Multi-Center Assessment of Health Literacy and Oral Health

描述（由申请人提供）：医疗保健变得越来越复杂，要求越来越高。未来技术、基因工程、高度特异的药物、复杂的保险计划，以及来自媒体的令人困惑和经常相互矛盾的信息，都加剧了这个问题。知道如何获取、理解和使用有关医疗保健的信息（即健康素养）对每个人来说都是一个更大的挑战。根据美国卫生局局长的《美国口腔健康报告》，当今美国存在着深刻而重要的口腔健康差距。流行病学评估显示，低收入和少数群体的口腔疾病和失调发病率和流行率最高。鉴于这些群体也最有可能拥有有限的卫生知识技能，这意味着他们特别容易受到卫生保健系统并发症的影响，并且最需要援助。然而，为了制定和实施有效的干预措施，需要更清楚地了解有限的卫生知识普及与口腔健康之间的关系。这种理解的核心是了解不同的卫生素养技能（例如，阅读理解、计算能力、概念知识）如何单独或作为一个群体来支持口腔卫生保健决策，并最终支持口腔健康结果。这些发现将改善口腔健康和整体福祉，并减少全国数百万人的差距。拟议的研究项目将来自巴尔的摩、洛杉矶、亚特兰大和华盛顿特区的经验丰富的多学科团队聚集在一起，全面研究健康素养与口腔健康之间的关系。在马里兰州和加利福尼亚州的三家牙科诊所就诊的牙科患者的横截面将被招募，并在面对面的接触中进行一系列评估。这些数据还将与临床记录联系起来，以便同时评估牙科保健服务的回顾性和前瞻性使用情况，包括支出和利用情况。该项目的具体目标包括：1)确定健康素养、口腔保健决策和口腔健康状况之间的结构关系；2)确定四种不同的卫生素养衡量标准在多大程度上代表了独特的技能；3)确定四种不同的健康素养测量与口腔健康的关联程度，独立于选定的社会人口统计学和卫生保健相关协变量。拟议的项目意义重大，因为它是第一个全面研究健康素养与口腔健康之间关系的项目。它的重要意义还在于，它将作为全面评估卫生知识普及和牙科以外的其他卫生成果的指南。该项目具有创新性，因为它将卫生知识普及、卫生保健决策和口腔健康结果的多种措施结合到一项调查中。这也是创新,因为它包含了强大的和现代统计分析,揭示了每个变量的相对贡献的整体模型,同时为上述协变量控制。

DESCRIPTION (provided by applicant): Healthcare is becoming more complicated and demanding each year. Futuristic technologies, genetic engineering, highly specific drugs, complex insurance plans, and confusing and often conflicting messages from the media all add to the problem. Knowing how to access, understand, and use information about healthcare (i.e., health literacy) is becoming more of a challenge for everyone. According to the Surgeon General's Report on Oral Health in America, profound and consequential oral health disparities exist in the United States today. Epidemiological assessments reveal that low-income and minority populations have the highest incidence and prevalence of oral diseases and disorders. Given that these groups are also most likely to have limited health literacy skills means that they are especially vulnerable to the complications of the healthcare system and most in need of assistance. In order for effective interventions to be developed and implemented, however, a clearer understanding of the associations between limited health literacy and oral health need to be gained. At the heart of that understanding is knowing the ways that different health literacy skills (e.g., reading comprehension, numeracy, conceptual knowledge) work individually and as a group to support oral healthcare decision making and, ultimately, oral health outcomes. These findings would improve oral health and general well-being, and reduce disparities for millions in the nation. The proposed research project brings an experienced multidisciplinary team together from Baltimore, Los Angeles, Atlanta, and Washington, DC to comprehensively study these associations between health literacy and oral health. A cross-section of dental patients presenting to three dental clinics in Maryland and California will be recruited and a series of assessments will be administered during face-to-face encounters. These data will also be linked to clinical records so that retrospective and prospective use of dental care services, including expenditures and utilization, may be concurrently assessed. The specific aims of the project include: 1) determining the structural relations between health literacy, oral healthcare decision making, and oral health status; 2) determining the extent to which four different measures of health literacy represent unique skills; and 3) determining the extent to which four different measures of health literacy are associated with oral health, independent of selected sociodemographic and healthcare-related covariates. The proposed project is significant because it represents the first to comprehensively study the associations between health literacy and oral health. It is also significant because it will serve as a guide for comprehensive assessments of health literacy and other health outcomes, outside of dentistry. The project is innovative because it combines multiple measures of health literacy, healthcare decision-making, and oral health outcomes into a single investigation. It is also innovative because it incorporates powerful and contemporary statistical analyses that will reveal the relative contribution of each variable to the overall model, while controlling for the aforementioned covariates. PUBLIC HEALTH RELEVANCE: Successful completion of the proposed project will result in a comprehensive understanding of the extent to which health literacy is associated with oral health. Gaining this understanding will lead to interventions aimed at improving oral health and reducing oral health disparities, benefitting millions of low-income and minority Americans. In addition, the proposed project will serve as a model for comprehensive studies of the links between health literacy and other health outcomes, beyond dentistry. This more global approach will greatly expand the field of health literacy and increase the likelihood of successful interventions in medicine.