Reducing Assessment Barriers for Patients with Low Literacy

背景：本R 01是对PAR-13-130：理解和促进健康素养（R 01）的回应。 健康素养是指个人能够获得、处理和理解基本健康的程度 信息，其中包括理解书面问卷的能力。几乎没有一项调查 全国各地正在使用的工具已经过验证，可用于卫生知识水平低的人。 调查方法中的这一基本的跨领域弱点损害了大量数据的准确性 在研究和临床护理中收集。书面问卷在医疗保健中无处不在，包括患者 人口统计表、症状评估工具和患者报告结果问卷。美国国立卫生研究院已经 投入巨资创建NIH患者报告结果测量信息系统 （PROMIS），它大大提高了健康测量。但PROMIS，像几乎所有的调查 工具，尚未验证可供健康素养低的人使用，并且以书面形式存在 这对于文化程度低的人来说是无法实现的。 目的：我们将通过以下方式消除健康素养对准确调查研究的障碍：1）评估 通过PROMIS问卷以及其他常用调查的健康素养进行心理测量; 2)确定和描述对健康素养低的人不起作用的调查项目; 以及3）为不同的考试管理模式创建调查项目开发和评估指南 最适合那些健康素养低的人。 方法：我们将在西北大学的两个初级保健网络中招募大量参与者 波士顿大学医学中心。样本将在英语与 西班牙语和适当的卫生知识水平。这些评估将在多个时间进行 作为纵向研究的一部分。我们将使用最先进的心理测量方法来确定 低健康素养与足够健康素养的参与者之间的差异，以及这些差异是否可以 通过其他调查管理模式克服。 影响：我们将通过以下方式确定与差异项目功能相关的调查项目特征： 不同测试管理模式的健康素养。根据我们的分析，我们将创建一个调查指南 项目开发和评估。这将导致人们更容易获得医疗保健评估 健康知识水平低，更准确。该项目具有广泛的相关性，因为许多广泛使用的健康 调查问卷尚未经过验证，可用于健康知识水平低的人。我们将提出一个 可以快速影响患者数据收集模式的可推广方法。我们还将介绍 数据分析模式，以了解健康素养为导向，这是调查的一个关键组成部分 验证活动。

Background: This R01 is in response to PAR-13-130: Understanding and Promoting Health Literacy (R01). Health literacy is the degree to which an individual can obtain, process, and understand basic health information, which includes the ability to understand written questionnaires. Almost none of the survey instruments being used across the country has been validated for use with people who have low health literacy. This fundamental cross-cutting weakness in survey methods undermines the accuracy of a broad swath of data collected in research and clinical care. Written questionnaires are omnipresent in healthcare, including patient demographic forms, symptom assessment tools, and patient-reported outcome questionnaires. The NIH has invested heavily in the creation of the NIH Patient-Reported Outcomes Measurement Information System (PROMIS), which has significantly advanced health measurement. But PROMIS, like almost all survey instruments, has not been validated for use by people with low health literacy and it exists in a written format that may be inaccessible to individuals with low literacy. Aims: We will remove health literacy barriers to accurate survey research by: 1) evaluating differences in psychometric properties by health literacy of PROMIS questionnaires as well as other commonly used surveys; 2) identifying and characterizing survey items that do not work properly for people with low health literacy; and, 3) creating a guide for survey item development and evaluation for different modes of test administration that are most appropriate for people who have low health literacy. Methods: We will recruit a large sample of participants across two primary care networks at Northwestern Universtiy and Boston University Medical Center. The sample will be evenly balanced across English versus Spanish language and adequate versus low health literacy. These assessments will be given at multiple time points as part of a longitudinal study. We will use state-of-the-art psychometric methods to determine differences among participants with low versus adequate health literacy, and whether these differences can be overcome by alternative modes of survey administration. Impact: We will identify survey item characteristics that are associated with differential item functioning by health literacy for different modes of test administration. Based on our analyses, we will create a guide for survey item development and evaluation. This will lead to assessments in healthcare that are more accessible for people with low health literacy and more accurate. This project has broad relevance insofar as many widely-used health questionnaires have not been validated for use with people who have low health literacy. We will present a generalizable approach that can rapidly influence the mode of data collection from patients. We will also present modes of data analyses oriented toward understanding health-literacy, which is a critical component of survey validation activities.