A Multifaceted Adaptive Testing Approach to Health Literacy in Older Adults

描述（由申请人提供）：医疗保健系统的最新变化需要健康消费者和患者在其健康管理中发挥更积极的作用。特别是老年人，在当今的医疗保健环境中面临着许多挑战，因为医疗保健系统越来越复杂，来自众多不同来源的健康信息越来越多。健康素养技能需要与医疗保健提供者沟通，阅读和理解健康信息，药物依从性，使用医疗设备和做出关于治疗方案的决定。7 - 65岁人群的健康知识普及率较低，特别是少数民族和社会经济地位较低的人群。目前的卫生知识普及措施范围有限，不足以诊断与知识普及有关的具体问题。本研究的总体目标是开发和验证一个健康素养的工具，为老年人采用最先进的计算机自适应测试方法和技术。第一个目标是制定一个综合框架，以确定和衡量老年消费者在了解、获取和使用与健康有关的信息和服务方面所需的核心能力。为此，我们将开展一系列的形成性研究活动，包括对现有措施进行系统性审查，召开一个关于健康知识的专家小组，并对与健康有关的活动进行一系列认知任务分析（例如，葡萄糖测试）。这将有助于制定和实施概念知识和算术模块。原型模块将作为基于测量决策理论的自适应测试来实施。将对15名不同健康素养水平的老年人进行初步研究，以制定测试规范。这些数据将由调查人员进行分析，并由专家小组成员进行审查。在此基础上，我们将修改这两个模块，并对两组老年人进行更大规模的验证研究：1）60-74岁和2）75-85岁。这一应用的主要优势是，我们正在解决一个相当大的和日益重要的问题，使用一个理论基础的框架，大大扩大了健康素养评估的范围。本申请中所述的全面健康素养框架可用于支持健康素养研究，为临床医生开发筛查工具，并为不同识字水平的老年人量身定制健康教育材料。公共卫生相关性：识字问题的存在在很大程度上是因为保健信息和服务系统不熟悉和复杂，这使得大多数人，特别是老年人难以有效利用这些系统。我们建议在一个全面框架的基础上开发一个卫生知识普及评估工具。该工具有可能用于支持卫生知识普及研究，为临床医生开发筛查工具，并为不同文化水平的老年患者和消费者量身定制健康教育材料。

DESCRIPTION (provided by applicant): Recent changes in the healthcare system necessitate that health consumers and patients play a more active role in the management of their health. Older adults, in particular, face many challenges in today's health care environment in terms of the increased complexity of health care systems and the proliferation of health information from numerous and diverse sources. Health literacy skills are needed for communication with healthcare providers, reading and understanding health information, medication compliance, using medical devices and making decisions about treatment options. Health literacy is lower among people aged 7 65, especially ethnic minorities and those with lower socio-economic status. Current measures of health literacy are limited in scope and inadequate in diagnosing specific literacy-related problems. The overall objective of this study is to develop and validate a health literacy instrument for older adults employing state-of-art computer-adaptive testing methods and technology. The first aim is to develop a comprehensive framework for identifying and measuring the core competencies that older adult consumers need to understand, access and use health related information and services. Towards that end, we will engage in a series of formative research activities including a systematic review of existing measures, convening an expert panel on health literacy and performing a series of cognitive task analyses on health related activities (e.g., glucose testing). This will contribute to the development and implementation of conceptual knowledge and numeracy modules. The prototype modules will be implemented as adaptive tests based on measurement decision theory. A preliminary study with 15 older adults at varying levels of health literacy will be conducted to develop testing norms. The data will be analyzed by investigators and scrutinized by members of the expert panel. On that basis, we will revise the 2 modules and subject it to a larger validation study with 2 groups of older adults: 1) ages 60-74 and 2) 75-85. A primary strength of this application is that we are addressing an issue of considerable and growing importance using a theoretically-grounded framework that greatly expands the scope of health literacy assessment. A comprehensive health literacy framework as described in this application can be used to support research on health literacy, develop screening tools for clinicians and tailor health education materials for older adult adults at varying levels of literacy. Public Health Relevance: literacy problems exist to a large extent because health information and services systems are unfamiliar and complex, which makes their effective utilization difficult for most people, especially for older adults. We are proposing to develop a health literacy assessment tool based on a comprehensive framework. The tool has the potential to be used to support research on health literacy, develop screening tools for clinicians and tailor health education materials for older adult patients and consumers at varying levels of literacy.