CVD NUTRITION MODULES TAILORED TO LOW LITERACY SKILLS

我们提出了一个三部分的研究：1）开发两种营养 针对识字能力低的南方患者的干预模块， 旨在降低心血管疾病的风险，2）测试 这些模块对标准治疗的有效性， 对照，临床试验，和3）确定的可行性， 将这些干预措施传播到工作场所、教堂和县 卫生部门通过国家卫生部门系统。 研究 分为三个阶段，以实现这些目标。 第一阶段的目标是开发两个创新护理模块， 使用人口统计学、心理社会学、营养学和行为学信息 为南方患者量身定制营养治疗方案 阅读能力还不到九年级 顾问指导创新 护理包括一个结构化的评估和干预方案， 简单的书面，图形导向的印刷材料，以指导 病人和健康顾问（营养学家，健康教育家，护士，或 医生）。 计算机辅助创新护理利用 用户友好，互动，计算机辅助程序允许更多 根据个人需求精心定制， 以生动、易懂的格式提供信息，并扩大服务范围， 健康顾问的电话 我们将使用低血糖患者的焦点小组， 识字技能，以帮助概念的发展和完善 提供干预的战略。 可靠和有效的评估 可读性和理解性将有助于我们进一步完善材料。 在第二阶段，我们将进行一项随机试验，以确定我们的 创新的模块产生有意义的降低胆固醇， 与标准治疗相比的总体心血管风险。 我们将确定 400名高胆固醇和低识字能力的患者， 社区卫生中心，并将他们随机分配到四个之一， 小组：创新护理-辅导员指导，创新护理-计算机 饮食治疗的辅助、标准护理和家庭护理 胆固醇、肥胖和高血压。 标准护理将涉及 与创新护理相同的时间和健康顾问接触，但 将使用现有的材料。 护理患者将 他们通常会被推荐到他们的治疗提供者。 四个月后， 同样在一年后，我们将评估血脂、血压和 重量. 第三阶段将包括一项可行性研究，以测试 两个创新的护理模块，通过县， 卫生部门、工地和教堂。 可行性结果 评估将帮助我们完善传播战略， 卫生部作为中央协调机构，县卫生 在社区一级实施干预措施。

We propose a three part study to: 1) develop two nutrition intervention modules for southern patients with low literacy skills that are designed to reduce the risk of cardiovascular disease, 2) test the efficacy of these modules against standard care in a randomized, controlled, clinical trial, and 3) determine the feasibility of disseminating these interventions to worksites, churches, and county health departments through the state health department system. The study is divided into three phases which address each of these aims. The goal of Phase I is to develop two innovative care modules that use demographic, psycho-social, nutritional, and behavioral information to individually tailor nutrition treatment programs for southern patients with less than ninth grade reading skills. Counselor Directed innovative care consists of a structured assessment and intervention package of simply written, graphically-oriented printed materials to guide the patient and health counselor (nutritionist, health educator, nurse, or physician). Computer Assisted innovative care makes use of a user-friendly, interactive, computer assisted program permitting more sophisticated tailoring to individual needs, conveying nutrition information in a vivid, understandable format, and extending the services of the health counselor. We will use focus groups of patients with low literacy skills to aid in concept development and refinement of intervention delivery strategies. Reliable and valid assessments of readability and comprehension will help us further refine the materials. In Phase II, we will conduct a randomized trial to determine if our innovative modules produce a meaningful reduction in cholesterol and overall cardiovascular risk compared to standard care. We will identify 400 patients with high cholesterol and low literacy skills served by four community health centers and will randomly assign them to one of four groups: Innovative Care-Counselor Directed, Innovative Care-Computer Assisted, Standard Care, and Usual Care for dietary treatment of cholesterol, obesity, and hypertension. Standard Care will involve the same amount of time and health counselor exposure as Innovative Care, but will use currently available materials. Usual Care patients will be referred to their usual provider for treatment. After four months and again at one year, we will assess changes in lipids, blood pressure, and weight. Phase Ill will consist of a feasibility study to test the ability of both innovative care modules to reach low literacy adults through county health departments, worksites, and churches. Results of the feasibility assessment will help us refine a dissemination strategy using the state health department as a centralized coordinating agency, and county health departments to implement the interventions at the community level.