Health literacy and aging: A process-knowledge approach

描述（由申请人提供）：该项目的主要目标是改善自我护理（例如，药物使用）和健康结果之间的健康素养不足的老年人。与年轻人相比，患有高血压等慢性疾病的老年人的健康知识技能效果较差，这预示着自我护理和结果较差。虽然健康素养和健康的关联通常被认为反映了对健康信息的理解不足，但这些关系几乎没有直接证据，部分原因是健康素养模型没有与语言理解理论相结合。本项目中的健康素养概念化的语言处理的认知模型，确定了多层次的代表文本传达的信息。具体目标是：（1）通过检查健康素养标准衡量标准中的个体差异在多大程度上由认知能力的一般衡量标准（即，工作记忆）和健康相关知识。(2)基于此模型，探讨健康素养的组成部分与高血压相关的药物和出院指导的理解过程之间的关系。这涉及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层次，从而有助于健康文本的理解，记忆和解决问题的变化;（3）调查关键文本特征（例如，在表现上的识字差异。研究的第一阶段将使用一系列广泛的流动心理能力和健康知识的测量方法，将健康素养建模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个以能力为基础的健康素养模型上，探讨健康文本理解和记忆的差异。回归分析将研究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保健教材提供指导方针，减轻保健知识普及不足对保健结果的影响。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的能力的影响。这些知识反过来将指导医疗保健文本的设计，如药物和出院说明，使这些文本更好地指导自我保健行为，从而减轻健康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.