Health Literacy Assessment and Intervention to Reduce Disparities: FLIGHT/VIDAS II

 描述（由申请人提供）：健康素养是一项至关重要的技能，可以帮助人们积极参与医疗保健。2003年全国成人识字评估显示，超过7500万美国人拥有基本的健康识字技能，这表明多达四分之一的美国人难以理解有关其医疗保健的信息。少数种族和族裔的人可能对卫生知识的掌握程度更低。24%的黑人（950万人）和41%的西班牙裔（2100万人）的健康知识水平低于基本水平。这些人的健康素养水平较低，有令人信服的证据，包括我们自己的研究结果（见下文），通过健康素养将种族和民族与健康差距联系起来。少数群体成员和老年人 更频繁地受到慢性疾病的影响，如癌症、高血压、心脏病发作、中风、糖尿病、胆固醇升高、哮喘、丙型肝炎、艾滋病毒感染、精神健康障碍和许多其他疾病。因此，慢性病和卫生知识水平低的双重负担不成比例地落在最需要的人身上-少数群体成员和老年人，他们都可能患有一种或多种慢性病，但往往没有卫生知识技能来帮助他们科普。慢性病自我管理（CDSM）是一般健康素养干预的逻辑目标。以一种跨越特定疾病的方法。CDSM针对的问题和技能，需要科普的问题，如疲劳，疼痛，压力，抑郁，睡眠障碍和治疗依从性。研究表明，面对面的CDSM课程可以改善患者的功能并降低医疗保健利用率，但由于缺乏合格的人员和成本，其可用性有限。同样，虽然已经制定了改善卫生知识普及的干预措施，但由于成本原因，这些措施难以扩大到应对卫生知识普及率低（4 000多万人）的挑战所需的水平。迫切需要采取有效的干预措施，并有可能以合理的成本更广泛地传播。在以前的研究中，我们表明，计算机提供的针对健康素养的定制信息干预，可以部署为临床办公室或互联网上的信息亭，在提高患者的健康素养和依从性方面具有成本效益。然而，目前尚不清楚，同样的计算机提供的，多媒体和互动的方法是否会有效地提高CDSM技能的人与低基线水平的健康素养，如果是，它的影响是否会超出健康素养的一般健康，自我效能，激活和治疗依从性。在这项后续研究中，我们将通过创建针对非裔美国人、西班牙裔美国人和白色非西班牙裔美国人的CDSM和健康素养的个人相关计算机干预来评估这种可能性：

 DESCRIPTION (provided by applicant): Health literacy is a critically important skill that helps people to become active participants in their health care. The 2003 National Assessment of Adult Literacy showed that more than 75 million Americans had basic health literacy skills, indicating that as many as 1 in 4 Americans can have difficulty understanding information about their healthcare. Persons in racial and ethnic minorities are likely to have even lower levels of health literacy. Twenty-four percent of blacks (9.5 million persons) and 41% of Hispanics (21 million persons) have below basic levels of health literacy. These persons have lower levels of health literacy and compelling evidence, including our own findings (see below), link race and ethnicity to disparities in health via health literacy. Members of minority groups and older adults are more frequently affected by chronic diseases such as cancer, high blood pressure, heart attack, stroke, diabetes, elevated cholesterol, asthma, hepatitis C, HIV infection, mental health disorders and many others. The twin burdens of chronic disease and low levels of health literacy thus fall disproportionately on those most in need - members of minorities and older adults, all of whom likely to experience one or more chronic conditions while often not having the health literacy skills to help them cope. Chronic disease self-management (CDSM) is a logical target for a general health literacy intervention. In an approach that cuts across specific diseases. CDSM targets problems and skills needed to cope with issues such as fatigue, pain, stress, depression, sleep disturbance and treatment adherence. Studies show that in- person CDSM classes improve patients' functioning and reduce healthcare utilization, but their availability is limited due to the lack of qualified personnel and cost. Similarly, while interventions have been developed to improve health literacy, they are difficult to scale to levels needed to meet the challenge of low health literacy (for more than 40 million persons) due to their cost. Effective interventions with the potential for wider dissemination at reasonable costs are urgently needed. In a previous study, we showed that a computer-delivered tailored information intervention targeting health literacy that can deployed either as an information kiosk in a clinical office or n the Internet could be cost- effective in improving patients' health literacy and adherence. It is nt clear, however, whether the same sort of computer-delivered, multimedia and interactive approach will be effective in improving CDSM skills in persons with low baseline levels of health literacy, and if it is, whether its effects will extend beyond health literacy to general health, slf-efficacy, activation, and treatment adherence. In this follow-up study we will evaluate this possibility by creating a personally relevant computer-delivered intervention targeting CDSM and health literacy among African-Americans, Hispanics, and white non-Hispanics: