Health literacy and aging: A process-knowledge approach

描述（由申请人提供）：本项目的主要目标是改善健康素养不足的老年人的自我护理（例如，药物使用）和健康结果。与年轻人相比，患有高血压等慢性疾病的老年人缺乏有效的健康素养技能，这预示着他们的自我照顾和结果会很差。虽然卫生素养和健康之间的关联通常被认为反映了对卫生信息的理解不足，但很少有直接证据表明这些关系，部分原因是卫生素养模型没有与语言理解理论相结合。在本项目中，卫生扫盲是根据语言处理的认知模型概念化的，该模型确定了文本所传达的信息的多个层次。具体目标是：(1)通过检查在多大程度上用认知能力（即工作记忆）和健康相关知识的一般措施来解释健康素养标准措施中的个体差异，对健康素养的组成部分进行建模。(2)在此模型的基础上，探讨健康素养构成要素与高血压相关用药和出院指示理解过程之间的关系。这包括a)探索构建这些文本的多层次表征所涉及的文本需求；b)评估健康素养（及其认知基础）的个体差异如何影响这些表征的不同水平，从而导致健康文本在理解、记忆和解决问题方面的差异；(3)研究批判性文本特征（如画报）对读写能力差异的影响。研究的第一阶段将使用一系列广泛的测量流体心理能力和健康知识的方法来模拟健康素养，将其作为对理解至关重要的患者能力的组合。第二阶段的研究建立在这种以能力为基础的健康素养模型上，以调查健康文本的理解和记忆差异。回归分析将调查这些表现差异如何反映认知能力和健康知识。最后的研究探讨了如何设计文本以减轻与认知和知识限制相关的理解困难。该项目将为具有不同认知资源和知识概况的老年人编写健康教材制定指导方针，减轻卫生知识普及不足对健康结果的影响。公共卫生相关性：该项目的研究结果将把健康素养模型与语言理解和认知老化理论相结合，以帮助解释健康素养对患者理解、记忆和使用健康信息能力的影响。这些知识反过来将指导医疗保健文本的设计，如用药和出院说明，使这些文本更好地指导自我保健行为，从而减轻卫生素养不足对健康行为和结果的影响。

DESCRIPTION (provided by applicant): The broad goals of this project are to improve self-care (e.g., medication use) and health outcomes among older adults with inadequate health literacy. Elders with chronic illness such as hypertension have less effective health literacy skills compared to younger adults, which predicts poor self-care and outcomes. While the association of health literacy and health is often presumed to reflect poor comprehension of health information, there is little direct evidence for these relationships, in part because health literacy models are not integrated with language comprehension theory. Health literacy in the present project is conceptualized in terms of a cognitive model of language processing that identifies the multiple levels of representing information conveyed by text. Specific aims are: (1) To model components of health literacy by examining the extent to which individual differences in standard measures of health literacy are explained by general measures of cognitive ability (i.e., working memory) and health-related knowledge. (2) Based on this model, to investigate relationships between components underlying health literacy and processes involved in understanding medication and discharge instructions related to hypertension. This involves a) Exploring the text demands involved in constructing multileveled representations of these texts; b) Assessing how individual differences in health literacy (and its cognitive underpinnings) impact different levels of these representations, so as to contribute to variation in comprehension, memory, and problem-solving from health texts; (3) To investigate the impact of critical text characteristics (e.g., pictorials) on literacy differences in performance. The first stage of the research will use a broad battery of measures of fluid mental abilities and health knowledge to model health literacy as a combination of patient abilities critical to comprehension. Studies in the second stage build on this ability-based model of health literacy to investigate differences in comprehension and memory for health texts. Regression analyses will investigate how these differences in performance reflect cognitive ability and health knowledge. The final studies investigate how to design texts to mitigate the comprehension difficulties associated with cognitive and knowledge limits. The project will produce guidelines for constructing health texts for older adults with different profiles of cognitive resources and knowledge, mitigating effects of inadequate health literacy on health outcomes. Public Health Relevance: Findings from this project will integrate health literacy models with theories of language comprehension and cognitive aging to help explain the impact of health literacy on patients' ability to understand, remember, and use health information. This knowledge in turn will guide design of health care texts such as medication and hospital discharge instructions, so that these texts better guide self-care behaviors, thereby mitigating the impact of inadequate health literacy on health behaviors and outcomes.