Refining and Standardizing Health Literacy Assessment

描述（由申请人提供）：背景：低识字率与获得健康信息、了解疾病/治疗、健康状况、了解和使用预防服务以及住院治疗方面的健康差距有关。更好地了解患者的健康素养将有助于采取有针对性的干预措施，以减少已查明的差距。然而，由于评估负担，评分不精确，英语和西班牙语的等效性不足，现有的健康素养措施在临床实践或研究中使用不是最佳的。目的：该应用程序的目的是：（1）开发英语和西班牙语试题库，用于衡量与阅读有关的健康素养技能;（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）开发和试行临床环境中健康素养的计算机化自适应测试;（4）采用理论驱动的框架评估健康素养、患者特征、使能资源、需求、与预防心血管疾病和癌症相关的健康行为以及健康状况之间的关联。研究方法：国家的科学分析方法将被用来开发健康素养问题集（“项目库”），以支持使用CAT的简短，有针对性的评估。一个验证的双语多媒体“会说话的触摸屏”将适用于管理CAT，以衡量英语和西班牙语的初级保健患者的健康素养。一项横断面研究将使用该工具来评估患者特征、行为、结果和健康素养之间的关联。重要性：该项目将通过开发一种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，提高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联的理解。

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.