Construction and Application of the Health Literacy Assessment Scale for Day Surgery Patients and Its Influence on Early Postoperative Recovery Quality
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摘要:
目的 通过研制日间手术患者的健康素养评估工具，并分析研究日间手术患者健康素养水平对早期术后康复的影响。 方法 以Nutbeam的健康素养理论为研究框架，在文献查阅及参照已有评估量表的基础上构建初始条目池。通过2轮德尔菲专家咨询，形成初始版量表；随机抽取20例日间手术患者进行小样本预实验，收集患者意见。于2021年4月至9月期间，在昆明市6所三级甲等医院的日间手术室，便利选取264名患者进行健康素养和早期术后康复质量的调查，并分析2个变量的现状水平及影响因素。 结果 “日间手术患者健康素养评估量表”最终版包含3个维度、24个条目。总量表的Cronbach’sα系数为0.944，折半信度为0.902，内容效度为0.920，探索性因子分析显示，累计方差贡献率为66.37%，该量表具有较好的结构效度。多元线性回归分析结果显示，年龄、功能性健康素养、互动性健康素养、批判性健康素可以解释日间手术患者术后恢复质量60.4%的变异（调整R2=0.583），是日间手术患者术后恢复质量的重要影响因素。 结论 本研究编制的日间手术患者健康素养量表具有良好的信效度，适用于相关人群的测评；同时日间手术患者健康素养水平是早期术后恢复质量的重要影响因素。 Abstract:Objective To investigate the health literacy level of day surgery patients by developing and constructing a health literacy assessment tool, and to analyze the impact of health literacy level of day surgery patients on early postoperative rehabilitation. Methods Nutbeam’ s health literacy theory was used as the research framework and the initial item pool was constructed on the basis of literature review and referring to the existing evaluation scales. Through the 2 rounds of Delphi expert letter consultation, the initial scale was formed. Twenty patients with day surgery were randomly selected for a small sample pre-experiment, and the scale items were further revised to form the clinical test version of the scale. From April to September 2021, 264 patients were selected from the day operating rooms of 5 top hospitals in Kunming to investigate the health literacy and early postoperative rehabilitation quality and analyze the status and influencing factors of the two variables. Results The final version of "health literacy assessment tool of day surgery patients" developed in this study contained 3 dimensions and 24 items. The Cronbach’ s α coefficient, half-fold reliability and content validity of the total scale were 0.944, 0.902 and 0.920 respectively. The exploratory factor analysis showed that the cumulative variance contribution rate was 66.37%, indicating that the scale has the excellent structure validity. Multiple linear regression analysis indicated that age, functional health literacy, interactive health literacy and critical health factors could explain 60.4% variation （adjusted R2 = 0.583） in postoperative recovery quality of day surgery patients, and were important influencing factors in postoperative recovery quality of day surgery patients. Conclusion The health literacy scale for day surgery patients developed in this study has the good reliability and validity and is suitable for the evaluation of related population. At the same time, the level of health literacy of day surgery patients is an important factor influencing the quality of early postoperative recovery. -
Key words:
- Day surgery /
- Health literacy /
- Scale /
- Reliability /
- Validity /
- Recovery quality
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表 1 探索性因素分析表（n = 239）
Table 1. Summary table of exploratory factor analysis results （n = 239）
条目 因素负荷量 因素一 因素二 因素三 共同性 功能性健康素养2 0.929 0.891 功能性健康素养1 0.928 0.899 功能性健康素养3 0.901 0.849 功能性健康素养4 0.683 0.593 功能性健康素养5 0.674 0.591 功能性健康素养11 0.666 0.52 功能性健康素养6 0.607 0.291 功能性健康素养10 0.603 0.353 功能性健康素养12 0.595 0.451 功能性健康素养9 0.588 0.421 功能性健康素养8 0.525 0.474 功能性健康素养7 0.509 0.405 互动性健康素养1 0.79 0.748 互动性健康素养2 0.754 0.864 互动性健康素养3 0.733 0.743 互动性健康素养4 0.731 0.717 互动性健康素养5 0.726 0.69 互动性健康素养6 0.676 0.794 批判性健康素养1 0.842 0.501 批判性健康素养2 0.796 0.55 批判性健康素养3 0.736 0.455 批判性健康素养4 0.647 0.574 批判性健康素养5 0.622 0.762 批判性健康素养6 0.598 0.718 
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表 2 日间手术患者健康素养水平与术后恢复质量之间的相关性 （n = 239）
Table 2. Correlation between health literacy level and postoperative recovery quality in day surgery patients （n = 239）
项目 健康素养总分 功能性健康素养 互动性健康素养 批判性健康素养 术后恢复质量（r） 0.735 0.605 0.705 0.553 P 0.001** 0.001** 0.001** 0.001** **P < 0.01。
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表 3 日间手术患者术后恢复质量影响因素多元线性回归分析
Table 3. Stepwise regression analysis of factors influencing postoperative recovery quality of patients undergoing day surgery
自变量 回归系数 标准化回归系数 t P 常量 78.491 —— 21.095 0.001** 年龄 −1.874 −0.239 −3.812 0.001** 功能性健康素养 0.211 0.218 3.693 0.001** 互动性健康素养 0.411 0.277 3.498 0.001** 批判性健康素养 0.311 0.165 2.923 0.001** **P < 0.01。
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