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

描述（由申请人提供）：健康素养，定义为理解或执行医疗/治疗指示的能力，越来越多地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，在将健康知识普及置于患者之间以及提供者与患者之间阻碍沟通和遵守的社会经济和文化差异的更广泛背景下方面所做的工作较少。拟议的项目旨在通过确定和解释形成低收入、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健康素养低的影响以及健康素养对健康的影响，拟议的项目结合了定性和定量方法，以实现以下具体目标： 1.评估母语和非母语英语者健康素养的差异; 2.确定与健康素养相关的因素，包括a）家中使用的语言，B）移民的新近程度，c）健康信息的来源，以及d）其他文化信仰和习俗; 3.采用前瞻性多方法研究设计，探讨健康素养对慢性 疾病结果（例如，哮喘、糖尿病和高血压），包括：a.健康素养与患者对治疗方案的依从性之间的关联，以及B.健康素养在医患沟通中的作用; 4.确定有效的方法，将定性和定量研究方法联合收割机结合起来， 卫生知识普及;以及 5.为基层卫生保健提供者制定慢性病管理建议， 不同种族的患者，健康素养低。 为达致这些目标，我们建议以500名为目标样本，进行流行病学调查 从位于马萨诸塞州西部的330健康中心Caring Health Center招募来自5个种族组的患者（每组100例）。图表摘要将收集基线和两次12个月随访时的慢性疾病结局。焦点小组、人种学访谈、慢性病日记和对患者子样本的家庭观察将提供更多的背景和细节，有助于调查的发展和对调查结果的解释。

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.