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

描述（由申请人提供）：尽管有二十多年的健康素养研究，将健康素养与健康结果联系起来的因果途径尚未明确。其结果是，在概念的定义和不太知情的干预措施，试图促进明确的，可操作的健康沟通或减少识字的差距，在医疗保健与变量的成功持续的争议。主要研究人员（Paasche-Orlow和Wolf）以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，但测试和完善基本前提的机会有限。事实上，迄今为止，还没有任何卫生知识普及的概念模型经过实证检验。利用几个独特的大型数据集，其中包括广泛的相关协变量，我们提出了严格的二次分析，以调查拟议的因果关系路径连接健康素养的健康结果，包括中间慢性疾病的结果，生活质量，住院和死亡风险。 此外，我们将专门研究如何健康素养可能起到调解作用，并在一定程度上解释某些已知的健康差距。 低健康素养和更糟糕的结果之间的关联将主要由知识不足，自我效能，服务使用和自我保健行为来解释。低健康素养、算术能力、解决问题能力和健康行为知识将是种族/民族与较差临床结局之间关系的重要介导因素。七个独特而多样的数据集，其中最常用的措施在健康素养研究（REALM，TOFHLA，NVS，其他）和一系列丰富的额外的关键变量进行了测量。将使用结构方程模型、冥想和元分析技术来确定将健康相关的识字、算术、解决问题和知识与健康行为、结果和差异联系起来的因果途径。慢性疾病（HbA 1c、血压、LDL胆固醇、哮喘控制）功能健康状况和生活质量认知功能住院风险和死亡率。 结果是更好地了解因果机制的健康素养的健康成果和健康素养的作用，解释健康差距。这将是同类调查中最广泛的一次，并将大大有助于我们了解定义健康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公布我们的调查结果，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.