CVD NUTRITION MODULES TAILORED TO LOW LITERACY SKILLS

我们提出了三个部分的研究：1)开发两种营养 针对低识字技能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 这些模块相对于标准护理的疗效在随机、 对照临床试验，以及3)确定 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。这项研究 分为三个阶段，每个阶段都涉及到这些目标。 第一阶段的目标是开发两个创新的护理模块， 使用人口统计、心理社会、营养和行为信息 为南方患者量身定做营养治疗方案 不到九年级的阅读能力。辅导员指导创新 CARE由结构化的评估和干预方案组成 简单书写、以图形为导向的印刷材料，以指导 患者和健康顾问(营养师、健康教育者、护士或 医生)。计算机辅助创新护理利用 用户友好、交互式、计算机辅助的计划允许更多 为个人需求量身定做复杂的产品，传递营养 以生动、易懂的格式提供信息，并扩展服务 健康顾问的名字。我们将使用低血压患者的焦点小组 有助于概念开发和改进的识字技能 干预交付策略。可靠和有效的评估 可读性和理解性将有助于我们进一步提炼材料。 在第二阶段，我们将进行一项随机试验，以确定我们的 创新模块可显著降低胆固醇和 与标准护理相比，总体心血管风险。我们将确定 400名高胆固醇和低识字率的患者由4名 社区卫生中心，并将随机分配到四个 小组：创新关怀-辅导员指导，创新关怀-计算机 辅助、标准护理和日常护理在饮食治疗中的应用 胆固醇、肥胖症和高血压。标准医疗服务将涉及 与创新关怀的时间和健康顾问接触相同，但 将使用目前可用的材料。常规护理患者将被 转介到他们通常的提供者那里接受治疗。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 这两个创新的护理模块通过县为低识字率的成年人提供服务 卫生部门、工地和教堂。可行性的结果 评估将帮助我们利用国家制定传播战略 卫生部门作为集中协调机构，县卫生局 各部门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.