Multi-Center Assessment of Health Literacy and Oral Health

描述（由申请人提供）：医疗保健每年都变得越来越复杂和苛刻。未来技术、基因工程、高度特异性的药物、复杂的保险计划，以及来自媒体的令人困惑且往往相互矛盾的信息，都加剧了这一问题。了解如何访问、理解和使用有关医疗保健的信息（即，卫生知识普及）对每个人来说都越来越成为一个挑战。根据美国外科医生关于口腔健康的报告，今天美国存在着深刻而重要的口腔健康差异。流行病学评估显示，低收入和少数民族人口的口腔疾病和紊乱的发病率和流行率最高。鉴于这些群体也最有可能具有有限的卫生知识技能，这意味着他们特别容易受到保健系统并发症的影响，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健康知识与口腔健康之间的关系。这种理解的核心是了解不同的健康素养技能（例如，阅读理解力、计算能力、概念知识）单独或作为一个小组工作，以支持口腔保健决策，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。拟议的研究项目汇集了来自巴尔的摩、洛杉矶、亚特兰大和华盛顿的经验丰富的多学科团队，全面研究健康素养与口腔健康之间的关联。在马里兰州和加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相联系，以便同时评估牙科保健服务的回顾性和前瞻性使用情况，包括支出和使用情况。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）确定四种不同的健康素养指标代表独特技能的程度;以及3）确定四种不同的健康素养措施与口腔健康相关的程度，独立于选定的社会人口统计学和医疗保健相关协变量。拟议的项目意义重大，因为它代表了第一个全面研究健康素养和口腔健康之间的关联。它也很重要，因为它将作为全面评估牙科以外的健康素养和其他健康结果的指南。该项目具有创新性，因为它将健康素养，医疗保健决策和口腔健康结果的多项措施结合到一项调查中。它也是创新的，因为它结合了强大的和当代的统计分析，将揭示每个变量对整体模型的相对贡献，同时控制上述协变量。 公共卫生相关性：成功完成拟议的项目将导致全面了解健康素养与口腔健康的关系。获得这种理解将导致旨在改善口腔健康和减少口腔健康差异的干预措施，使数百万低收入和少数民族美国人受益。此外，拟议的项目将作为一个模型，全面研究健康素养和其他健康成果之间的联系，超越牙科。这一更具全球性的方法将大大扩大卫生知识普及领域，并增加成功干预医学的可能性。

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.