Refining Conceptual Models for the Role of Health Literacy in Health Outcomes

说明(申请人提供)：尽管健康素养研究已有二十多年，但将健康素养与健康结果联系起来的因果路径还没有明确界定。其结果是，这一概念的定义持续存在争议，信息较少的干预措施试图要么促进明确、可操作的健康沟通，要么减少医疗保健领域的识字差距，但取得了不同的成功。主要调查人员(Paasche-Orlow&Wolf)此前提出了健康素养的概念框架。虽然它在文献中经常被引用，但测试和完善潜在前提的机会有限。事实上，到目前为止，还没有对健康素养的概念模型进行过实证检验。利用包括大量相关协变量的几个独特的大型数据集，我们建议进行严格的二次分析，以调查拟议的将健康素养与健康结果(包括中等慢性病结果、生活质量、住院和死亡风险)联系起来的因果路径。此外，我们还将具体研究健康知识如何潜在地起到中介作用，并部分解释某些已知的健康差距。低健康素养和更差的结果之间的联系将主要由知识不足、自我效能、服务使用和自我护理行为来解释。较低的健康素养、计算能力、解决问题能力和对健康行为的了解将是种族/民族与较差临床结果之间关系的重要中介因素。测量了七个独特和多样化的数据集，其中包括在健康素养研究中使用的最常见的衡量标准(REAL、TOFHL、NVS等)和一系列丰富的额外关键变量。将使用结构方程建模、冥想和元分析技术来确定将与健康相关的识字、计算、解决问题和知识与健康行为、结果和差异联系起来的因果路径。慢性病(糖化血红蛋白、血压、低密度脂蛋白、哮喘控制)、功能健康状况和生活质量、认知功能、住院风险和死亡率。其结果是更好地理解了健康素养与健康结果之间的因果机制，以及健康素养在解释健康差距方面的作用。这将是此类调查中最广泛的一次，并将大大有助于我们理解界定健康素养所固有的重要因素以及如何最好地应对这一问题。我们将在一个网站上公布我们的调查结果，以提高透明度，并允许在获得更多数据后继续修改该模型。

DESCRIPTION (provided by applicant): Despite more than two decades of health literacy research, causal pathways linking health literacy to health outcomes have not been well-defined. The result has been continued controversy in the concept's definition and less-informed interventions attempting to either promote clear, actionable health communication or reduce literacy disparities in healthcare with variable success. The lead investigators (Paasche-Orlow & Wolf) have previously proposed a conceptual framework for health literacy. While it has been frequently cited in the literature, there have been limited opportunities to test and refine the underlying premises. Indeed, no conceptual model of health literacy to date has been empirically tested. Leveraging several unique and large datasets that include an expanse of relevant covariates, we propose rigorous secondary analyses to investigate proposed causal pathways linking health literacy to health outcomes including intermediary chronic disease outcomes, quality of life, hospitalization and mortality risk. In addition, we will specifically examine how health literacy may potentially serve a mediating role and in part explain certain known health disparities. Associations between low health literacy and worse outcomes will be mostly explained by inadequate knowledge, self-efficacy, services use, and self-care behavior. Low health literacy, numeracy, problem-solving, and knowledge with health behaviors will represent significant mediators of the relationship between race/ethnicity and worse clinical outcomes. Seven unique and diverse datasets in which the most common measures used in health literacy research (REALM, TOFHLA, NVS, others) and a rich array of additional key variables were measured. Structural equation modeling, meditational and meta-analytic techniques to determine causal pathways linking health-related literacy, numeracy, problem-solving, and knowledge with health behaviors, outcomes, and disparities will be used. Chronic disease (HbA1c, blood pressure, LDL cholesterol, asthma control) functional health status and quality of life cognitive function risk of hospitalization and mortality. The outcomes are an improved understanding of the causal mechanisms linking health literacy to health outcomes and the role of health literacy in explaining health disparities. This will be the most extensive investigation of its kind, and will significantly contribute to our understanding of the important factors inherent in defining health literacy and how best to respond to the problem. We will disseminate our findings on a Web site to promote transparency and allow continued modification of the model as further data become available.