Health Literacy and Cognitive Function among Older Adults

描述（由申请人提供）：健康素养的测量和认知功能的测量都可以预测健康知识、健康行为和健康结果。这两个变量之间存在明确的理论和实证关系，最近研究人员质疑，医疗保健中最常用的阅读能力测试是否实际上是在测量认知功能。然而，目前还没有研究充分探讨这种关系。本研究的总体目的是调查健康素养与老年人认知功能领域之间的关系，并确定这些因素如何预测一个人进行日常健康活动的能力。本研究的具体目的是：1)探索最常见的健康素养测量（REALM、TOFHLA、NVS）与老年人认知功能测试之间的关系；2a)研究老年人认知功能测试与各种健康学习任务表现之间的关系；2b)在控制认知功能测试后，确定REALM、TOFHLA和NVS与老年人健康学习任务表现之间的关系。几个假设也被确认。我们将对从多个地点招募的1000名55至74岁的社区老年人进行深入的结构化访谈。通过两次访谈，将对所有受试者进行认知功能、健康素养技能和执行常规健康学习任务的能力的详细评估，以减轻应答者的负担。对于某些卫生学习任务，可采用其他形式（即多媒体、增强印刷）和教学方法（即按目标教学）。我们将随机分配受试者接受标准或替代格式的任务。研究将在36个月的时间内分三个阶段进行：1)准备、2)实施和3)分析，研究这些潜在策略对提高特定健康学习任务绩效的效果，以及与认知措施的相互作用。结构方程模型分析将用于阐明健康素养措施，认知测试和健康学习任务表现之间的各种关系。探索性分析还将评估改进卫生信息材料的设计策略的有效性。

DESCRIPTION (provided by applicant): Measures of health literacy and measures of cognitive function both predict health knowledge, health behaviors, and health outcomes. A clear theoretical and empirical relationship exists between these two variables, and recently investigators have questioned whether the most commonly used tests of reading ability in health care may actually be measuring cognitive function. However, no study has fully explored this relationship. The overall objective of this study is to investigate the relationship between health literacy and domains of cognitive function in older adults, and to determine how these factors predict one's ability to perform routine health activities. Specific aims of our study are to: 1) Explore associations between the most common measures of health literacy (REALM, TOFHLA, NVS) with tests of cognitive function in older adults, 2a) Investigate the association between tests of cognitive function and performance on various health learning tasks in older adults, and 2b) Determine the relationship between the REALM, TOFHLA, and NVS with older adults' performance on health learning tasks after controlling for tests of cognitive function. Several hypotheses have also been identified. We will conduct in-depth, structured interviews among a diverse cohort of 1,000 community-dwelling older adults ages 55 to 74 recruited from multiple sites. Detailed assessments of cognitive function, health literacy skills, and the ability to perform routine health learning tasks will be administered to all subjects over a two- session interview process to reduce respondent burden. For some of the health learning tasks, alternative formats (i.e. multimedia, enhanced print) and instructional methods (i.e. teach-to-goal) are available. We will randomly assign subjects to receive either the standard or alternative format of the task. The efficacy of these potential strategies to improve performance on the specified health learning tasks, and the interactions with cognitive measures will be investigated Research activities will be carried out over a 36 month period in three phases: 1) preparation, 2) implementation, and 3) analysis. Structural Equation Modeling analyses will be used to elucidate the various relationships between health literacy measures, tests of cognition, and performance on health learning tasks. Exploratory analyses will also evaluate the efficacy of design strategies to improve health information materials.