A Multifaceted Adaptive Testing Approach to Health Literacy in Older Adults

描述(由申请人提供)：医疗保健系统最近的变化要求健康消费者和患者在管理他们的健康方面发挥更积极的作用。尤其是老年人，在当今的卫生保健环境中面临着许多挑战，因为卫生保健系统日益复杂，来自众多不同来源的卫生信息激增。健康素养技能是与医疗保健提供者沟通、阅读和理解健康信息、服药依从性、使用医疗设备和做出治疗方案决策所必需的。7-65岁人群的健康素养较低，特别是少数民族和社会经济地位较低的人群。目前的健康扫盲措施范围有限，不足以诊断与扫盲有关的具体问题。这项研究的总体目标是开发和验证适用于老年人的健康素养工具，该工具采用最先进的计算机自适应测试方法和技术。第一个目标是制定一个全面的框架，以确定和衡量老年消费者需要了解、获取和使用与健康有关的信息和服务的核心能力。为此，我们将开展一系列具有建设性的研究活动，包括对现有措施进行系统审查，召开健康素养专家小组，并对与健康有关的活动(如血糖测试)进行一系列认知任务分析。这将有助于开发和实施概念知识和计算模块。原型模块将作为基于测量决策理论的自适应测试来实现。将对15名健康素养水平不同的老年人进行初步研究，以制定测试规范。这些数据将由调查人员分析，并由专家小组成员仔细审查。在此基础上，我们将修改两个模块，并对两组老年人进行更大规模的验证性研究：1)60-74岁和2)75-85岁。这一应用程序的一个主要优点是，我们正在使用一个理论上有基础的框架来解决一个相当重要且日益重要的问题，该框架极大地扩大了健康素养评估的范围。本申请中描述的全面健康素养框架可用于支持健康素养的研究，为临床医生开发筛查工具，并为识字水平不同的老年人定制健康教育材料。与公共卫生的相关性：识字问题在很大程度上是因为卫生信息和服务系统不熟悉和复杂，这使得大多数人，特别是老年人难以有效地利用这些系统。我们建议在一个全面框架的基础上开发一个健康素养评估工具。该工具有可能被用于支持健康素养的研究，为临床医生开发筛查工具，并为不同识字水平的老年患者和消费者量身定做健康教育材料。

DESCRIPTION (provided by applicant): Recent changes in the healthcare system necessitate that health consumers and patients play a more active role in the management of their health. Older adults, in particular, face many challenges in today's health care environment in terms of the increased complexity of health care systems and the proliferation of health information from numerous and diverse sources. Health literacy skills are needed for communication with healthcare providers, reading and understanding health information, medication compliance, using medical devices and making decisions about treatment options. Health literacy is lower among people aged 7 65, especially ethnic minorities and those with lower socio-economic status. Current measures of health literacy are limited in scope and inadequate in diagnosing specific literacy-related problems. The overall objective of this study is to develop and validate a health literacy instrument for older adults employing state-of-art computer-adaptive testing methods and technology. The first aim is to develop a comprehensive framework for identifying and measuring the core competencies that older adult consumers need to understand, access and use health related information and services. Towards that end, we will engage in a series of formative research activities including a systematic review of existing measures, convening an expert panel on health literacy and performing a series of cognitive task analyses on health related activities (e.g., glucose testing). This will contribute to the development and implementation of conceptual knowledge and numeracy modules. The prototype modules will be implemented as adaptive tests based on measurement decision theory. A preliminary study with 15 older adults at varying levels of health literacy will be conducted to develop testing norms. The data will be analyzed by investigators and scrutinized by members of the expert panel. On that basis, we will revise the 2 modules and subject it to a larger validation study with 2 groups of older adults: 1) ages 60-74 and 2) 75-85. A primary strength of this application is that we are addressing an issue of considerable and growing importance using a theoretically-grounded framework that greatly expands the scope of health literacy assessment. A comprehensive health literacy framework as described in this application can be used to support research on health literacy, develop screening tools for clinicians and tailor health education materials for older adult adults at varying levels of literacy. Public Health Relevance: literacy problems exist to a large extent because health information and services systems are unfamiliar and complex, which makes their effective utilization difficult for most people, especially for older adults. We are proposing to develop a health literacy assessment tool based on a comprehensive framework. The tool has the potential to be used to support research on health literacy, develop screening tools for clinicians and tailor health education materials for older adult patients and consumers at varying levels of literacy.