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。 健康素养不足每年花费美国1000 - 2000亿美元，并在相关司法部门中观察到 成年人（JIA）-约2000万美国人，其中非老年人和非洲裔美国人不成比例， 黑人和西班牙裔由于系统性的种族主义和过度警务。JIA在进入方面面临许多障碍 医疗保健是慢性病和传染病的终身负担。医疗保健服务是 定义为1）有健康保险，2）有定期护理来源，3）获得医疗保健 及时地。对JIA的健康知识干预是迫切需要的，但却不可用，NIH- 包括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 从一项旨在建立JIA健康素养的新干预措施的试点研究中获得了有希望的结果， 改善他们的医疗服务。因此，我们建议实施纵向混合式方法 随机临床试验（RCT），以评估UCSD RELINK教练指导的健康素养的影响 干预组与自学对照组对JIA的医疗保健获取。为了实现这一目标，300名18-50岁的JIA 将在San Diego，CA招募并以1：1随机分配至治疗组（即，教练指导健康 识字干预）或对照组（即，自我研究的干预）。研究人员将评估JIA的 6个月随访时6个月内使用医疗保健作为主要结局。次要结局包括 在12个月随访时评估医疗保健服务的维持情况。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指标方面均有所改善 参与者（目标1），特别是，他们将更有可能在6个月内报告医疗保健使用，而不是 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， JIA对干预的满意度;医疗态度;医疗使用自我效能;影响因素 随着时间的推移，维持医疗服务的获得;干预措施对健康和福祉的贡献， 以及干预对JIA社会交往的扩散。为了达到这个目标，我们将进行半- 对40名有目的抽样的参与者进行结构化定性访谈（每个干预组20人）， 报告了基线时的医疗保健获取障碍。这项研究是及时的，可以为健康素养提供信息 JIA的干预措施，在机构和社区环境中建立JIA健康素养的政策，以及 JIA的服务交付模式。拟议的干预措施在提高健康素养方面具有巨大潜力 在JIA之间，从而改善这个规模庞大且服务不足的社区的福祉。时发现的问题 这项研究也可能与寻求建立其他低收入人群健康素养的干预措施有关。 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.