Amelioration of Literacy Deficits in Prenatal Care

描述（由申请人提供）：医学对话的识字挑战是相当大的和显著的;由于这些挑战属于概念和口头识字的相对未开发的领域，它们在指数增长的识字文献中几乎被忽视。然而，正是在口头和概念扫盲领域，在与保健提供者的面对面互动中出现了关键问题。正是在这里，病人在实现最基本的目标--理解和被理解--时，挫折感越来越大。有理由相信，这些挑战对于寻求产前护理的识字率低的妇女尤其明显。尽管有证据表明，在产前、围产期和产后服务利用和健康结果方面存在持续的社会经济和种族差异，但联邦相对较少关注制定目标，以改善影响孕妇和产后妇女及其婴儿的识字和健康沟通缺陷（《健康人》，2010年），或设计识字干预措施，以改善这一人群的健康结果。正是在第一次产前检查中，在对产前检查作出知情选择所需的复杂信息中，以及在面对怀孕的心理社会和情感挑战时，可能会出现重大的认知和情感挑战。因此，这是第一次访问，很可能设置阶段没收交流，并确定发展的关系，以及一系列的态度，心理，行为和健康的结果，从照顾。本研究的具体目的是：（1）了解印刷、概念和口头识字维度之间的关系，并调查这些领域中缺陷的沟通特征;（2）与低识字妇女和健康素养专家合作，制定沟通干预措施，旨在：（a）改善与产前基因检测的知情选择有关的口头和概念识字缺陷，以及（B）促进对敏感的情感和心理社会话题的披露和讨论，及（3）进行随机试验，以评估干预对各种结局的影响，包括：互动、理解、满意度、产前护理利用、产后预约、产前和产后抑郁症状以及早产。

DESCRIPTION (provided by applicant): The literacy challenges of the medical dialogue are considerable and significant; as these challenges fall within the relatively unexplored domains of conceptual and oral literacy, they have been all but ignored in the exponentially growing literacy literature. Nevertheless, it is in the oral and conceptual literacy domains that critical issues arise in face-to-face interactions with health providers. It is here that the frustration grows in the accomplishment of the most basic of patient goals- to understand and be understood. There is reason to believe that these challenges are especially evident for low-literate women seeking prenatal care. Despite evidence of persistent socioeconomic and racial disparity in prenatal, perinatal, and post-partum services utilization and health outcomes, there has been relatively little federal focus on setting goals for the amelioration of literacy and health communication deficits affecting pregnant and post-partum women and their babies (Healthy People 2010), or in designing literacy interventions to improve health outcomes for this population. It is in the first prenatal visit that significant cognitive and emotional challenges are likely to arise in the complex information needed to make an informed choice about prenatal testing and in facing the psychosocial and emotional challenges of pregnancy. Consequently, it is the first visit that is likely to set the stage forfeiture exchanges and determine the relationship that develops, and the array of attitudinal, psychological, behavioral, and health outcomes that derive from care. The specific aims of the study are: (1) To understand the relationships among print, conceptual and oral literacy dimensions and to investigate the communication characteristics of deficits in these realms; (2) To work collaboratively with low-literate women, and health literacy experts, to develop a communication intervention designed to: (a) ameliorate oral and conceptual literacy deficits related to informed choice regarding prenatal genetic testing and (b)to facilitate disclosure and discussion about sensitive emotional and psychosocial topics, and (3) to conduct a randomized trial to evaluate the effect of the intervention on a variety of outcomes including: interaction, understanding, satisfaction, prenatal care utilization, post-partum appointment keeping, antenatal and post-partum depression symptoms, and pre-term deliveries.