An RCT Testing a Health Literacy Intervention to Reduce Disparities in Access to Care Among Justice Involved Adults (JIA)

摘要 健康素养是指有效获取、理解和使用卫生资源所需的技能。 健康素养不足每年给美国造成 100 至 2000 亿美元的损失，这在相关司法人员中得到了体现 成年人 (JIA)——约 2000 万美国人的群体，其中大部分是非老年人和非裔美国人， 由于系统性种族主义和过度治安，黑人和西班牙裔。 JIA 在准入方面面临重重障碍 医疗保健导致慢性和传染病的终身沉重负担。医疗保健访问是 定义为 1) 拥有健康保险，2) 拥有定期护理来源，以及 3) 获得医疗保健 及时。幼年特发性关节炎的健康素养干预措施是迫切需要的，但却无法实现，并且 NIH- 包含 JIA 在内的资助研究非常缺乏。这项及时的研究解决了这些差距。我们有 一项新颖干预措施的试点研究取得了有希望的结果，该干预措施旨在提高 JIA 的健康素养， 改善他们的医疗保健服务。因此，我们建议实施纵向混合方法 随机临床试验 (RCT) 评估 UCSD RELINK 教练指导的健康素养的影响 干预与自学对照组对 JIA 医疗保健获取的影响。为了实现这一目标，300 名 18-50 岁的 JIA 将在加利福尼亚州圣地亚哥招募并按 1:1 随机分配到治疗组（即教练指导的健康 识字干预）或对照组（即干预的自学）。研究人员将评估 JIA 以 6 个月随访时 6 个月内使用医疗保健作为主要结局。次要结果包括 在 12 个月的随访中评估医疗保健获取的维持情况。我们假设参与者 与对照组相比，治疗组在所有医疗保健获取措施方面均表现出改善 参与者（目标 1），特别是，他们更有可能在 6 个月内报告医疗保健使用情况 对照组。对于目标 2，我们将在 6 个月和 12 个月时进行纵向个人访谈，以评估 JIA 对干预的满意度；医疗保健态度、医疗保健用途的自我效能；影响因素 随着时间的推移维持医疗保健的可及性；干预措施对健康和福祉的感知贡献 存在；以及将干预措施扩散到 JIA 的社会交往中。为了实现这一目标，我们将进行半 对 40 名有意抽样的参与者（每个干预组 20 名）进行结构化定性访谈，他们 报告了基线的医疗保健获取障碍。这项研究很及时，可以为健康素养提供信息 针对幼年特发性关节炎的干预措施、在机构和社区环境中培养幼年特发性关节炎健康素养的政策，以及 JIA 的服务交付模式。拟议的干预措施对于提高健康素养具有巨大潜力 JIA 之间的联系，从而改善这个规模庞大且服务不足的社区的福祉。由此得出的结论 研究还可能与旨在提高其他低收入人群健康素养的干预措施相关 社区。

Abstract Health literacy refers to the skills needed to effectively access, understand, and use health resources. Inadequate health literacy annually costs the U.S. $100-$200 billion and is observed among justice involved adults (JIA)—a group of ~20 million U.S. persons who are disproportionately non-elderly and African American, Black, and Hispanic due to systemic racism and over-policing. JIA face numerous barriers in accessing healthcare which contributes to a high, lifelong burden of chronic and infectious disease. Healthcare access is defined as 1) having health insurance coverage, 2) having a regular source of care and 3) obtaining healthcare in a timely manner. Health literacy interventions for JIA are critically needed but are unavailable and NIH- funded research that is inclusive of JIA is sorely lacking. This timely study addresses these gaps. We have obtained promising results from a pilot study of a novel intervention that seeks to build JIA’s health literacy and improve their healthcare access. Therefore, we propose to implement a longitudinal mixed-methods randomized clinical trial (RCT) to assess the impact of the UCSD RELINK coach-guided health literacy intervention vs. a self-study control group on JIA’s healthcare access. To achieve this aim, 300 JIA ages 18-50 will be recruited in San Diego, CA and randomized 1:1 to the Treatment Group (i.e., coach-guided health literacy intervention) or the Control Group (i.e., self-study of the intervention). Researchers will assess JIA’s use of healthcare within 6 months at 6-month follow-up as the primary outcome. Secondary outcomes include assessing maintenance of healthcare access at 12-month follow-up. We hypothesize that participants in the Treatment Arm will exhibit improvements in all healthcare access measures as compared to Control Group participants (Aim 1) and specifically, that they will be more likely to report healthcare use within 6 months than the control group. For Aim 2, we will conduct longitudinal individual interviews at 6- and 12-months to assess JIA’s satisfaction with the intervention; healthcare attitudes, self-efficacy for healthcare use; factors impacting maintenance of healthcare access over time; perceived contribution of the intervention to health and well- being; and diffusion of the intervention to JIA’s social contacts. To achieve this aim, we will conduct semi- structured qualitative interviews with 40 purposively sampled participants (20 per intervention arm) who reported healthcare access barriers at baseline. This study is timely and may inform health literacy interventions for JIA, policies to build health literacy among JIA in institutional and community settings, and the service delivery models for JIA. The proposed intervention has great potential for increasing health literacy among JIA and thus improving the well-being of this sizeable and underserved community. Findings from this study may also have relevance for interventions seeking to build the health literacy of other low-income communities.