国外健康素养型医疗机构建设与评价及对我国的启示

介绍了美国医学研究所(Institute of Medicine,IOM)发布《健康素养型医疗机构的10个特征(Ten Attributes of Health Literate Health Care Organizations,HLHO 10个特征)》文件的背景及健康素养型医疗机构(health literate health care organization,HLHO)概念,并以Donabedian的理论为指导综述了HLHO的特征和建设措施及HLHO评价的研究进展。提出了我国医疗机构可借鉴《HLHO 10个特征》文件与国外HLHO评价现状,从人员培训、文化、制度、物理和信息环境建设,要求员工应用健康素养策略,促进服务对象参与健康材料的开发及医务人员健康教育工作的考核等措施入手,践行《健康中国行动(2019—2030年)》提出的“医务人员在诊疗过程中主动提供健康指导”和“建立医务人员开展健康教育绩效考核机制”两项指标。     

奉化市健康教育讲师团实施效果分析

为推进奉化市公众健康素养促进行动的开展,普及《中国公民健康素养——基本知识与技能（试行）》知识,提高全市居民健康知识知晓率,促进健康生活方式的形成,奉化市爱卫办于2008年6月成立了奉化市健康教育讲师团,采用“点菜”式预约模式开展讲课活动。为评价讲师团开展效果,了解市民健康教育需求,分别于2009和2012年对参加听课的居民进行调查,现将结果报告如下。     

健康素养全球研究概况及其在中国的发展展望

1974年,健康素养(health literacy)一词首次出现在一篇标题为《健康教育和社会政策》的论文。此后,随着发达国家对健康素养的研究在方法学上取得的重大进展,尤其是一些快速素养评估工具的开发使用[2],引起国外研究者和政府对健康     

福建省三明市社区居民健康素养促进行动实施效果评价

目的 评价福建省三明市社区居民健康素养促进行动实施效果,为探索健康素养干预方式提供有效依据.方法 采用多阶段整群随机抽样的方法,抽取三明市社区居民450人进行健康素养促进行动干预.干预前后应用 《2009中国公民健康素养调查问卷》调查并进行数据比较.结果 在健康理念和基本知识方面,“健康成年人一次献血200 ml对健康无害”、“成年人正常脉搏、体温”和“肺结核病人可以享受免费抗结核药物治疗”等问题,在实施强化干预后答对率从58％以下提高到78％以上,提高达20％以上.在生活方式与行为判断情况方面,干预后均有不同程度的提高,差异有统计学意义(P＜0.05),其中以“发现有人煤气中毒时的正确做法”答对率最高,达91.28％;有6项内容在干预后行为形成率仍在60％以下,以“不与他人共用毛巾”为最低,仅30％.结论 开展健康素养促进行动能够有效提高居民的健康素养水平,应总结示范点经验,因地制宜,逐步扩大干预范围,实施更为高效的干预策略,最终达到提高公众健康素养的目标.     

北峰社区居民健康素养调查分析

目的了解北峰社区居民健康素养知识与技能基本状况,为制定适合的健康干预策略提供依据。方法采用问卷方法,问卷采用《中国居民健康素养调查问卷》部分内容,共调查482名。结果北峰社区健康素养平均知晓率为75.67%,北峰社区居民健康素养基本知识还达不到《全国健康教育与健康促进工作规范纲要（2005-2010年）》的要求。结论应积极开展健康促进与健康教育,提高居民健康素养水平。     

湖北省2008年健康素养调查数据分析

目的了解湖北省居民健康素养具备情况,为湖北省健康素养促进行动提供参考。方法在湖北省抽取了3个城市地区和3个农村地区,采用多阶段分层随机整群抽样方法确定调查对象,用卫生部《首次中国居民健康素养调查报告》的数据分析方法对湖北省调查数据进行分析。结果湖北省居民健康素养具备率为12.0%,具备基本知识和理念、健康生活方式与行为、基本技能三方面素养的比例分别为23.7%、11.1%和22.4%;湖北省居民具备5类健康问题素养的比例由高到低分别是:科学健康观素养37.2%、传染病预防素养23.8%、安全与急救素养22.6%、基本医疗素养11.3%和慢性病预防素养5.9%。结论湖北省居民健康素养具备情况高于全国平均水平,但仍不容乐观,健康素养水平受到城乡、性别、年龄、文化程度等因素的影响,在开展健康素养促进行动工作时,应做好需求调查,并考虑如何提高目标人群的理解和交流能力。     

基于因子分析法的中国成人主动健康素养 评估体系构建*

摘 要: 目的：构建中国成人主动健康素养评估体系，为我国居民的主动健康素养评价提供工具。方法：通过文献分 析法、专题小组访谈法制定指标体系和问卷，采用方便抽样方法，对500名社区居民进行问卷调查，采用因子分析法对评估 体系进行统计分析。结果：评估体系最终确定为3个一级指标 （包括主动健康理念、主动健康知识、主动健康行动）、8个二 级指标 （包括主动学习、主动规划、掌握基本的健康知识、掌握基本的急救知识技能、主动监测、生活习惯、社会行为、疾 病干预） 和36个三级指标。评价指标中各维度和指标间具有相关性，对3个维度的因子分析结果显示，特征值均≥1.0的公 因子分别是2个、2个和4个，累积贡献率分别为59.132%、69.425%和54.586%，各因子负荷值均在0.4以上。结论：本研究 构建的主动健康素养评估体系具有较高的科学性和实用性，可考虑作为我国居民的主动健康素养评价工具。     

落实健康中国行动 提升全民健康素养

2019年7月,国务院印发《关于实施健康中国行动意见》,并组织印发《健康中国行动(2019—2030年)》以及健康中国行动实施方案重磅文件,对健康中国战略的实施进行高规格部署面对新形势下卫生健康工作的新挑战,如何提高全民健康水平、推进健康中国行动,成为一个高层重视、全民关注的持续性热点话题,普及健康知识,提高全民健康素养是提升全民健康水平最根本、最有效的措施之一。近日,在《中国卫生》杂志社举办的中卫沙龙上,与会嘉宾就如何落实健康中国行动、提升全民健康素养等问题进行了深入讨论。     

健康中国行动之“慢性病防控体系”在“健康深圳”建设中的作用

随着社会经济的发展,居民生活方式日益变化,随之而来的慢性病已成为深圳居民的主要健康问题。2019年,健康中国行动推进委员会印发的《健康中国行动(2019-2030年)》,围绕着疾病预防和健康促进两大核心,提出15项重大专项行动,促进以治病为中心向以人民健康为中心的转变。深圳市委市政府提出将以《健康中国行动(2019-2030年)》为依据,大力推进"健康深圳"建设。围绕着健康中国行动之"慢性病防控体系",阐明其在"健康深圳"中的核心地位和作用,并针对存在的问题提出具体建议和措施。     

健康中国行动与健康环境促进

目的分析《健康中国行动(2019—2030年)》中的健康环境促进内容,为指导健康环境促进提供参考。方法对《健康中国行动(2019—2030年)》中健康环境促进的主要指标、要求和具体措施进行分析,在此基础上思考健康环境促进问题并提出建议。结果国务院《关于实施健康中国行动的意见》,提出了健康中国行动到2022年和2030年的总体目标,明确实施的3个板块、15项专项行动,为个人、家庭、社会和政府参与健康中国行动,为实现从"以治病为中心"转向"以健康为中心"提供了有效抓手。结论开展健康环境促进个人和家庭行动、社会行动和政府行动,需要统筹各方面力量,共同为实现2030年健康中国健康环境促进行动目标而奋斗。     

Ten Suggested Health Literacy Attributes of a Health Care Organization

The health care system in the United States is becoming increasingly complex, placing greater demands on consumers to be more proactive and informed about their care. However, 88% of the population is unable to successfully navigate the health care system due to low levels of health literacy. Health care organizations can play a role in improving health literacy. The “Ten Attributes of the Health Literate Health Care Organizations” produced by members of the Institute of Medicine’s Roundtable on Health Literacy provides guidance.     

Findings and recommendations from the interim evaluation of the Bright Futures for Women's Health and Wellness Physical Activity and Healthy Eating tools

The Bright Futures for Women's Health and Wellness Initiative (BFWHW) Physical Activity and Healthy Eating tools encourage patient-provider discussion in the primary care setting, and promote patient self-management, goal setting, and behavior change. An interim evaluation of the BFWHW tools with 274 female adult patients, 18 providers, and 4 site administrators was conducted at 4 health care sites in the United States. Results suggest that patients, particularly overweight women, were interested in discussing healthy eating and physical activity with their provider during the health care visit and that the tools were helpful for goal setting. Nearly three quarters of providers reported that the materials strengthened their discussion of healthy eating with patients; 67% reported an enhanced conversation about physical activity. Site administrators reported several common themes, including the need for flexibility to adopt new routines and using a patient self-management approach. Barriers to implementation included lack of time in the clinical visit and lack of reimbursement. Recommendations for new approaches to address multiple structural, financial, and literacy barriers in order to facilitate the integration of gender-specific health promotion materials into primary care settings are discussed.     

