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。 不充分的健康素养每年给美国造成1000-2000亿美元的损失，在涉及的司法中被观察到 成年人(JIA)-大约2000万美国人，他们不成比例地是非老年人和非裔美国人， 黑人和西班牙裔，因为系统性的种族主义和过度警力。贾跃亭在访问时面临着许多障碍 医疗保健造成长期的慢性和传染性疾病的沉重负担。医疗保健接入是 定义为1)有医疗保险，2)有固定的护理来源，3)获得医疗保健 及时采取行动。JIA的健康素养干预是迫切需要的，但缺乏，NIH- 包括JIA在内的资助研究严重缺乏。这项及时的研究解决了这些差距。我们有 从一项新的干预措施的试点研究中获得了有希望的结果，该干预措施旨在培养JIA的健康素养和 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医疗服务准入的影响。为了实现这一目标，300名18-50岁的贾樟柯 将在加利福尼亚州圣地亚哥招募，并随机1：1分配到治疗组(即教练指导的健康 识字干预)或控制组(即干预的自学)。研究人员将评估JIA的 在6个月内使用医疗保健和6个月随访作为主要结果。次要结果包括 在12个月的随访中评估医疗保健服务的维持性。我们假设，这项研究的参与者 与对照组相比，治疗组在所有医疗服务准入措施方面都有改善 参与者(目标1)，具体地说，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 贾跃亭对干预的满意度；保健态度、保健利用自我效能；影响因素 随着时间的推移保持医疗保健的可获得性；感知干预对健康和健康的贡献 存在；以及将干预扩散到JIA的社会关系。为了达到这一目标，我们将进行半 对40名有目的地抽样的参与者(每个干预组20名)进行结构化定性访谈 报告的医疗服务获得障碍处于基线水平。这项研究是及时的，可能会为健康素养提供信息 对联署的干预措施、在机构和社区环境中建立联署健康素养的政策，以及 JIA的服务交付模式。拟议的干预措施对提高健康素养有很大潜力。 因此，改善了这一规模庞大、服务不足的社区的福祉。由此得出的结论 这项研究也可能与寻求建立其他低收入者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.