Adaptation of Consumer Guides for Patients with Low Health Literacy

描述（由申请人提供）：本申请的总体目标是开发替代多媒体产品，以翻译和传播针对健康素养低的患者和消费者的比较有效性研究总结指南（CERSG）中提供的信息。对于本提案，我们选择了与三种肌肉骨骼疾病相关的四种CERSG：骨关节炎（OA），类风湿性关节炎（RA）和骨质疏松症（OP）。它们是最常见的慢性疾病之一，我们在这些疾病方面拥有广泛的专业知识。我们将使用一种新的方法来翻译和传播这些指南，即被定义为“健康教育娱乐”的产品。这些是教育和健康决策工具，使用视觉、听觉或视听工具，结合故事情节和叙述，告知消费者在面临健康问题时的替代行动方案，并明确讨论益处和风险。多媒体患者决策辅助工具在健康素养水平低的人群中可能特别有用。我们的具体目标是：1）评估OA、RA和OP患者以及治疗他们的临床医生的信息需求，并测试当前CERSG的组成部分对这些主题的可接受性; 2）根据当前OA、RA和OP患者CERSG的内容，开发低识字率英语和西班牙语多媒体患者决策辅助工具（MM-PtDA）; 3）在包括经济困难和少数民族患者的随机临床试验（RCT）中，评价MM-PtDA与当前CERSG产品相比的疗效; 4）制定MM-PtDA的实施和传播计划。对于第一个目标，我们将对感兴趣的CERSG进行定性评估，并探索首选的内容和交付方法。将对OA、RA和OP患者进行访谈，以确定其信息需求以及当前CERSG的可接受性。治疗这些患者的临床医生也将接受采访，了解a）患者的信息需求，B）如何在其环境中实施决策支持技术，以及c）信息材料应采用何种格式。MM-PtDA产品改编将以教育娱乐决策辅助模型（埃达姆）为指导，该模型是一个将学习理论和娱乐教育联系起来的框架，旨在为健康素养较低的患者设计引人入胜且用户友好的决策辅助工具（目标2）。多媒体材料将与载有主要学习内容的小册子一起分发。它们将以模块的形式编制，以便在获得新信息时容易更新。我们将首先对开发的材料和评估工具进行试点测试，以根据需要进行调整和修改。然后，我们将进行三项随机对照试验，每个指南一项，以测试MM-PtDA的疗效，涉及几个结果：知识，自我效能，决策冲突和自我报告的健康行为（目标3）。最后，我们将召集一批利益攸关方，协助我们制定一项计划，以便向有关人口目标（目标4）实施和传播《千年发展目标》。 公共卫生相关性：骨关节炎、类风湿性关节炎和骨质疏松症是最常见的慢性健康问题。患有这些疾病的患者面临许多治疗选择。该项目将为健康素养较低的患者提供教育工具，以帮助他们做出知情的治疗决定。

DESCRIPTION (provided by applicant): The overall goal of this application is to develop alternative multimedia products to translate and disseminate the information provided in Comparative Effectiveness Research Summary Guides (CERSGs) for patients and consumers with low health literacy. For this proposal we have chosen four CERSGs related to three musculoskeletal disorders: osteoarthritis (OA), rheumatoid arthritis (RA) and osteoporosis (OP). They are among the most common chronic disorders and we have extensive expertise in these conditions. We will use a novel approach to translate and disseminate these guides, namely what has been defined as 'health edutainment' products. These are educational and health decision-making tools that use visual, audio, or audiovisual tools, incorporating story lines and narratives to inform consumers about alternative courses of action when facing health problems, with explicit discussion of benefits and risks. Multimedia patient decision aids may be of particular utility in populations with low levels of health literacy. Our specific aims are: 1) to evaluate the information needs of patients with OA, RA, and OP, and clinicians who treatment them, and test the acceptability of the components of the current CERSGs for these topics; 2) to develop low literacy English and Spanish language multimedia patient decision aids (MM-PtDA) following the content of current patient CERSGs for OA, RA, and OP; 3) to evaluate the efficacy of the MM-PtDA, compared to current CERSG products, in randomized clinical trials (RCT) including economically disadvantaged and ethnic minority patients; and 4) to develop implementation and dissemination plans for the MM-PtDA. For the first aim we will conduct a qualitative evaluation of the CERSGs of interest and exploration of preferred content and delivery methods. Interviews will be conducted with patients who have OA, RA, and OP to determine their information needs and also acceptability of the current CERSGs. Clinicians who treat these patients will also be interviewed about a) information needs of their patients, b) how decision support technologies might be implemented in their settings, and c) what format the information materials should take. The MM-PtDA product adaptations will be guided by the Edutainment Decision Aid Model (EDAM), a framework for linking learning theory and entertainment education to design engaging and user-friendly decision aids for patients with lower health literacy (Aim 2). The multimedia materials will be distributed together with a booklet containing the key learner content. They will be developed in modules, so they can be easily updated as new information becomes available. We will initially pilot test the developed materials and evaluation tools to adjust and modify them as needed. We will then conduct three RCTs, one for each guide, to test the efficacy of the MM-PtDA, with respect to several outcomes: knowledge, self-efficacy, decisional conflict and self-reported health behaviors (Aim 3). Finally, we will gather a group of stakeholders to assist us with the development of a plan for implementation and dissemination of the MS to the population targets of interest (Aim 4). PUBLIC HEALTH RELEVANCE: Osteoarthritis, rheumatoid arthritis and osteoporosis are among the most common chronic health problems. Patients with these disorders face many treatment options. This project will provide tools for patients with lower health literacy educational tools to assist them in making informed treatment decisions.