主动健康视角下健康素养测评工具的研究现状及其对我国的启示

Research Status of Health Literacy Assessment Tools from the Perspective of Active Health and Its Enlightenment to China

背景《“健康中国2030”规划纲要》提出:健全覆盖全国的健康素养和生活方式监测体系,强化个人健康责任,提高居民自我健康管理能力和健康水平,提高全民健康素养水平。科学的健康素养测评工具可以系统地了解居民健康素养水平并提供针对性的干预措施。我国的健康素养测评研究起步较晚,现有健康素养测评工具《中国公民健康素养-基本知识与技能(试行)》的评估内容尚存在较大完善空间,因此研发有效、可靠的健康素养评价工具至关重要。目的基于主动健康视角,对国内外健康素养评价工具相关文献进行综述。方法于2021年7月,以“Health Literacy”“Tool”“Evaluation”“Assessment”“Questionnaire”“Scale”“健康素养”“工具”“测评”“评价”“问卷”“量表”等为中/英文关键词,系统检索PubMed、Web of Science、中国知网、万方数据知识服务平台、维普数据库,以获取健康素养测评工具相关文献,检索时限为1990-01-01至2021-06-30,对健康素养测评工具的现状及内容进行综述。结果共筛选出47种健康素养测评工具,包含27个客观测评工具和20个主观测评工具。研发和应用最多的是美国(22个),其次是欧洲地区(13个)。语言方面,英语最多(25个),其次是葡萄牙语(5个)、意大利语(3个)、西班牙语(2个)。测评所需时间方面,成人医学语言阅读能力简化快速测试量表(REALM-SF)、单问题健康素养筛查量表(SILS)用时最短(1 min),汉语健康素养测试量表(MHLS)用时最长(25 min)。测评条目最少的是SILS(1条),最多的是完整版成人医学语言阅读能力测试量表(REALM)(125条)。客观测评工具中被广泛应用的是成人医学语言阅读能力测试量表系列量表(REALM Family)与成人功能性健康素养测试量表系列量表(TOFHLA Family),主观测评工具中被广泛应用的是欧洲健康素养调查问卷(HLS-EU-Q)。测评内容主要涉及阅读理解、计算能力、信息获取、信息应用、信息交流、词汇识别等方面。结论在健康素养测评工具的研发和应用中,欧美国家占据主导地位,客观健康素养测评工具数量居多,随着健康素养的内涵从单一的个人评价转变为个人与外部环境的综合评价,我国健康素养测评工具的研发提倡以健康素养内涵深化和主动健康理念为前提,全国建立统一标准,指标以定量或半定量指标为主,开发出涵盖整个生命周期的适合我国国情的健康素养评价工具,从而为提升居民健康素养提供科学、有效的支持。

Background The Outline of the"Healthy China 2030"Plan points out improve the health literacy and lifestyle monitoring system covering the whole country,strengthen personal health responsibility,improve residents'self-health management ability and health level,in order to greatly improve the level of national health literacy.Scientific health literacy assessment tools can systematically understand the health literacy level of residents and provide targeted interventions.The health literacy assessment started late in China.The content of existing health literacy assessment tool should been improved,which is called Chinese Citizens'Health Literacy-Trial Implementation of Basic Knowledge and Skills(to try out),because it is definitely important to create an effective and reliable health literacy assessment tool.Objective Based on the perspective of active health,this paper reviews the relevant literature on health literacy assessment tools at home and abroad.Methods Chinese and foreign databases of PubMed,Web of Science,CNKI,Wanfang and VIP were systematically retrieved using keywords including"Health literacy""Tool""Evaluation""Assessment""Questionnaire""Scale".The related literature of health literacy assessment tools was obtained with the retrieval time from 1990-01-01 to 2021-06-30,and the current situation and contents of health literacy assessment tools were reviewed.Results A total of 47 health literacy assessment tools were screened,including 27 objective assessment tools and 20 subjective assessment tools.The most of research and development(R&D)and application is in the United States(22),followed by Europe(13).The number of English tools is the largest(25),followed by Portuguese(5),Italian(3)and Spanish(2).The evaluation time of REALM-SF,SILS is the shortest(1 minute),and the longest for MHLS(25 minutes).The least item is in SILS(1 item),and REALM(125 items)has the most evaluated items.The most widely used evaluation tools are the REALM series scale and TOFHLA series scale in objective evaluation tools,and the HLS-EU-Q series scale in subjective evaluation tools.The evaluation mainly content involves vocabulary recognition,information acquisition,computing ability,reading comprehension,information exchange,information application and so on.Conclusion The development and application of health literacy assessment tools are dominated by European and American countries,and the number of objective health literacy assessment tools is in the majority.As the change of the connotation of health literacy from a single personal assessment to a comprehensive assessment of individuals and external environment,the R&D of health literacy assessment tools in China should be based on the establishment of unified standards across the country on the premise of deepening the connotation of health literacy and the concept of active health,the indicators should mainly be quantitative or semi quantitative indicators.A health literacy assessment tool suitable for China's national conditions covering the whole life cycle should be developed to provide scientific and effective support for improving the health literacy level of residents.