Addressing Literacy and Numeracy in Self-care & Clinical Outcomes in ESRD

描述(由申请人提供)： 患者识字或算术(数学)技能对终末期肾病患者实施临床自我护理建议的影响尚不清楚。在理解患者在复杂慢性疾病的日常护理中合并、解释和应用与健康相关的信息的基本机制方面，存在着巨大的知识差距。我的主要长期目标是：1)。探讨肾病患者自我护理行为的决定因素和障碍，特别是识字/算术的作用。系统地制定和评估针对低识字/算术患者的教育干预措施，以增加自我护理的参与度并改善临床结果。终末期肾脏疾病需要提供者和患者的密集管理。在慢性血液透析(CHD)中，患者的自我护理行为包括遵守饮食和液体限制、获得处方透析治疗、血管通路护理、坚持复杂的用药方案和管理并存疾病。冠心病患者对自我护理的参与度通常较低，并与死亡风险增加有关。在美国，健康素养低是常见的，影响着9000多万人，并与慢性病知识较少和对慢性病的遵从性较低有关。我们假设，识字和算术能力是冠心病患者自我护理行为和临床结果的重要决定因素。本申请的主要研究目标是：1)。开发描述冠心病患者的识字和算术技能及其相关特征的方法，2)。确定低识字/算术能力与知识、自我效能感、参与冠心病自我护理行为和临床结局的关系。评估针对低识字率患者的提供者干预对自我护理行为和临床结果的影响。这项拟议的研究将产生识别和衡量冠心病患者自我护理机制和障碍的基础知识和新方法，这将使设计和实施以患者为中心的、教育和适应性干预措施来提高对自我护理建议的依从性。重要的是，这一经验将为候选人提供新的和先进的方法技能，使她能够发展成为一名成功的独立调查员，为改善肾脏疾病患者的护理做出重大贡献。

DESCRIPTION (provided by applicant): The influence of patient literacy or numeracy (math) skill on the implementation of clinical self-care recommendations in patients with end-stage renal disease is not known. Large knowledge gaps exist in understanding the basic mechanisms by which patients incorporate, interpret and apply health-related information in the daily care of complex chronic diseases. My primary long term goals are : 1). to explore the determinants and barriers of self-care behaviors in patients with kidney disease, specifically the role of literacy/numeracy and 2). to systematically develop and evaluate educational interventions targeted for low literacy/numeracy patients to increase participation in self-care and improve clinical outcomes. End-stage renal disease requires intensive management by both provider and patient. In chronic hemodialysis (CHD), patient self-care behaviors include adherence to dietary and fluid restrictions, obtaining prescribed dialysis therapy, vascular access care, adherence to complex medication regimes and management of comorbid diseases. Participation in self-care by CHD patients is often low and has been associated with an increased mortality risk. Low health literacy is common affecting over 90 million people in the U.S., and has been associated with lower knowledge of chronic disease and lower adherence. We hypothesize that literacy and numeracy are important determinants of self-care behaviors and clinical outcomes in CHD patients. The primary research goals of this application are: 1). to develop methods to describe literacy and numeracy skills and associated characteristics of CHD patients, 2). to determine the association of low literacy/numeracy with knowledge, self-efficacy, and participation in CHD self-care behaviors and clinical outcomes, and 3). to evaluate the impact of a provider intervention, targeted to patients with low literacy, on self-care behaviors and clinical outcomes. The proposed research will result in fundamental knowledge and new methodology to identify and measure mechanisms and barriers of self-care in CHD patients, which will enable the design and implementation of patient-centered, educational, and adaptive interventions to improve adherence to self-care recommendations. Importantly, this experience will provide the candidate with a new and advanced methods skill-set that will enable her to develop into a successful independent investigator well equipped for significant contributions to improving the care of patients with kidney disease.