Addressing Literacy and Numeracy in Self-care & Clinical Outcomes in ESRD

描述（由申请人提供）： 患者识字或算术（数学）技能对终末期肾病患者实施临床自我护理建议的影响尚不清楚。在理解患者在复杂慢性病的日常护理中吸收、解释和应用健康相关信息的基本机制方面存在巨大的知识差距。我的长期目标是：（1）。探讨肾脏病患者自我护理行为的决定因素和障碍，特别是识字/算术的作用; 2）。系统地制定和评估针对识字/算术能力低的患者的教育干预措施，以提高自我护理的参与度并改善临床结果。终末期肾病需要由提供者和患者进行强化管理。在慢性血液透析（CHD）中，患者的自我护理行为包括遵守饮食和液体限制、获得处方透析治疗、血管通路护理、遵守复杂的药物治疗方案和管理共病。CHD患者自我护理的参与程度通常较低，并且与死亡风险增加相关。在美国，健康素养低下的现象很普遍，影响了9000多万人，并且与慢性病知识的缺乏和依从性的降低有关。我们假设识字和算术能力是冠心病患者自我护理行为和临床结局的重要决定因素。本申请的主要研究目标是：1）。开发描述CHD患者的读写能力和计算能力以及相关特征的方法，2）。确定低识字/算术能力与知识、自我效能、参与CHD自我护理行为和临床结局的相关性，以及3）。评估针对低识字率患者的提供者干预对自我护理行为和临床结局的影响。拟议的研究将产生基础知识和新方法，以识别和测量CHD患者自我护理的机制和障碍，这将使设计和实施以患者为中心的教育和适应性干预措施，以提高对自我护理建议的依从性。重要的是，这一经验将为候选人提供新的和先进的方法技能，使她能够发展成为一个成功的独立研究者，为改善肾脏疾病患者的护理做出重大贡献。

DESCRIPTION (provided by applicant): The influence of patient literacy or numeracy (math) skill on the implementation of clinical self-care recommendations in patients with end-stage renal disease is not known. Large knowledge gaps exist in understanding the basic mechanisms by which patients incorporate, interpret and apply health-related information in the daily care of complex chronic diseases. My primary long term goals are : 1). to explore the determinants and barriers of self-care behaviors in patients with kidney disease, specifically the role of literacy/numeracy and 2). to systematically develop and evaluate educational interventions targeted for low literacy/numeracy patients to increase participation in self-care and improve clinical outcomes. End-stage renal disease requires intensive management by both provider and patient. In chronic hemodialysis (CHD), patient self-care behaviors include adherence to dietary and fluid restrictions, obtaining prescribed dialysis therapy, vascular access care, adherence to complex medication regimes and management of comorbid diseases. Participation in self-care by CHD patients is often low and has been associated with an increased mortality risk. Low health literacy is common affecting over 90 million people in the U.S., and has been associated with lower knowledge of chronic disease and lower adherence. We hypothesize that literacy and numeracy are important determinants of self-care behaviors and clinical outcomes in CHD patients. The primary research goals of this application are: 1). to develop methods to describe literacy and numeracy skills and associated characteristics of CHD patients, 2). to determine the association of low literacy/numeracy with knowledge, self-efficacy, and participation in CHD self-care behaviors and clinical outcomes, and 3). to evaluate the impact of a provider intervention, targeted to patients with low literacy, on self-care behaviors and clinical outcomes. The proposed research will result in fundamental knowledge and new methodology to identify and measure mechanisms and barriers of self-care in CHD patients, which will enable the design and implementation of patient-centered, educational, and adaptive interventions to improve adherence to self-care recommendations. Importantly, this experience will provide the candidate with a new and advanced methods skill-set that will enable her to develop into a successful independent investigator well equipped for significant contributions to improving the care of patients with kidney disease.