Objective: To understand the relationship between health literacy and patient experience of outpatients in China, and to explore its mechanism.
Methods: The conceptual framework was developed based on Andersen's behavioral model of health services use and health literacy skills framework. An online cross-sectional survey was conducted with snowball sampling method, while the health literacy was measured by self-designed patient health literacy scale, and the patient experience was measured by the Chinese patient experience questionnaire for ambulatory care developed by Peking Union Medical College. And a structural equation model was built to explore the relationship between them and test the mechanism of health literacy influencing patient experience.
Results: A total of 2 773 subjects were investigated. The average score of health literacy was (90.72±12.90) points, accounting for 78.89% of the full score, and the dimension of seeking social support had the lowest score. The average score of overall rating of patient experience was (3.71±0.74) points, and the scores of each dimension of patient experience were between 3.56 and 3.80. The model fit indices of structural equation model for overall rating of patient experience among the outpatients were χ2/df=9.29 (χ2=4 107.27, df=442), root mean square error of approximation (RMSEA)=0.055 (< 0.06), comparative fit index (CFI)=0.926 (>0.90), Tucker-Lewis index (TLI)=0.918 (>0.90), standardized root mean square residual (SRMR)=0.061 (< 0.08), the model was acceptable. The variance in patient experience explained by the model was 0.108. The structural equation model analysis results showed that the overall rating of outpatient experience was directly affected by health literacy (β=0.263, P < 0.001), also indirectly affected by health literacy (β=0.012, P < 0.001). In other words, the overall rating increased by 0.275 units for each standard deviation increase of health literacy. Self-evaluated health status mediated the relationship between health literacy and the overall rating of outpatient experience. In terms of diffe-rent dimensions of patient experience, the standardized path coefficient of the total effect of health literacy on patient experience was as follows: Information guidance 0.337, humanistic care 0.319, communication with doctors 0.294, service efficiency 0.240, and hospital environment 0.173.
Conclusion: The patients with higher level of health literacy were more likely to have a better outpatient experience in China, and the information guidance experience and humanistic care experience were most affected by health literacy. And the communication and information utilization ability had the greatest influence on patient experience.
目的: 探究中国门诊患者的健康素养与就医体验之间的关联，分析其具体的影响机制。
方法: 以安德森医疗卫生服务利用行为模型和健康素养技能模型为理论依据，构建患者层面的就医体验影响因素理论框架。采用滚雪球抽样法，通过线上电子问卷调查，利用自行设计的患者健康素养量表和北京协和医学院开发的中国门诊患者体验量表，评估门诊患者的健康素养和就医体验，构建结构方程模型探究两者之间的关系。
结果: 最终纳入门诊患者2 773名，健康素养总得分的平均值为(90.72±12.90)分，就医体验综合评价的平均分为(3.71±0.74)分。结构方程模型分析结果表明，门诊患者的健康素养对其就医体验的综合评价产生积极影响，健康素养每提升一个标准差，就医体验增加0.275个单位。在就医体验的不同维度上，健康素养对就医体验总效应的标准化路径系数从高到低依次是：信息引导体验0.337，人文关怀体验0.319，诊疗行为体验0.294，流程效率体验0.240，环境设施体验0.173。
结论: 提升个体的健康素养水平，对于门诊患者的就医体验有显著促进作用，其中信息引导体验和人文关怀体验受健康素养影响最大。
Keywords: Health literacy; Outpatients; Patient experience; Structural equation model.