Parental Health Literacy and Child ADHD

描述（由申请人提供）：医学研究所在其2004年题为《健康素养——消除困惑的处方》的报告中对健康素养的定义是：“个人有能力获取、处理和理解做出适当健康决定所需的基本健康信息和服务的程度(2)。”健康素养有限与一系列不良成人健康结果相关，包括住院风险增加、预防性保健服务利用率降低、特定疾病不良结果和死亡（3-6）。然而，很少有研究调查了父母健康素养技能与儿童慢性疾病之间的关系。一种健康素养具有潜在重要性的儿童疾病是注意缺陷多动障碍（ADHD）。ADHD是儿童最常见的慢性疾病之一，影响了美国5- 10%的学龄儿童（34-37）。多项研究表明药物治疗对ADHD有疗效（44,45）；然而，数据也表明，只有一半的ADHD儿童采用循证用药方案（34）。注意缺陷多动障碍的有效治疗是复杂的，通常需要每天服药，使用行为矫正技术，以及父母、学校和卫生保健机构之间的密切沟通。鉴于ADHD管理的复杂性，我们假设父母健康素养有限可能会对ADHD儿童的预后产生负面影响。我们建议研究一项为期6个月的前瞻性队列研究的可行性，该研究将在波士顿医疗中心进行，这是一家城市安全网医院。我们相信，在一项可行性研究中，我们将对40对父母/孩子进行为期6个月的跟踪调查，这将使我们有能力在未来招募和维持一项适当的研究。这在我们的人群中尤其重要，因为社会经济风险因素和父母多动症可能会增加随访不良的风险。我们研究的目的是：1)实地测试研究的后勤方面；2)获得研究参数的经验估计，这将为适当的前瞻性队列研究的规划提供信息；以及3)估计父母健康素养与以下措施之间的关系：a)儿童ADHD药物治疗的使用，b)父母ADHD特异性健康知识，c)参加和错过ADHD治疗的医疗预约数量，d)儿童ADHD症状随时间的变化。如果发现父母健康素养有限与儿童ADHD预后不良有关，我们计划制定具体的干预措施，以增加对父母健康素养有限的儿童的有效ADHD治疗的使用。公共卫生相关性：多动症是一种常见的儿童疾病，发病率很高，但许多家庭未能利用循证治疗。卫生知识普及的潜在可变性和卫生保健系统适应特定需求的能力使其成为一个值得考虑的理想风险因素。如果发现有限的健康素养与儿童ADHD预后不良有关，我们计划制定干预措施，以提高父母健康素养技能有限的儿童对有效ADHD治疗的利用。

DESCRIPTION (provided by applicant): Health literacy is defined by the Institute of Medicine in its 2004 report entitled, Health Literacy - A Prescription to End Confusion, as "the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions (2)." Limited health literacy has been associated with a range of adverse adult health outcomes including increased risk of hospitalization, decreased utilization of preventive health services, adverse disease-specific outcomes, and death (3-6). Few studies, however, have examined the relationship between parental health literacy skills and chronic childhood illnesses. One childhood illness in which health literacy is potentially important is Attention Deficit Hyperactivity Disorder (ADHD). ADHD is one of the most common chronic diseases of childhood, affecting 5-10 percent of school-aged children in the US (34-37). Multiple studies have shown the efficacy of medication therapy in the treatment of ADHD (44, 45); however, the data also demonstrate that only half of all children with ADHD utilize evidence- based medication regimens (34). The effective management of ADHD is complex, often requiring daily medications, the utilization of behavioral modification techniques, and close communication between parents, schools, and health care facilities. Given the complexities of ADHD management, we hypothesize that limited parental health literacy is likely to negatively impact the outcomes of children with ADHD. We propose to study the feasibility of a 6-month prospective cohort study to be conducted at Boston Medical Center, an urban safety-net hospital. We believe that a feasibility study, in which we will follow 40 parent/child dyads for 6-months, will allow us to develop the capacity to recruit and maintain an appropriately powered study in the future. This is particularly important in our population for whom the risk of poor follow-up may be increased by socioeconomic risk factors and parental ADHD. The aims of our study will be to: 1) Field test the logistical aspects of the study; 2) Obtain empirical estimates of study parameters that will inform the planning of an appropriately powered prospective cohort study; and 3) Obtain estimates of the associations between parental health literacy and the following measures: a) use of pharmacologic therapy for the treatment of child ADHD, b) parental ADHD-specific health knowledge, c) number of both attended and missed medical appointments for ADHD management, and d) change in child ADHD symptoms over time. If limited parental health literacy is found to be associated with poor child ADHD outcomes, we plan to develop specific interventions to increase the use of effective ADHD therapies for children of parents with limited health literacy skills. PUBLIC HEALTH RELEVANCE: ADHD is a common childhood illness associated with considerable morbidity, yet many families fail to utilize evidence-based treatments. It is the potential mutability of health literacy and the capacity of the health care system to accommodate specific needs which makes it such a desirable risk factor to consider. If limited health literacy is found to be associated with poor child ADHD outcomes, we plan to develop interventions to increase the utilization of effective ADHD therapies in children of parents with limited health literacy skills.