고령자의 건강정보이해능력(Health Literacy) 측정도구 타당화

Validation of the Measure of Health Literacy for the Elderly

  • 천희란 (중원대학교 보건행정학과) ;
  • 조성일 (서울대학교 보건환경연구소) ;
  • 김일호 (서울시공공의료재단)
  • Chun, Heeran (Department of Health Administration, Jungwon University) ;
  • Cho, Sung-il (Institute of Environment and Health, Seoul National University) ;
  • Kim, Il-Ho (Institute of Seoul Public Health Foundation)
  • 투고 : 2018.10.22
  • 심사 : 2018.11.27
  • 발행 : 2018.11.30

초록

연구목적: "건강정보이해능력은 개인이 보건의료 관련 의사결정을 스스로 하는데 충분한 건강정보와 보건의료서비스를 제대로 얻고 처리하고 이해하는 능력"으로 정의된다. 고령자는 건강정보이해능력이 특히 취약한 인구집단이다. 이 연구는 Chew 등이 개발한 척도를 적용하여 우리나라 고령자의 건강정보이해능력을 측정하기 위한 도구의 신뢰도와 타당도를 검증하였다. 연구방법: 자료는 단면조사로 수집된 2016년 '서울 고령자 건강과 기능조사' 60~79세 725명 응답자를 대상으로 분석하였다. 대상자를 무작위로 두 표본으로 나누어 표본 A (n=400)는 탐색적 요인분석과 척도의 타당화를 위한 분석에 사용하고, 표본 B (n=325)는 확증적 요인분석을 위해 사용하였다. 설문지는 번역-역번역, 전문가 교차검토 등을 통해 최종 12문항으로 구성하였고, 내적신뢰도 분석을 통해 최종 8문항을 선택하였다. 연구결과: 연구결과 8개 설문문항은 2개의 요인 구조를 보였고, 탐색적 요인분석 결과 신뢰도와 타당도가 높았다 (KMO=.872, Bartlett's ${\chi}^2=2431.248$, df=28, p<.001). 확증적 요인분석은 추출된 이 두 요인 구조(건강정보 "이해"와 건강정보 "활용")의 구성타당도가 충족되는 결과를 보였다(${\chi}^2=53.386/df=19$, GFI=.960, CFI=.979, TLI=.969, RMSEA=0.075). 결론: 본 연구는 이 도구가 고령자의 건강정보이해능력을 측정하는 도구로 타당도가 있음을 증명한다.

Objective : Health literacy (HL) is, defined as "the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions." Being old is one of the main risk factors with limited health literacy. This study aims to adapt Chew's health literacy scale into the Korean language and validate the scale for the use of the elderly. Methods : Data were drawn from the '2016 Seoul Survey on Elderly Health and Functional Assessment, which includes a total of 725 people aged 60 to 79. The sample was randomly divided into two groups for reliability and validity tests of the modified Chew's scale of 8 items. The Korean version of the questionnaire was developed by group translation, expert reviews, and forward-backward translation. Exploratory and confirmatory factor analyses were conducted to assess and validate the factor structure of the scale. Results : Results suggest the two-factor structure ("Understanding" and "Applying" of HL) with 8 items. Exploratory factor analyses of the first sample (n=400) revealed that the internal reliability of the scale was high (Cronbach's ${\alpha}=.904$). Principal axis factoring extracted two factors ("Understanding" and "Applying" of HL) and explained 78.3% of total variance (KMO=.872, Bartlett's ${\chi}^2=2431.3$, df=28, p<.001). Confirmatory factor analysis of the second sample (n=325) was performed and the two-factor model was supported (GFI=.960, CFI=.979, TLI=.969, RMSEA=0.075). Conclusions : This study provides evidence for adequate criterion and validity of the health literacy scale for the community dwelling elderly in Korea.

