Literacy and improving patient-clinician encounters for Asthma

扫盲和改善哮喘患者与临床医生的接触

• 批准号: 7416773
• 负责人: ANDREA J. APTER
• 金额: $ 10.52万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-05-02 至 2012-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7416773
• 关键词: Accounting; Address; Adherence; Adrenal Cortex Hormones; Adult; Adult asthma; Affect; African American; Asthma; Attention; Attitude; Behavior Therapy; Behavioral; Behavioral Medicine; Breathing; Caring; Chronic; Chronic Disease; Clinic; Clinical; Cohort Studies; Collaborations; Communication; Condition; Data; Date/Time; Diabetes Mellitus; Economics; Education; Educational process of instructing; Electronics; Focus Groups; Funding; Goals; Health; Healthcare; Hospitalization; Hypertension; Independent Living; Inhalators; Institute of Medicine (U.S.); Intervention; K-Series Research Career Programs; Knowledge; Language; Latino; Lead; Life; Living Wills; Low income; Measures; Minority; Minority Groups; Monitor; Morbidity - disease rate; Motivation; Outcome; Parents; Participant; Patients; Pilot Projects; Population; Population Study; Powder dose form; Prednisone; Prevalence; Problem Solving; Property; Protocols documentation; Pulmonary Function Test/Forced Expiratory Volume 1; Quality of life; Questionnaires; Randomized; Randomized Controlled Trials; Rate; Recording of previous events; Recruitment Activity; Reporting; Research; Research Personnel; Resources; Risk; Score; Self Management; Social Environment; Solutions; Standards of Weights and Measures; Steroids; Testing; Visit; Week; Weight maintenance regimen; Work; abstracting; base; behavior measurement; cohort; concept; contextual factors; design; functional health literacy; health disparity; health literacy; improved; inattention; instrument; literacy; member; pill; programs; prospective; skills; social; therapy adherence; trial comparing

DESCRIPTION (provided by applicant): Low literacy is widespread and particularly prevalent among low-income and minority groups, the same groups in which asthma morbidity is excessive. Inattention by clinicians to the literacy and related health literacy of patients may result in ineffective communication and subsequent poor patient self-management. Some aspects of health literacy such as understanding numerical concepts may be particularly important. We recently developed and validated an asthma-specific numeracy questionnaire (ANQ). We found that many adults do not understand the numerical concepts embedded in standard asthma education. Those with low ANQ scores were also more likely to have had hospitalizations and ED visits for asthma. The initial aims of this application are to use the participants and outcomes of the parent R01 HL073932 to conduct a cohort study to examine the association of (Specific Aim 1) a standard health literacy instrument and (Specific Aim 2) ANQ with adherence to inhaled steroids (measured electronically), asthma control (FEV1), and asthma-related quality of life in adults with moderate or severe asthma. The parent R01 HL073932 addresses another barrier to successful asthma care involving patient-clinician interaction. It is a randomized controlled trial comparing the effect of a behavioral individualized intervention, problem-solving (PS) with standard asthma education (Attention Control (AC)), on these same outcomes. PS seeks to empower lowincome and minority asthmatic adults and allows clinicians to take account of the social context of these patients' lives. Exploratory Aim 3 will examine the interaction between literacy and PS versus AC interventions. We will use focus groups of patients and clinicians to refine the ANQ as a brief individualized assessment for clinicians. We will then develop and pilot an intervention to test whether ANQ-based individualized interventions result in improved adherence and asthma outcomes (Specific Aim 4). This will lead to subsequent research applications to test whether ANQ-based interventions alone or combined with PS results in better asthma outcomes and adherence. That is, we anticipate that both PS and ANQ will lead to simple brief additive or synergistic ways for clinicians to assess patients and tailor information. My Overarching Research Goal is examine barriers to asthma care that operate at the interface between patient and clinician and that may differentially affect members of ethnic and racial minority groups with my ultimate goal being to design and implement ways to reduce such health disparities. This K02 application will allow me to continue along my current trajectory to become an independent investigator focusing on strategies directed at both clinicians and patients. By enhancing current collaborations, building others, and participating in relevant research working groups, I will create a team of expert collaborators in health and literacy, education, bioenqineerinq (directed at behavior measurement), and behavioral medicine (End of Abstract)

描述（由申请人提供）： 低收入和少数群体中，低识字率是普遍的，尤其是普遍存在的，与哮喘发病率过高的相同群体相同。临床医生对患者的素养和相关健康素养的注意力不集中可能会导致沟通无效，随后患者的自我管理差。健康素养的某些方面，例如理解数值概念可能尤其重要。我们最近开发并验证了哮喘特异性计算问卷（ANQ）。我们发现许多成年人不了解标准哮喘教育中嵌入的数值概念。 ANQ得分较低的人也更有可能住院和ED诊断哮喘。本应用的最初目的是使用父母R01 HL073932的参与者和结果进行同类研究，以检查（特定目标1）标准健康素养工具的关联（特定目标1） AIM 2）ANQ遵守吸入类固醇（以电子方式测量），哮喘控制（FEV1）和与中度或重度哮喘的成年人中与哮喘相关的生活质量。家长R01 HL073932解决了涉及患者 - 临床互动的成功哮喘护理的另一个障碍。这是一项随机对照试验，比较了行为个性化干预，解决问题（PS）与标准哮喘教育（注意控制（AC））对这些相同结果的影响。 PS试图赋予低收入和少数群体哮喘成年人的能力，并允许临床医生考虑这些患者生活的社会环境。探索目标3将检查识字与PS与AC干预措施之间的相互作用。我们将使用患者和临床医生组成的焦点小组来完善ANQ作为临床医生的简短个性化评估。然后，我们将开发并试行一项干预措施，以测试基于ANQ的个性化干预措施是否会改善依从性和哮喘结果（特定目标4）。这将导致随后的研究申请，以测试单独基于ANQ的干预措施或与 PS导致更好的哮喘结局和依从性。也就是说，我们预计PS和ANQ都将为临床医生评估患者和量身定制信息而导致简单的简短添加剂或协同方法。我的总体研究目标是检查在患者与临床医生之间界面上运作的哮喘护理的障碍，并且可能会差异地影响族裔和种族少数群体的成员，而我的最终目标是设计和实施减少这种健康差异的方法。这项K02应用程序将使我能够继续沿着目前的轨迹成为一名专注于针对临床医生和患者的策略的独立研究者。通过加强当前的合作，建立他人并参加相关的研究工作组，我将建立一个由健康和扫盲，教育，Bioenqineerinq（针对行为测量）和行为医学的专家合作者组成的团队 （抽象的结尾）