| 摘要: | 背景：健康識能(health literacy)是取得、理解、評論與應用健康資訊與服務的能力，具備有良好的健康識能表現才能擁有足夠的能力有效利用各種健康資訊以維持並提升自我健康。因此如何提升乳癌術後復健病人的健康識能，促進乳癌病人有效利用各種資源，並且在癌症治療後的存活期仍然維持良好的健康狀態(身體功能、個人心理因素、活動參與、環境互動及生活品質)為現今復健醫療關注的議題。
目的：本研究將發展一套適性化復健衛教(Tailored rehabilitated education, TRE)，以有效提升乳癌術後病人的健康識能與健康狀態。
方法：本研究為單盲(評估者盲性)隨機分配對照試驗，採塊狀方式分成適性衛教介入組與控制組，研究場所與對象為乳癌術後1週內的乳癌住院病人。為期一個月一週一次的介入後將以「歐洲健康識能問卷」測量健康識能表現，以「上肢功能評量表」、「巴氏日常生活功能量表」、「芙蘭切日常生活功能量表」、「歐洲五維健康量表」、「簡式健康表」測量身體功能、活動、個人因素、參與及整體健康狀況等面向。統計方法使用SPSS/PC 18.0套裝軟體進行分析，首先採用獨立樣本T檢定與皮爾森卡方檢定兩組在介入前人口與疾病基本變相、健康識能及健康狀態的差異，其次使用獨立樣本T檢定分析兩組經由適性介入後在健康識能與健康狀態的差異。
結果：本研究總共有99位接受乳癌手術的受試者參與，介入組(N=49)，控制組(N=50)，接受介入後兩組在主要結果之健康識能的成效表現，在整體健康識能分數的改變平均分數方面，介入組進步的分數較控制組多(5.54/6.47 vs -1.70/7.27, P<0.001)；在健康照護健康識能的改變平均分數方面，介入組進步的分數較控制組有統計上顯著意義的增加 (6.27/6.47 vs 0.48/6.34, P<0.001)；在疾病預防健康識能的改變平均分數方面，介入組進步的分數較控制組有統計上顯著意義的增加(5.89/7.41 vs -0.98/9.51, P<0.001)；健康促進健康識能的改變平均分數，介入組進步的分數較控制組有統計上顯著意義的增加(7.93/8.56 vs -1.75/10.25, P<0.001)；在次要結果的健康狀態部分，接受適性衛教介入後除了在巴氏日常生活功能量表(P>0.05)之外，在芙蘭切日常生活功能量表、上肢功能量表、簡式健康表、歐洲五維健康量表與復工狀況皆有統計顯著的分數進步(P<0.05)，顯示適性衛教介入可以顯著進乳癌術後病人參與面向、個人面向、環境面向、整體健康狀況面向、身體結構與功能面向的健康狀態，然而在活動面向無顯著成效。
討論：本研究結果發現乳癌病人得以經由適性復健衛教提升健康識能及提升整體健康狀態在身體結構與功能面向、環境面向、個人因素面向以及參與面向，然而在活動面向無顯著成效。
預期結果與貢獻：本研究致力於發展一套術後乳癌的適性復健衛教系統，藉由此適性復健衛教方式不僅有效提升術後乳癌病人的健康識能，同時促進乳癌存活者在面臨長時間的術後合併症時擁有全方位健康，並且協助臨床醫療人員針對術後乳癌病人執行有系統及有成效的衛教介入。
Purpose：The research is devoted developing a tailored rehabilitated education(TRE) to improve health literacy and health status (i.e., six aspects of the International Classification of Functioning, Disability and Health).
Design：Single-blind randomized controlled trial comparing tailored rehabilitated education and usual education
Setting：Inpatient, medical hospital of breast operated wards in a teaching hospital.
Participants：Nity-nine female (49 in intervention group；50 in control group) with breast cancer within 1-week of cancer operations and without accepted breast cancer education before.
Intervention：Four weekly individual sessions of tailored rehabilitated educated (TRE) programs were intervened to improve the health literacy and health status.
Measurements：The primary outcome was the health literacy, assessing by European Health Literacy Survey Questionnaires. The secondary outcomes were six questionnaires evaluating health status of body function and structure, activity, participation, personal factor, environment, and quality of life with the measurements of Disability of Arm Shoulder and Hand, Barthel Index, Frenchay activities index, Brief Symptom Rating Scale, return to work, and The EuroQOL five dimensions questionnaire.
Results：Our results supported that the TRE produced significant improvement in health literacy and health status of body function and structure, participation, personal factor, environment, and quality of life. However, there was no significant difference of the activity scores assessed by Barthel Index between two groups did not change.
Conclusions：The findings supported the clinical efficacy of TRE in breast cancer patients after surgery. Further implementations of the TRE programs in patients after breast cancer surgery is practical to improve health literacy and health status effectively. |