키워드

과제정보

연구 과제 주관 기관 : 한국연구재단

참고문헌

  1. Nutbeam D. Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century. Health Promot Int. 2000;15(3):259-267. https://doi.org/10.1093/heapro/15.3.259
  2. Sorensen K, Broucke SV, Doyle G, Pelikan J, Slonska Z, Brand H. Health literacy and public health: A systematic review and integration of definitions and models. BMC Public Health. 2012;12:80-92. https://doi.org/10.1186/1471-2458-12-80
  3. WHO Commission on the Social Determinants of Health. Achieving health equity: From root causes to fair outcomes. Geneva: World Health Organization; 2007.
  4. Baker DW, Wolf MS, Feinglass J, Thompson JA, Gazmararian JA, Huang J. Health literacy and mortality among elderly persons. Arch Intern Med. 2007;167(14):1503-1509. https://doi.org/10.1001/archinte.167.14.1503
  5. Bostock S, Steptoe A. Association between low functional health literacy and mortality in older adults: longitudinal cohort study. BMJ 2012;344:e1602. https://doi.org/10.1136/bmj.e1602
  6. Nutbeam D. Health promotion glossary. Health Promot Int. 1998;13.349-364. https://doi.org/10.1093/heapro/13.4.349
  7. Institute of Medicine. Health literacy: a prescription to end confusion. Washington DC: The National Academies: 2004.
  8. Kutner M, Greenber E, Jin Y, Paulsen C. The health literacy of America's adults: Results from the 2003 National Assessment of adult literacy (NCES 2006-483). Washington DC: 2007.
  9. Kim SH, Lee E. The influence of functional literacy on perceived health status in Korean older adults. J Korean Acad Nur. 2008;38(2):195-203. https://doi.org/10.4040/jkan.2008.38.2.195
  10. Kim SS, Kim SH, Lee SY. Health literacy: Development of a Korean Health literacy assessment tool. Korean J Health Educ Promot. 2005;12:215-229.
  11. Kim SH. Older adults' self-reported difficulty in understanding and utilizing health information. J Korean Geriatr Soc. 2010;30(4):1281-1292.
  12. Son YJ, Song EK. Impact of health literacy on disease-related knowledge and adherence to self-care in patients with hypertension. J Korean Acad Fundam Nur. 2012;19(1):6-15. https://doi.org/10.7739/jkafn.2012.19.1.006
  13. Kim YS, Park BH, Lee HY. A study on predicting health literacy of Korean elderly using Andersen's health behavior model. J Welf Aged. 2014;65:35-57.
  14. Kim NH, Yang Y, Lee MH. Effects of health literacy and knowledge on diabetic self-care in the elderly with DM living alone. J Korean Acad Community Health Nur. 2016;27(4):370-379. https://doi.org/10.12799/jkachn.2016.27.4.370
  15. Chung S, Lim J, Lee M, Chung S. The study on factors affecting self-perception of psycho-social aging for older adults: focused on perceived health status, mental health, health literacy, and mental health literacy. Korea J Soc Welfare Stu. 2016;47(1):123-149. https://doi.org/10.16999/kasws.2016.47.1.123
  16. Hwang H. Health literacy, cancer knowledge, and cancer preventive behaviors among rurla older adults. Asian Oncol Nurs. 2016;16(4):234-241. https://doi.org/10.5388/aon.2016.16.4.234
  17. Hwang H. Impacts of colorectal cancer knowledge and health literacy on self-management behaviors among elderly women in rural areas. Korean J Adult Nurs. 2017;29(5): 527-535. https://doi.org/10.7475/kjan.2017.29.5.527
  18. Oh JH, Park E. The impact of health literacy on self-care behaviors among hypertensive elderly. Korean J Health Educ Promot. 2017;34(1):35-45. https://doi.org/10.14367/kjhep.2017.34.1.35
  19. Kim SH. Validation of the short version of Korean functional health literacy test. Int J Nurs Pract. 2017;23e12559.
  20. Lee H, Lee J, Kim NK. Gender differences in health literacy amogn Korean adults: Do women have a higher level of health literacy than men? Am J Mens Health. 2015;9(5):370-379. https://doi.org/10.1177/1557988314545485
  21. Rhee TG, Lee HY, Kim NK, Han G, Lee J, Kim K. Is health literacy associated with depressive symptoms among Korean adults? Implications for mental health nursing. Perspect Psychiatr Care. 2017;00:1-9
  22. Chew LD, Bradley KA, Boyko EJ. Brief questions to identify patients with inadequate health literacy. Fam Med. 2004;36(8):588-594.
  23. Nam-Gung HK, Kim IH, Chun H. Study on the correlates of digital disparity among older Seoul residents. J Digit Converg, 2017;15(4):73-81. https://doi.org/10.14400/JDC.2017.15.4.73
  24. Tabachnick BG, Fidell LS. Using Multivariate statistics. Boston: Pearson Education Inc; 2007.
  25. Williams B, Brown T, Onsman A. Exploratory factor analysis: A five-step guides for novices. Journal of Emergence Primary Health Care. 2012;8(3):
  26. Raykov T, Widaman KF. Issues in applied structural equation modeling research. Struct Equ Modeling. 1995;2(4):289-318. https://doi.org/10.1080/10705519509540017
  27. Yu JP. Structural equation model: Concepts and understanding. Seoul: Hannarye; 2012, p150-188.
  28. Chew LD, Griffin JM, Partin MR, Noorbaloochi S, Grill JP, Annamay S et al., Validation of screening questions for limited health literacy in a large VA outpatient population. J Gen Inten Med. 2008;23(5):561-566. https://doi.org/10.1007/s11606-008-0520-5
  29. Kim J. Meta analysis of the correlation between health literacy and health related variables. Korean J Health Educ Promot. 2018;35(1):101-113. https://doi.org/10.14367/kjhep.2018.35.1.101
  30. Noh S, Kaspar V, Chen X. Measuring depression in Korean immigrants: Assessing validity of the translated Korean version of CES-D scale. Cross-Cult Res, 1998; 32(4): 358-377. https://doi.org/10.1177/106939719803200403