E. (2012). Prevalence of functional gastrointestinal disorders in Taiwan: questionnaire-based survey for adults based on the Rome III criteria. Asia Pac J Clin Nutr, 21(4), 594-600.
Chen, G. D., Huang, C. N., Yang, Y. S., & Lew-Ting, C. Y. (2014). Patient perception of understanding health education and instructions has moderating effect on glycemic control. BMC Public Health, 14, 683. doi: 10.1186/1471-2458-14-683
Chen, M. L., Chang, H. K., & Yeh, C. H. (2000). Anxiety and depression in Taiwanese cancer patients with and without pain. Journal Of Advanced Nursing, 32(4), 944-951.
Chung, M. H., Chen, L. K., Peng, L. N., & Chi, M. J. (2015). Development and validation of the health literacy assessment tool for older people in Taiwan: potential impacts of cultural differences. Arch Gerontol Geriatr, 61(2), 289-295. doi: 10.1016/j.archger.2015.06.015
Davis, T. C., Crouch, M., Long, S. W., Jackson, R. H., Bates, P., George, R. B., & Bairnsfather, L. E. (1991). Rapid assessment of literacy levels of adult primary care patients. Family medicine, 23(6), 433-435.
Davis, T. C., Long, S. W., Jackson, R. H., Mayeaux, E., George, R. B., Murphy, P. W., & Crouch, M. A. (1993). Rapid estimate of adult literacy in medicine: a shortened screening instrument. Family medicine, 25(6), 391-395.
DeWalt, D. A., Berkman, N. D., Sheridan, S., Lohr, K. N., & Pignone, M. P. (2004). Literacy and health outcomes. Journal of general internal medicine, 19(12), 1228-1239.
Drossman, D. A. (2006). The functional gastrointestinal disorders and the Rome III process. Gastroenterology, 130(5), 1377-1390. doi: 10.1053/j.gastro.2006.03.008
Duong, V. T., Lin, I. F., Sorensen, K., Pelikan, J. M., Van Den Broucke, S., Lin, Y. C., & Chang, P. W. (2015). Health Literacy in Taiwan: A Population-Based Study. Asia Pac J Public Health, 27(8), 871-880. doi: 10.1177/1010539515607962
Fang, Y. J., Liou, J. M., Chen, C. C., Lee, J. Y., Hsu, Y. C., Chen, M. J., . . . Helicobacter, C. (2015). Distinct aetiopathogenesis in subgroups of functional dyspepsia according to the Rome III criteria. Gut, 64(10), 1517-1528. doi: 10.1136/gutjnl-2014-308114
Faramarzi, M., Kheirkhah, F., Shokri-Shirvani, J., Mosavi, S., & Zarini, S. (2014). Psychological factors in patients with peptic ulcerand functional dyspepsia. Caspian journal of internal medicine, 5(2), 71.
Ford, A. C., Marwaha, A., Sood, R., & Moayyedi, P. (2015). Global prevalence of, and risk factors for, uninvestigated dyspepsia: a meta-analysis. Gut, 64(7), 1049-1057. doi: 10.1136/gutjnl-2014-307843
Gazmararian, J. A., Williams, M. V., Peel, J., & Baker, D. W. (2003). Health literacy and knowledge of chronic disease. Patient Education and Counseling, 51(3), 267-275. doi: 10.1016/s0738-3991(02)00239-2
Hsu, Y. C., Liou, J. M., Liao, S. C., Yang, T. H., Wu, H. T., Hsu, W. L., . . . Wu, M. S. (2009). Psychopathology and personality trait in subgroups of functional dyspepsia based on Rome III criteria. Am J Gastroenterol, 104(10), 2534-2542. doi: 10.1038/ajg.2009.328
Jang, S. H., Ryu, H. S., Choi, S. C., & Lee, S. Y. (2016). Psychological factors influence the overlap syndrome in functional gastrointestinal disorders (FGIDs) and their effect on quality of life among firefighters in South Korea. J Dig Dis. doi: 10.1111/1751-2980.12330
Jordan, J. E., Osborne, R. H., & Buchbinder, R. (2011). Critical appraisal of health literacy indices revealed variable underlying constructs, narrow content and psychometric weaknesses. J Clin Epidemiol, 64(4), 366-379. doi: 10.1016/j.jclinepi.2010.04.005
Kickbusch, I. (2004). Improving health literacy-A key priority for enabling good health in Europe. Paper presented at the European Health Forum Gastein.
Kim, S. H. (2009). Health literacy and functional health status in Korean older adults. Journal of clinical nursing, 18(16), 2337-2343.
Kugler, T. (2015). [ANXIETY AND DEPRESSIVE DISORDERS IN FUNCTIONAL DYSPEPSIA: CAUSE OR CONSEQUENCE?]. Eksperimental'naia i klinicheskaia gastroenterologiia= Experimental & clinical gastroenterology(9), 29-35.
