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

描述（由申请人提供）：尽管健康素养研究已经进行了二十多年，但将健康素养与健康结果联系起来的因果路径尚未明确定义。其结果是，对该概念的定义持续存在争议，而干预措施则试图促进清晰、可操作的健康沟通或减少医疗保健方面的识字差距，但效果参差不齐。主要研究人员（Paasche-Orlow & Wolf）此前提出了健康素养的概念框架。 尽管它在文献中经常被引用，但测试和完善其基本前提的机会却很有限。事实上，迄今为止还没有任何健康素养的概念模型经过实证检验。利用包括大量相关协变量的几个独特的大型数据集，我们提出了严格的二次分析，以调查将健康素养与健康结果（包括中间慢性病结果、生活质量、住院和死亡风险）联系起来的拟议因果路径。 此外，我们将专门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。 健康素养低与较差结果之间的关联主要是由于知识、自我效能、服务使用和自我护理行为不足造成的。健康素养、计算能力、问题解决能力和健康行为知识水平低将成为种族/民族与较差临床结果之间关系的重要中介因素。七个独特且多样化的数据集，其中测量了健康素养研究中最常用的衡量标准（REALM、TOFHLA、NVS 等）以及丰富的其他关键变量。将使用结构方程模型、冥想和荟萃分析技术来确定将健康相关读写能力、计算能力、问题解决能力和知识与健康行为、结果和差异联系起来的因果路径。慢性病（HbA1c、血压、低密度脂蛋白胆固醇、哮喘控制）功能健康状况和生活质量认知功能住院和死亡风险。 结果是更好地理解将健康素养与健康结果联系起来的因果机制以及健康素养在解释健康差异中的作用。这将是同类中最广泛的调查，并将极大地有助于我们理解定义健康素养所固有的重要因素以及如何最好地应对这一问题。我们将在网站上传播我们的发现，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.