Refining Conceptual Models for the Role of Health Literacy in Health Outcomes

描述（由申请人提供）：尽管进行了二十多年的健康素养研究，但将健康素养与健康结果联系起来的因果途径尚未得到明确定义。结果在概念的定义和不太知情的干预措施方面一直存在争议，这些干预措施要么试图促进明确的、可操作的健康沟通，要么试图以不同的成功减少医疗保健中的扫盲差距。主要研究者（Paasche-Orlow & Wolf）先前提出了一个健康素养的概念框架。虽然它在文献中经常被引用，但测试和改进基本前提的机会有限。事实上，迄今为止还没有任何健康素养的概念模型经过经验检验。利用几个独特的大型数据集，包括大量相关协变量，我们提出严格的二次分析，以调查将健康素养与健康结果（包括中间慢性疾病结果、生活质量、住院和死亡风险）联系起来的因果途径。此外，我们将具体研究健康素养如何可能发挥中介作用，并部分解释某些已知的健康差异。低健康素养与较差结果之间的关联主要可以用知识不足、自我效能、服务使用和自我保健行为来解释。较低的健康素养、计算能力、解决问题能力和健康行为知识将是种族/民族与较差临床结果之间关系的重要中介。七个独特而多样的数据集，其中测量了卫生素养研究中最常用的测量方法（REALM、TOFHLA、NVS等）和一系列丰富的其他关键变量。将使用结构方程建模、冥想和元分析技术来确定与健康相关的识字、计算、解决问题和知识与健康行为、结果和差异之间的因果关系。慢性疾病（HbA1c、血压、LDL胆固醇、哮喘控制）功能健康状况及生活质量认知功能住院及死亡风险。其结果是增进了对卫生知识普及与健康结果之间的因果机制的理解，以及卫生知识普及在解释健康差异方面的作用。这将是同类调查中最广泛的调查，并将大大有助于我们理解定义卫生素养的内在重要因素以及如何最好地应对这一问题。我们将在一个网站上发布我们的发现，以提高透明度，并允许在获得更多数据时继续修改模型。

DESCRIPTION (provided by applicant): Despite more than two decades of health literacy research, causal pathways linking health literacy to health outcomes have not been well-defined. The result has been continued controversy in the concept's definition and less-informed interventions attempting to either promote clear, actionable health communication or reduce literacy disparities in healthcare with variable success. The lead investigators (Paasche-Orlow & Wolf) have previously proposed a conceptual framework for health literacy. While it has been frequently cited in the literature, there have been limited opportunities to test and refine the underlying premises. Indeed, no conceptual model of health literacy to date has been empirically tested. Leveraging several unique and large datasets that include an expanse of relevant covariates, we propose rigorous secondary analyses to investigate proposed causal pathways linking health literacy to health outcomes including intermediary chronic disease outcomes, quality of life, hospitalization and mortality risk. In addition, we will specifically examine how health literacy may potentially serve a mediating role and in part explain certain known health disparities. Associations between low health literacy and worse outcomes will be mostly explained by inadequate knowledge, self-efficacy, services use, and self-care behavior. Low health literacy, numeracy, problem-solving, and knowledge with health behaviors will represent significant mediators of the relationship between race/ethnicity and worse clinical outcomes. Seven unique and diverse datasets in which the most common measures used in health literacy research (REALM, TOFHLA, NVS, others) and a rich array of additional key variables were measured. Structural equation modeling, meditational and meta-analytic techniques to determine causal pathways linking health-related literacy, numeracy, problem-solving, and knowledge with health behaviors, outcomes, and disparities will be used. Chronic disease (HbA1c, blood pressure, LDL cholesterol, asthma control) functional health status and quality of life cognitive function risk of hospitalization and mortality. The outcomes are an improved understanding of the causal mechanisms linking health literacy to health outcomes and the role of health literacy in explaining health disparities. This will be the most extensive investigation of its kind, and will significantly contribute to our understanding of the important factors inherent in defining health literacy and how best to respond to the problem. We will disseminate our findings on a Web site to promote transparency and allow continued modification of the model as further data become available.