Computer Agents to Promote Walking in Older Adults with Low Health Literacy

超过三分之一的美国65岁以上的成年人没有足够的或边缘的功能性健康知识，在城市地区的贫困和少数民族患者中，这一数字上升到80%以上。与医疗服务提供者进行面对面的交谈仍然是向健康素养低的患者传达健康信息的最佳方法之一。研究人员已经开发并成功地试点测试了一种新的计算机代理技术，用于模拟与老年患者的面对面对话，以实现健康教育和身体活动促进领域的行为改变。在这项研究项目中，研究人员将把这项试点工作转化为一个计算机系统和协议，可以很容易地部署到门诊护理环境，并将评估所产生的系统作为一种机制，以促进行为改变的有效性在一个双臂随机临床试验中，老年患者的健康素养低。该干预措施将主要针对城市、非裔美国人、老年人人群，并在类似的研究人群中进行评价。在老年人中促进步行的计算机代理干预将分两个阶段进行：（1）在患者从诊所带回家的便携式触摸屏计算机上进行为期两个月的强化家庭日常接触干预，然后（2）通过基于亭的计算机进行偶尔接触干预，患者在前往其初级保健诊所时使用该计算机，再持续10个月，以促进步行行为的维持。将在一项随机研究中评价由此产生的干预措施，以评估其对按健康素养水平分层的患者的步行行为、健身和活动能力以及福祉的影响，并与标准治疗对照条件进行比较。开始锻炼计划的老年人可以降低他们患几种慢性疾病的风险（例如，心血管疾病、2型糖尿病、骨质疏松症等）以及抑郁症、残疾、福尔斯和总体死亡率。健康素养低与工具性日常生活活动、日常生活活动以及身体健康导致的活动限制有关。这项拟议的研究将确定一个低成本的自动化系统，可以很容易地部署从门诊诊所将有效地激励老年人识字率低，以获得更多的身体活动。

DESCRIPTION (provided by applicant): More than one-third of U.S. adults over 65 years of age have inadequate or marginal functional health literacy, and among indigent and minority patients in urban areas this number rises to over 80 percent. Face-to- face conversation with health providers remains one of the best methods for communicating health information to patients with low health literacy. The investigators have developed and successfully pilot tested a new computer agent technology for simulating face-to-face conversation with older adult patients in order to effect health education and behavior change in the area of physical activity promotion. In this research project the investigators will translate this pilot work into a computer system and protocol that can be readily deployed to ambulatory care settings, and will evaluate the efficacy of the resulting system as a mechanism to promote behavioral change among older adult patients with low health literacy in a two-arm randomized clinical trial. The intervention will be tailored for use primarily by an urban, African American, older adult population and evaluated in a similar study population. The computer agent intervention for walking promotion among older adults will occur in two-phases: (1) an intensive in-home, two-month, daily contact intervention deployed on a portable, touch-screen computer that patients carry home from the clinic, followed by (2) an occasional contact intervention via a kiosk-based computer that patients use when they come to their primary care clinic for an additional 10 months, to promote maintenance of walking behavior. The resulting intervention will be evaluated in a randomized study to assess its impact on walking behavior, fitness and mobility, and well-being in patients stratified by health literacy level, compared to a standard-of- care control condition. Older adults who begin an exercise program can reduce their risk of several chronic diseases (e.g., cardiovascular disease, type 2 diabetes, osteoporosis, etc.) as well as depression, disability, falls and overall mortality. Low health literacy has been associated with limitations in instrumental activities of daily living, activities of daily living, and limitations in activity because of physical health. The proposed study will determine whether a low-cost automated system that can be easily deployed from ambulatory clinics will be effective in motivating older adults with low literacy to obtain more physical activity.