發展第二型糖尿病病人之營養素養量表與信效度檢驗

背景：第二型糖尿病（Type 2 Diabetes Mellitus, T2DM）為全球盛行率持續上升之慢性疾病，良好的營養管理為疾病控制的重要基礎。營養素養（Nutrition Literacy, NL）係指個人獲取、理解、評估及應用營養資訊，以做出適當飲食決策的能力，與健康飲食行為及疾病自我管理密切相關。然而，目前國內尚缺乏適用於第二型糖尿病患者之本土化營養素養評估工具，因此有必要發展具良好信效度之量表，以作為臨床評估與營養教育之依據。目的：發展「第二型糖尿病營養素養量表」，並驗證其信效度。方法：本研究採橫斷式研究設計（cross-sectional study），依據文獻探討建構量表初稿共41題，經5位糖尿病照護相關領域專家進行內容效度及表面效度檢定後，修訂為24題正式量表。另邀請5位第二型糖尿病患者進行前驅測試，以確認題項之可理解性及適切性。正式研究採方便取樣方式，以中部某區域醫院住院及內分泌科門診300位第二型糖尿病患者為研究對象。效度檢定包括專家內容效度、試題難度與鑑別力及效標關聯效度；信度檢定則包括KR-20內部一致性及組內相關係數（Intraclass Correlation Coefficient, ICC）。結果：本量表經專家審查後完成24題正式版本，內容效度良好，題項內容效度指數（I-CVI）介於 .80至1.00，量表內容效度指數（S-CVI/Ave）內容相關性及內容清晰度分別為 .91及 .92。試題難度介於 .38至 .98，鑑別度介於 .08至 .56，多數題目具有可接受之鑑別能力。效標關聯效度分析顯示：整體營養素養與健康飲食行為呈顯著正相關（r＝ .27，p＜.01）。信度分析結果顯示：KR-20為 .62，再測信度ICC單一測量為 .95、平均測量為 .97（p＜.001），顯示本量表具有良好的內部一致性與再測信度。受試者營養素養總分平均為18.8±2.9分（滿分24分），整體營養素養程度屬中上水準，其中評估與互動性營養素養表現較佳，而理解、分析及功能性營養素養仍有提升空間。結論：本研究成功發展「第二型糖尿病營養素養量表」，結果顯示量表具有良好的內容效度、效標關聯效度及再測信度，可作為臨床及社區評估第二型糖尿病患者營養素養之工具。未來可應用於營養教育需求評估、健康促進及介入成效評估，協助醫療人員依據患者營養素養程度提供個別化營養教育，以提升健康飲食行為及疾病自我管理能力。

Background: Type 2 diabetes mellitus (T2DM) is a chronic disease with a rapidly increasing global prevalence. Appropriate nutrition management is fundamental to effective diabetes control. Nutrition literacy (NL) refers to an individual's ability to obtain, understand, evaluate, and apply nutrition information to make appropriate dietary decisions. It is closely associated with healthy eating behaviors and self-management of diabetes. However, a culturally appropriate nutrition literacy assessment tool for patients with T2DM is currently lacking in Taiwan.Objective: To develop and validate the Nutrition Literacy Scale for Patients with Type 2 Diabetes Mellitus.Methods: A cross-sectional study was conducted. An initial 41-item scale was developed based on a literature review. After a review by expert reviewers of content and face validity by five diabetes care specialists, the scale was revised to a final version of 24 items. A pilot test involving five patients with T2DM was conducted to evaluate the clarity and appropriateness. Convenience sampling was used to recruit 300 patients with T2DM from inpatient wards and endocrinology outpatient clinics of a regional hospital in central Taiwan. Psychometric evaluation included content validity, item difficulty and discrimination analyses, criterion-related validity, internal consistency using the Kuder–Richardson Formula 20 (KR-20) and test–retest reliability using the intraclass correlation coefficient (ICC).Results: The final 24-item scale demonstrated satisfactory content validity, with item-level content validity indices (I-CVI) ranging from .80 to 1.00 and scale-level content validity indices (S-CVI/Ave) of .91 for relevance and .92 for clarity. The difficulty ranged from .38 to .98, and the discrimination of the item ranged from .08 to .56, indicating acceptable psychometric properties. Overall nutrition literacy was positively correlated with healthy eating behaviors (r = .27, p < .01), supporting the validity of the scale. The KR-20 coefficient was .62. The reliability was excellent, with ICC values of .95 for single measures and .97 for average measures (p < .001). The mean nutritional literacy score was 18.8 ± 2.9 (out of 24), suggesting a moderate to high level of nutrition literacy among participants. Participants performed better in the evaluation and interactive nutrition literacy domains, while comprehension, analysis, and functional nutrition literacy required further improvement.Conclusions: The Nutrition Literacy Scale for Patients with Type 2 Diabetes Mellitus demonstrated satisfactory validity and reliability. It can serve as a practical instrument to assess nutrition literacy among patients with T2DM in both clinical and community settings. The scale may also facilitate individualized nutrition education, health promotion, and evaluation of intervention outcomes to improve healthy eating behaviors and diabetes self-management.