Literacy & maternal health: defining obstacles to care

描述（由申请人提供）：这是NICHD指导患者导向研究职业发展奖（K23）的修订申请，旨在支持发展与导致母婴健康差异的社会因素相关的研究项目。特别是，我感兴趣的是确定与母亲低识字率相关的早产儿预防儿科护理的障碍。虽然低识字率在早产率高的人群中很常见，并且与其他环境中的不良护理利用有关，但人们对识字率在儿科护理利用中的作用知之甚少。本研究旨在为社区干预奠定基础，以减少低识字率妇女有效利用儿科护理的障碍。建议的学习课程包括：1)教育部分，以及2)通过三个相关研究进行的研究计划。研究1是一项前瞻性研究的分析，对低收入，市中心妇女早产后（< 35周妊娠；n=700）。本研究的目的是检查产妇识字和预防性儿科护理（儿童访视和最新疫苗接种状况）之间的关系，并评估这种关系的潜在中介。研究2，在相同的人群中，将利用定性的方法来澄清研究1中确定的因素，并从母亲的角度发现新的护理障碍。研究3利用先前工作的发现，开发了一种基于社区的干预措施，以修改研究1和研究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，以包括保健和扫盲教学，以解决已确定的儿童护理利用方面的障碍。教育部分侧重于先进的社会科学方法论、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，这些都是计划的研究和随后的独立研究生涯所需要的。这项工作将在第四年提交R01干预研究提案。提出的研究代表了一个独特的机会来研究低识字率和儿科护理利用的作用，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有重要的意义，理解识字在医疗保健利用的作用，为较大的群体足月婴儿。

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.