Lacy, B. E., Everhart, K., & Crowell, M. D. (2011). Functional dyspepsia is associated with sleep disorders. Clin Gastroenterol Hepatol, 9(5), 410-414. doi: 10.1016/j.cgh.2011.02.010
Lacy, B. E., Weiser, K. T., Kennedy, A. T., Crowell, M. D., & Talley, N. J. (2013). Functional dyspepsia: the economic impact to patients. Aliment Pharmacol Ther, 38(2), 170-177. doi: 10.1111/apt.12355
Lee, S. Y. D., Tsai, T. I., Tsai, Y. W., & Kuo, K. N. (2010). Health literacy, health status, and healthcare utilization of Taiwanese adults: results from a national survey. BMC Public Health, 10, 614. doi: 10.1186/1471-2458-10-614
Lee, S. Y. D., Tsai, T. I., Tsai, Y. W., & Kuo, K. N. (2012). Development and validation of the short-form Mandarin Health Literacy Scale. Taiwan Journal of Public Health, 31(2), 184-194.
Lu, C. L., Lang, H. C., Chang, F. Y., Chen, C. Y., Luo, J. C., Wang, S. S., & Lee, S. D. (2005). Prevalence and health/social impacts of functional dyspepsia in Taiwan: A study based on the Rome Criteria Questionnaire Survey assisted by endoscopic exclusion among a physical check-up population. Scandinavian Journal of Gastroenterology, 40(4), 402-411. doi: 10.1080/00365520510012190
Miwa, H., Ghoshal, U. C., Fock, K. M., Gonlachanvit, S., Gwee, K. A., Ang, T. L., . . . Bak, Y. T. (2012). Asian consensus report on functional dyspepsia. J Gastroenterol Hepatol, 27(4), 626-641. doi: 10.1111/j.1440-1746.2011.07037.x
Nielsen-Bohlman, L., Panzer, A., & Kindig, D. (2004). Health Literacy: A Prescription to End Confusion.
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.
O'Connor, M., Weir, J., Butcher, I., Kleiboer, A., Murray, G., Sharma, N., . . . Sharpe, M. (2012). Pain in patients attending a specialist cancer service: prevalence and association with emotional distress. J Pain Symptom Manage, 43(1), 29-38. doi: 10.1016/j.jpainsymman.2011.03.010
Parker, R. M., Baker, D. W., Williams, M. V., & Nurss, J. R. (1995). The test of functional health literacy in adults. Journal of general internal medicine, 10(10), 537-541.
Sander, G. B., Mazzoleni, L. E., Francesconi, C. F., Balbinotto, G., Mazzoleni, F., Wortmann, A. C., . . . Helicobacter Eradication Relief of Dyspetic Symptoms Trial, I. (2011). Influence of organic and functional dyspepsia on work productivity: the HEROES-DIP study. Value Health, 14(5 Suppl 1), S126-129. doi: 10.1016/j.jval.2011.05.021
Seyedmirzaei, S. M., Haghdoost, A. A., Afshari, M., & Dehghani, A. (2014). Prevalence of dyspepsia and its associated factors among the adult population in southeast of iran in 2010. Iran Red Crescent Med J, 16(11), e14757. doi: 10.5812/ircmj.14757
Snaith, R. P. (2003). The hospital anxiety and depression scale. Health and quality of life outcomes, 1(1), 1.
Speros, C. (2005). Health literacy: concept analysis. Journal Of Advanced Nursing, 50(6), 633-640.
Tack, J., Talley, N. J., Camilleri, M., Holtmann, G., Hu, P., Malagelada, J. R., & Stanghellini, V. (2006). Functional gastroduodenal disorders. Gastroenterology, 130(5), 1466-1479. doi: 10.1053/j.gastro.2005.11.059
Talley, N. J., & Ford, A. C. (2015). Functional Dyspepsia. N Engl J Med, 373(19), 1853-1863. doi: 10.1056/NEJMra1501505
Tsai, T. I., Lee, S. Y., Tsai, Y. W., & Kuo, K. N. (2011). Methodology and validation of health literacy scale development in Taiwan. J Health Commun, 16(1), 50-61. doi: 10.1080/10810730.2010.529488
U.S. Department of Health and Human Services. (2000). Healthy People 2010: Understanding and Improving Health (2nd ed.). Washington, DC: U.S. Government Printing Office.
Wang, K.-Y., Chu, N.-F., Lin, S.-H., Chiang, I. C., Perng, W.-C., & Lai, H.-R. (2014). Examining the causal model linking health literacy to health outcomes of asthma patients. Journal of clinical nursing, 23(13-14), 2031-2042. doi: 10.1111/jocn.12434
Weiss, B. D., Mays, M. Z., Martz, W., Castro, K. M., DeWalt, D. A., Pignone, M. P., . . . Hale, F. A. (2005). Quick assessment of literacy in primary care: the newest vital sign. The Annals of Family Medicine, 3(6), 514-522.
World Health Organization. (1998). Health promotion glossary.
Yu, J., Liu, S., Fang, X. C., Zhang, J., Gao, J., Xiao, Y. L., . . . Hou, X. H. (2013). Gastrointestinal symptoms and associated factors in Chinese patients with functional dyspepsia. World J Gastroenterol, 19(32), 5357-5364. doi: 10.3748/wjg.v19.i32.5357
Zigmond, A. S., & Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta psychiatrica scandinavica, 67(6), 361-370.