The development of building wellness™, a youth health literacy program

Health literacy research has concentrated on adults; there has been inadequate research on youth health literacy and the effect it may have on health outcomes. Low-income, minority populations have low levels of health literacy and are at higher risk of illness and disease. Building Wellness? is a youth health literacy curriculum targeting low-income youth from 3rd grade to 8th grade in order to prepare the youth to be active, educated participants in their healthcare. Lessons focus on asthma, obesity and overweight, accidental injury, and drug and alcohol use. Curriculum development was based on qualitative and quantitative assessment of the target population. The preliminary findings from the pilot project show an increase in knowledge, improved healthy behaviors, and enthusiasm from participants and facilitators. The development of the pilot project is described, with a suggestion for future development of youth health literacy assessment tools.     

Charting a health literacy journey--overview and outcomes from a stakeholder workshop

Through a combination of Personal, social, health and economic education (PSHE), Science, Healthy Schools and a range of other initiatives, we are increasingly preparing our children to understand key topics in health education. However, to what extent are we equipping them with a picture of a healthy, happy future and giving them the tools to access this? In June, The Royal Society for Public Health (RSPH) hosted a workshop entitled "Charting a Health Literacy Journey" to examine this. The workshop brought together a broad group of over 20 stakeholders from the health and education sectors. The aims of the day were to address the following six questions: What is health literacy? What does health literacy look like in action? What are the benefits of health literacy? How is health literacy reflected on the ground at present? How does health literacy fit with the current policy context? What are the options going forward? This report summarises the key findings of the workshop.     

中国健康预期寿命指标体系构建

健康预期寿命(HLE)研究是老龄化社会和健康中国建设需求, 但我国尚未制定具体政策目标值, 也未官方公布过HLE。需建立HLE指标体系, 指导HLE测算和研究。根据WHO对健康的定义, 融入联合国可持续发展目标、全健康和主动健康理念, 在梳理国际现有HLE指标体系基础上, 基于WHO的国际功能、残疾和健康分类和国际疾病分类框架, 提出了多维度HLE指标体系概念框架和指标结构。概念框架包括基本的身体、心理、行为、社会和环境健康5个维度, 同时增加测量残障程度的综合指标"失能指数"。以此为基础, 提出HLE主要健康测量指标的框架, 包括行为因素、生理和病理原因、残障、功能受限、失能和死亡, 并进一步讨论了HLE指标体系的构建思路、数据类型和来源。本文有助于促进HLE研究和实践, 助力老龄化应对和健康中国建设。     

政策工具视角下我国省级层面健康规划政策文本量化分析

目的：分析我国省级健康规划政策文本内容的特点,总结归纳出相关政策文本的优势和弱项,为后续制定和优化健康中国建设的提供政策建议。方法：本文基于政策工具视角,结合健康中国实施的五大战略举措构建二维分析框架,对我国省级的31篇政策文本进行内容分析和量化分析。结果：我国省级健康规划文件中三类基本政策工具呈现环境型政策工具强依赖、供给型政策工具弱依赖、需求型政策工具缺位的差异化使用格局;基本政策工具内部结构缺乏均衡性;五大战略举措的开展具有差异性;政策工具与战略措施之间组合搭配尚需优化。结论：建议加强三类基本政策工具以及政策工具内部运用的均衡性;促进政策工具和具体战略举措的二维整合,提升两者的搭配度;制定可实施、可操作性的政策。     

Population and public health ethics in Canada: a snapshot of current national initiatives and future issues

To date, some work has been undertaken to define a code and stewardship framework for public health ethics. However, gaps in our understanding and application of ethics to the field of population and public health (PPH) remain. This paper presents the approach to building capacity for PPH ethics by three national-level organizations: the Canadian Institutes of Health Research-Institute of Population and Public Health, the National Collaborating Centre for Healthy Public Policy, and the Public Health Agency of Canada. By first looking at each of the organizations' respective activities and then across organizations, we synthesize our common approaches, highlight future directions and pose questions aimed at stimulating dialogue about the role of, and challenges confronting, the emerging field of PPH ethics in Canada.     

Scientific and popular health knowledge in the education work of community health agents in Rio de Janeiro shantytowns

Health education for socially marginalized populations challenges the efficacy of existing strategies and methods, and the pertinence of the educational and philosophical principles that underpin them. The Brazilian Community Health Agents Initiative (CHAI) hires residents of deprived marginalized communities to undertake health promotion and education in their communities. The ultimate goal of the CHAI is to connect populations with the public healthcare system by promoting social re-affiliation, protecting civil rights and enhancing equity of access to health services. In this article, we present the education work of community health agents through interplay between popular and scientific health knowledge in nine Rio de Janeiro shantytowns. A critical ethnographic research design, using thematic analysis, allowed us to explore agents' education work to enhance family health literacy in shantytowns. Local culture and social practices inspire Agents to create original strategies to reconcile forms of health knowledge in their work.