Refining and Standardizing Health Literacy Assessment

说明(申请人提供)：背景：识字率低与在获得保健信息、了解疾病/治疗、健康状况、了解和使用预防服务以及住院方面的健康差距有关。更好地了解患者的健康素养将允许采取有针对性的干预措施，以减少已确定的差异。然而，由于评估负担、评分不准确以及英语和西班牙语的等价性不足，现有的健康素养衡量标准并不适合用于临床实践或研究。目的：1)开发用于测量与阅读相关的健康素养技能的英语和西班牙语题库；2)评估基于计算机的健康素养综合评估方法的可行性、有效性和可接受性；3)开发和试点临床环境中健康素养的计算机化适应性测试(CAT)；以及4)使用理论驱动的框架来评估健康素养、患者特征、使能资源、需求、与心血管疾病和癌症预防相关的健康行为和健康状况之间的关系。方法：将使用最先进的分析方法来开发健康素养问题集(“题库”)，以支持使用CAT进行简短的、有针对性的评估。一种经过验证的双语多媒体“会说话的触摸屏”将被用来管理CAT，以衡量英国和西班牙初级保健患者的健康素养。一项横断面研究将使用这一工具来评估患者特征、行为、结果和健康素养之间的关联。意义：该项目将通过开发一种最先进的计算机自适应工具来推进测量技术，该工具将允许精确和快速地测量健康素养，增强区分语言和识字障碍的能力，并增加对健康素养、健康行为和健康结果之间关系的理解。

DESCRIPTION (provided by applicant): Background: Low literacy is associated with health disparities in access to health information, understanding of illness / treatment, health status, understanding and use of preventive services, and hospitalizations. Better understanding of patients' health literacy would allow for targeted interventions to reduce identified disparities. However, due to assessment burden, scoring imprecision, and inadequate English and Spanish language equivalence, available health literacy measures are not optimal for use in clinical practice or research. Aims: The aims of this application are 1) to develop English and Spanish language item banks for measuring reading-related health literacy skills; 2) to evaluate the feasibility, validity and acceptability of computer-based methods for comprehensive assessment of health literacy; 3) to develop and pilot computerized adaptive testing (CAT) of health literacy in clinical settings; and 4) to use a theory-driven framework to evaluate the associations between health literacy, patient characteristics, enabling resources, needs, health behaviors related to prevention of cardiovascular disease and cancer, and health status. Methods: State-of-the-science analytical methods will be used to develop sets of health literacy questions ("item banks") to support brief, targeted assessment using CAT. A validated bilingual multimedia "Talking Touchscreen" will be adapted to administer CAT to measure health literacy in English and Spanish primary care patients. A cross-sectional study will use this tool to evaluate the associations between patient characteristics, behaviors, outcomes and health literacy. Significance: This project will advance measurement technique through the development of a state-of-the-science computer adaptive tool that will allow precise and rapid measurement of health literacy, enhance ability to distinguish between language and literacy barriers, and increase understanding of associations between health literacy, health behaviors and health outcomes.