The Impact of Cultural Differences on Health Literacy & Chronic Disease Outcomes

描述（由申请人提供）：健康素养，定义为理解或按照医疗/治疗指示行事的能力，越来越被认为是患者依从性和慢性疾病结局的重要因素。卫生保健提供者开始从可读性和患者素养的角度评估患者教育和其他材料。然而，将卫生知识素养置于患者之间以及提供者和患者之间阻碍沟通和遵守规定的社会经济和文化差异这一更广泛背景下的工作做得较少。拟议的项目旨在通过确定和考虑影响低收入、少数民族和移民人口健康素养的文化因素，扩大我们对健康素养的理解。为了更好地了解文化对卫生知识普及程度低的影响以及卫生知识普及对健康的影响，拟议的项目结合了定性和定量方法，以实现以下具体目标：

DESCRIPTION (provided by applicant): Health literacy, defined as the ability to understand or act on medical/therapeutic instructions, is increasingly recognized as an important factor in patient compliance and chronic disease outcomes. Health care providers are beginning to assess patient education and other materials from the perspective of readability and patient literacy. Less work has been done, however, to place health literacy in the broader context of socioeconomic and cultural differences among patients and between providers and patients that hinder communication and compliance. The proposed project aims to broaden our understanding of health literacy by identifying and accounting for the cultural factors that shape health literacy in low-income, ethnic minority and immigrant populations. To better understand the cultural influences on low health literacy and the effects of health literacy on health, the proposed project combines qualitative and quantitative methods to meet the following specific aims: 1. To assess variation in health literacy among native and non-native English speakers; 2. To identify factors associated with health literacy, including a) language spoken at home, b) recency of immigration, c) sources of health information, and d) other cultural beliefs and practices; 3. To use a prospective multimethod research design to explore the impact of health literacy on chronic disease outcomes (e.g., asthma, diabetes, and hypertension), including: a. the association between health literacy and patient compliance with therapeutic regimens, and b. the role of health literacy in patient-provider communication; 4. To identify effective ways to combine qualitative and quantitative research methods to further knowledge of health literacy; and 5. To develop recommendations for primary health care providers on chronic disease management for ethnically diverse patients with low health literacy. To achieve these aims, we propose to conduct epidemiological surveys with a targeted sample of 500 patients from 5 ethnic groups (100 per group) recruited from Caring Health Center, a Section 330 health center in western Massachusetts. Chart abstracts will collect chronic disease outcomes at baseline and two 12-month follow-ups. Focus groups, ethnographic interviews, chronic disease diaries and home observations with a subsample of patients will provide greater contextualization and detail, aiding in survey development and the interpretation of survey findings.