Longitudinal study of cognition, health literacy, and self-care in COPD patients

项目总结 本研究的总体目标是调查认知、健康素养和健康素养之间的纵向联系 慢性阻塞性肺疾病(COPD)患者的自我护理，并确定是否 来自非正式照顾者的社会支持缓解了这些联系。认知功能，认知功能的主要组成部分 在许多COPD患者中，HL呈进行性下降。HL也可能随着时间的推移而改变，逐渐改变 慢性阻塞性肺疾病患者对健康信息的理解和利用能力。然而，关于HL的纵向数据并不是 可用。急性COPD急性加重是否会暂时恶化认知和HL，也是未知的。 可能是由于低氧血症所致。非正式护理人员经常帮助COPD患者管理他们的 家庭健康，但关于社会支持在多大程度上补偿HL和 这些患者的认知限制，以及照顾者自身的HL问题是否限制了他们的帮助能力 其他人则在管理自己的慢性病。阐明这些问题可以为制定 针对患者和照顾者的干预措施，以克服成功COPD的HL和认知障碍 管理，也许对其他慢性病也是如此。因此，这项研究的具体目标是 为了(1)纵向检查慢性阻塞性肺疾病患者中HL的轨迹，随着疾病的进展 随着时间的推移和急性加重之后；(2)评估HL及其亚组分之间的关联， 以及COPD患者的特定自我管理行为，如服药依从性和吸入器 技术；(3)评估来自非正式照顾者和照顾者HL的支持对 慢性阻塞性肺疾病患者HL与自我管理的关系我们将通过开展一项 来自不同社会经济和种族的400名讲英语和西班牙语的COPD成年人的研究 纽约市、纽约州和伊利诺伊州芝加哥的市中心初级保健实践。患者将接受为期2年的跟踪调查 收集有关HL、认知功能、COPD症状和自我管理行为的数据。这些数据还将 在COPD恶化出院时和一周后进行评估。此外，100 部分COPD患者的非正式照顾者将接受访谈，以确定他们的HL。这项研究是 在对HL和认知功能的影响及其潜在缓解的纵向检查方面的创新 照顾者支持和照顾者HL的角色。它将扩大我们对以下机制的理解： HL和认知影响COPD自我管理，为我们提供了一个设计干预措施的机会 改善高度脆弱人群的结果。

PROJECT SUMMARY The overall objective of this study is to investigate longitudinal associations between cognition, health literacy (HL), and self-care in patients with chronic obstructive pulmonary disease (COPD), and determine whether social support from informal caregivers mitigates these associations. Cognitive function, a major component of HL, declines progressively in many COPD patients. HL might change over time as well, progressively altering COPD patients' ability to understand and use health information. However, longitudinal data on HL are not available. It is also unknown whether acute COPD exacerbations temporarily worsen cognition and HL, as might be expected owing to hypoxemia. Informal caregivers frequently help COPD patients manage their health at home, but little is known about the extent to which social support compensates for the HL and cognitive limitations of these patients, and whether caregivers' own problems of HL limit their ability to help others manage their chronic disease. Elucidating these issues could provide important data for developing interventions aimed at both patients and caregivers to overcome HL and cognition barriers to successful COPD management, and perhaps to other chronic diseases as well. Accordingly, the Specific Aims of this study are to (1) Examine longitudinally the trajectory of HL among patients with COPD, both as the disease progresses over time and following acute exacerbations; (2) Assess the association between HL, and it subcomponents, and specific self-management behaviors in patients with COPD, such as medication adherence and inhaler technique; (3) Evaluate the mitigating role of support from informal caregivers and caregivers' HL on the relationship between patients' HL and COPD self-management. We will address these aims by conducting a study of 400 English and Spanish-speaking adults with COPD from two socioeconomically and racially diverse inner-city primary care practices in New York City, NY and Chicago, IL. Patients will be followed for 2 years to collect data on HL, cognitive function, COPD symptoms and self-management behaviors. These data will also be assessed at the time of a hospital discharge for COPD exacerbation and one week later. Additionally, 100 informal caregivers of a subset of patients with COPD will be interviewed to determine their HL. This study is innovative in its longitudinal examination of the effects of HL and cognitive function and the potential mitigating role of caregiver support and caregiver HL. It will expand our understanding of the mechanisms through which HL and cognition influence COPD self-management, offering us an opportunity to design interventions to improve outcomes in a highly vulnerable population.