Literacy & Maternal Health; Defining Obstacles to Care

描述(由申请者提供)：NICHD以患者为导向的研究职业发展奖(K23)的修订申请寻求支持，以开发与导致母婴健康差异的社会因素相关的研究计划。特别是，我感兴趣的是找出与产妇识字率低有关的早产儿预防性儿科护理的障碍。虽然识字率低在早产率高的人群中很常见，而且在其他情况下与护理利用率低有关，但对识字率在儿科护理利用率方面的作用知之甚少，甚至一无所知。这项研究旨在为以社区为基础的干预措施奠定基础，以减少低识字率妇女面临的有效利用儿科保健的障碍。拟议的研究课程包括：1)教育部分；2)通过三个相互关联的研究开展的研究计划。研究1是对早产(怀孕35周；n=700)后的低收入市中心妇女的前瞻性研究的分析。这项研究的目的是审查产妇识字与预防性儿科护理(儿童就诊和最新疫苗接种情况)之间的联系，并评估这种联系的潜在调停者。研究2将利用定性方法澄清研究1中确定的因素，并从母亲的角度揭示护理的新障碍。研究3利用前一项工作的结果，制定了以社区为基础的干预措施，以改善研究1和2中确定的障碍。将对广泛用于向低收入妇女及其婴儿提供服务的家访模式进行调整，以包括健康和识字指导，以解决已确定的儿科护理利用障碍。教育部分侧重于高级社会科学方法、统计方法和成人识字评估的具体领域，以及干预试验的设计，这些都是计划中的研究研究和随后的独立研究事业所需要的。这项工作将导致在第四年提交R01干预研究提案。拟议的研究为研究低识字率和儿科保健利用的作用提供了一个独特的机会，在这种情况下，有效利用的好处是明确和明确的。这项工作的结果也将对理解识字在更大的足月儿群体的卫生保健利用中的作用具有重要意义。

DESCRIPTION (provided by applicant): This revised application for an NICHD Mentored Patient-Oriented Research Career Development Award (K23) seeks support to develop a program of research related to social factors contributing to disparities in maternal-child health. In particular, I am interested in identifying obstacles to preventive pediatric care for preterm infants related to maternal low literacy. While low literacy is common in populations with high rates of preterm birth and has been associated with poor care utilization in other settings little to nothing is known about the role of literacy in the utilization of pediatric care. This research is designed to lay the groundwork for a community based intervention to reduce obstacles to effective pediatric care utilization faced by women with low literacy. The proposed course of study includes: 1) an educational component, and 2) a research plan to be carried out through three linked studies. Study 1 is an analysis of a prospective study of low income, inner-city women following a preterm birth (< 35 weeks gestation; n=700). The goal of this study is to examine the association between maternal literacy and preventive pediatric care (well child visits and Up to Date vaccination status) as well as to assess potential mediators of this association. Study 2, with the same population, will utilize qualitative methods to clarify factors identified in Study 1 and uncover new obstacles to care from the perspective of the mothers. Study 3 utilizes the findings of the preceding work to develop a community based intervention to modify the obstacles identified in Studies 1 and 2. A home visiting model used widely to deliver services to low income women and their infants will be adapted to include health and literacy instruction to address the identified obstacles to pediatric care utilization. The educational component focuses on specific areas of advanced social science methodology, statistical methods, and the assessment of adult literacy, as well as the design of intervention trials, which are needed for the planned research studies and subsequent independent research career. This work will result in an R01 intervention study proposal to be submitted in the fourth year. The proposed research represents a unique opportunity to study the role of low literacy and pediatric care utilization in a setting in which the benefits of effective utilization are clear and well defined. The results of this work will also have important implications for understanding the role of literacy in health care utilization for the larger group of term infants.