Literacy & maternal health: defining obstacles to care

描述（由申请人提供）：这一修订后的申请NICHD指导的以患者为导向的研究职业发展奖（K23）寻求支持，以制定一项与导致母婴健康差异的社会因素相关的研究计划。特别是，我感兴趣的是确定与母亲识字率低有关的早产儿预防性儿科护理的障碍。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护理利用率低下有关，但人们对识字在儿科护理利用率方面的作用知之甚少。这项研究的目的是奠定基础，以社区为基础的干预，以减少障碍，有效的儿科护理利用所面临的妇女识字率低。拟议的研究课程包括：1）教育部分，和2）通过三个相互关联的研究进行的研究计划。研究1是对低收入、市中心早产妇女（妊娠< 35周; n=700）的前瞻性研究的分析。本研究的目的是检查产妇识字率和预防性儿科护理（以及儿童访问和最新的疫苗接种状态）之间的关联，以及评估这种关联的潜在介质。研究2，与相同的人口，将利用定性方法来澄清研究1中确定的因素，并从母亲的角度发现新的障碍，照顾。研究3利用前面的工作的结果，开发一个基于社区的干预措施，以修改研究1和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，以包括健康和识字指导，以解决已查明的儿科护理利用障碍。教育部分侧重于先进的社会科学方法、统计方法和成人识字率评估的具体领域，以及干预试验的设计，这是计划中的研究和随后的独立研究生涯所需的。这项工作将导致在第四年提交R 01干预研究提案。拟议的研究代表了一个独特的机会，研究低识字率和儿科护理利用率的作用，在有效利用的好处是明确和明确的设置。这项工作的结果也将有重要的影响，了解识字的作用，在卫生保健利用的较大群体的足月婴儿。

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.