Health Literacy Assessment and Intervention to Reduce Disparities: FLIGHT/VIDAS II

 描述(申请人提供)：健康素养是一项极其重要的技能，有助于人们成为健康护理的积极参与者。2003年全国成人扫盲评估显示，超过7500万美国人拥有基本的健康素养技能，这表明多达四分之一的美国人在理解有关他们的医疗保健的信息方面存在困难。种族和族裔少数群体的健康素养水平可能更低。24%的黑人(950万人)和41%的西班牙裔(2100万人)的健康素养低于基本水平。这些人的健康素养水平较低，有令人信服的证据，包括我们自己的发现(见下文)，通过健康素养将种族和族裔与健康方面的差异联系起来。少数群体成员和老年人 癌症、高血压、心脏病、中风、糖尿病、高胆固醇、哮喘、丙型肝炎、艾滋病毒感染、精神健康障碍等慢性病的影响更频繁。因此，慢性病和低水平健康素养的双重负担不成比例地落在最需要帮助的人身上--少数民族成员和老年人，他们都可能经历一种或多种慢性病，但往往没有健康素养技能来帮助他们应对。慢性病自我管理(CDSM)是一般健康素养干预的合乎逻辑的目标。以一种跨越特定疾病的方法。CDSM针对的是应对疲劳、疼痛、压力、抑郁、睡眠障碍和治疗依从性等问题所需的问题和技能。研究表明，面对面CDSM课程改善了患者的功能，降低了医疗利用率，但由于缺乏合格的人员和成本，其可用性受到限制。同样，虽然已经制定了提高健康素养的干预措施，但由于成本原因，这些干预措施很难达到应对(4000多万人)健康素养低这一挑战所需的水平。迫切需要有效的干预措施，有可能以合理的成本进行更广泛的传播。在之前的一项研究中，我们表明，针对健康素养的计算机交付定制信息干预可以作为临床办公室或互联网上的信息亭部署，在提高患者的健康素养和忠诚度方面可能具有成本效益。然而，目前尚不清楚，同样的计算机提供的、多媒体的和互动的方法是否会有效地提高健康素养基线水平较低的人的CDSM技能，如果是，其影响是否会从健康素养延伸到一般健康、SLF的有效性、激活度和治疗依从性。在这项后续研究中，我们将通过创建针对非裔美国人、拉美裔和非拉美裔白人的CDSM和健康素养的个人相关计算机干预来评估这一可能性：

 DESCRIPTION (provided by applicant): Health literacy is a critically important skill that helps people to become active participants in their health care. The 2003 National Assessment of Adult Literacy showed that more than 75 million Americans had basic health literacy skills, indicating that as many as 1 in 4 Americans can have difficulty understanding information about their healthcare. Persons in racial and ethnic minorities are likely to have even lower levels of health literacy. Twenty-four percent of blacks (9.5 million persons) and 41% of Hispanics (21 million persons) have below basic levels of health literacy. These persons have lower levels of health literacy and compelling evidence, including our own findings (see below), link race and ethnicity to disparities in health via health literacy. Members of minority groups and older adults are more frequently affected by chronic diseases such as cancer, high blood pressure, heart attack, stroke, diabetes, elevated cholesterol, asthma, hepatitis C, HIV infection, mental health disorders and many others. The twin burdens of chronic disease and low levels of health literacy thus fall disproportionately on those most in need - members of minorities and older adults, all of whom likely to experience one or more chronic conditions while often not having the health literacy skills to help them cope. Chronic disease self-management (CDSM) is a logical target for a general health literacy intervention. In an approach that cuts across specific diseases. CDSM targets problems and skills needed to cope with issues such as fatigue, pain, stress, depression, sleep disturbance and treatment adherence. Studies show that in- person CDSM classes improve patients' functioning and reduce healthcare utilization, but their availability is limited due to the lack of qualified personnel and cost. Similarly, while interventions have been developed to improve health literacy, they are difficult to scale to levels needed to meet the challenge of low health literacy (for more than 40 million persons) due to their cost. Effective interventions with the potential for wider dissemination at reasonable costs are urgently needed. In a previous study, we showed that a computer-delivered tailored information intervention targeting health literacy that can deployed either as an information kiosk in a clinical office or n the Internet could be cost- effective in improving patients' health literacy and adherence. It is nt clear, however, whether the same sort of computer-delivered, multimedia and interactive approach will be effective in improving CDSM skills in persons with low baseline levels of health literacy, and if it is, whether its effects will extend beyond health literacy to general health, slf-efficacy, activation, and treatment adherence. In this follow-up study we will evaluate this possibility by creating a personally relevant computer-delivered intervention targeting CDSM and health literacy among African-Americans, Hispanics, and white non-Hispanics: