Explanatory models of illness and decision heuristics in HIV care

描述(由申请者提供)：健康素养通常通过单词发音或阅读理解测试来实现。这些能力和健康结果之间的因果关系尚未阐明。对健康素养和艾滋病毒护理成果之间关系的研究产生了相互矛盾的结果。我们认为，解决这一困惑需要理解艾滋病毒携带者关于艾滋病毒疾病、抗逆转录病毒作用和其他与治疗相关的结构的实际解释模型。我们对艾滋病毒携带者如何选择开始或继续药物治疗方案，或采取个人剂量，以及其他与健康有关的行为知之甚少。除非我们填补我们知识的这一空白，否则我们无法设计循证教育战略，向艾滋病毒携带者提供知识和理解，以支持有效的自我护理和知情决策。这项研究的长期目标是将新的理解和工具应用于教育干预措施的开发和测试，以支持改善自我护理和艾滋病毒的结果。本R21的总体目标是了解艾滋病毒携带者关于疾病及其治疗的解释模型，特别是确定以潜在有害方式与生物医学理解相冲突的模型。我们还建议根据这一更广泛的识字概念开发和试行一种新的艾滋病毒识字评估工具。未来的研究将检验该工具对抗逆转录病毒治疗依从性和医患沟通要素的预测有效性，并利用它开发教育工具，以提高艾滋病毒特有的健康素养。我们的中心假设是，其概念模型与生物医学理解更接近的个人更有可能按照医学建议行事。我们提出这一方法的理由是，需要扩大证据基础，以扩大健康素养的概念，使其与慢性病患者的临床护理更相关。我们有两个具体目标：1)深入了解艾滋病毒携带者对艾滋病毒和艾滋病毒治疗的常见认知模式。我们将深入采访50名HIV患者的不同样本，了解他们的知识、信念和概念模型，并使用扎根的理论方法来分析采访，以阐明用于治疗决策的认知模型和启发式分类。2)基于目标1的结果，我们将设计和认知测试问卷项目，以评估受访者的艾滋病毒内容素养，以及解释模型和决策启发式的类别，并初步评估反应模式与药物依从性的关系，以250名艾滋病毒感染者为样本。这一新的理解(目标1)可以产生巨大的影响，因为它使用严格的定性方法为艾滋病毒治疗教育建立以患者为中心的证据基础；而评估工具(目标2)将把结果转化为实用的临床工具。许多经验教训将适用于其他慢性疾病，如抑郁症、糖尿病和高血压。

DESCRIPTION (provided by applicant): Health literacy is commonly operationalized by tests of word pronunciation or reading comprehension. The causal connection between these abilities and health outcomes has yet to be elucidated. Research into the relationship between health literacy and outcomes in HIV care has produced conflicting results. We believe that resolving this confusion requires understanding the actual explanatory models of people living with HIV about HIV disease, ARV action, and other constructs relevant to treatment. We know little about how people with HIV choose to initiate or continue a medication regimen, or to take individual doses, along with other health-related behaviors. Until we fill this gap in our knowledge, we cannot design evidence-based educational strategies to give people with HIV the knowledge and understanding to support effective self-care and informed decision making. The long-term goal of this research is to apply new understanding and tools to the development and testing of educational interventions to support improved self-care and outcomes in HIV. The overall objective of this R21 is to understand the explanatory models of persons with HIV about the disease and its treatment, and in particular to identify models that conflict in potentially harmful ways with biomedical understanding. We also propose to develop and pilot test a novel HIV literacy assessment tool based on this broader concept of literacy. Future research will examine the predictive validity of the instrument for ART adherence and elements of physician-patient communication, and use it to develop educational tools to improve HIV-specific health literacy. Our central hypothesis is that individuals whose conceptual models accord more closely with biomedical understanding are more likely to act in accordance with medical advice. The rationale for the approach we propose is that a broadened evidence base is needed to expand the concept of health literacy to become more relevant to the clinical care of persons with chronic diseases. We have two Specific Aims: 1) Develop an in-depth understanding of common patterns of cognition about HIV and HIV treatment among people living with HIV. We will conduct in depth interviews with a diverse sample of 50 persons with HIV regarding their knowledge, beliefs, and conceptual models, and use a grounded theory approach to analyze the interviews to elucidate a taxonomy of cognitive models and heuristics for treatment decision making. 2) Based on the findings from Aim 1, we will design and cognitively test questionnaire items to assess respondents' HIV content literacy, and categories of explanatory models and decision heuristics, and preliminarily assess the relationship of response patterns to medication adherence with a diverse sample of 250 people living with HIV. This new understanding (Aim 1) can have tremendous impact because it uses rigorous qualitative methods to develop a patient-centered evidence base for HIV treatment education; while the assessment instrument (Aim 2) will translate the findings into a practical, clinical tool. Many of the lessons learned will be generalizable to other chronic conditions such as depression, diabetes, and hypertension.