An Automated, Tailored Information Application for Medication Health Literacy

描述(由申请人提供)：健康素养是改善艾滋病毒感染者健康状况的一个至关重要的问题。患者的行为对于成功治疗艾滋病毒感染至关重要，例如高水平的服药依从性，这可能取决于患者对如何服药、如何解决与药物相关的问题以及如何应对药物副作用的理解。因此，解决受艾滋病毒感染影响的个人健康素养低的问题可能是改善其健康状况的重要途径。然而，目前尚不清楚如何提高艾滋病毒感染者的健康素养，以及提高健康素养可能在多大程度上影响服药依从性和健康结果等重要变量。在制定干预措施以提高任何患者群体的健康素养时，一个相关的问题是如何以具有成本效益的方式提供干预措施。为健康素养水平较低的个人提供的医疗服务往往是在资源有限的诊所或忙碌的私人执业医生的办公室提供的，这些医生几乎没有机会提供或支持额外的干预措施。在繁忙或资源有限的情况下提供健康素养干预的一个有前途的战略是通过基于计算机的自动化应用程序提供这些干预措施。以信息技术为基础的促进保健知识普及的干预措施有可能在台式计算机或因特网上随时可用。电子健康应用可能是解决健康差距的重要战略(疾病预防和健康促进办公室，2006年)。一旦创建，它们的持续维护和部署成本可能会很低。因此，它们可能是解决艾滋病毒感染者健康素养问题的一种具有成本效益的战略(Brown，Vanable，&Eriksen，2008)，但尚未得到广泛开发或验证。正如一个小组(Wolf等人，2007a)所建议的，“多媒体技术的新进展可以用来更好地传播患者教育。”(第259页)。本申请中提出的研究的目的是创建一个基于计算机的自动化应用程序，为艾滋病毒感染者提供个性化的健康素养教育。开发后，这一应用程序将在100名目前正在接受抗逆转录病毒治疗的人中进行测试，这些人将从当地一家诊所招募。他们将在研究期间每隔四周参加三次会议。在培训干预前后和四周后，将通过检查参与者的药物和疾病相关知识以及对解决问题技能的意识来评估干预的效果。还将评估干预前后四周内的自我报告和电子监控遵守情况。这项研究的结果将是一个自动化的定制信息应用程序，以提高应对艾滋病毒感染的人的健康素养。PHS 398/2590(Rev.11/07)页面续页格式页面公共卫生相关性：健康素养是与HIV+患者治疗成功相关的一个至关重要的公共卫生问题。本申请中提出的应用程序将通过创建一个基于计算机的健康素养教学应用程序来解决这个问题，该应用程序可以很容易地部署在互联网上。PHS 398/2590(11/07版)页面续格式页面

DESCRIPTION (provided by applicant): Health literacy is a critically important problem in improving the health outcomes in patients with HIV infection. Patient behaviors essential to the successful treatment of HIV infection, such as high levels of medication adherence, may depend on patients' understanding how to take medication, how to solve medication-related problems, and how to cope with medication side effects. Addressing the problem of low health literacy in individuals affected by HIV infection may thus be an important way of improving their health status. It is unclear, however, exactly how to improve health literacy in persons with HIV infection and the extent to which improving it might affect important variables such as medication adherence and health outcomes. A related problem in developing interventions to improve health literacy in any patient group is how to provide the intervention in a cost effective manner. Medical care for individuals with low levels of health literacy is often provided in clinics in limited-resource settings or in the offices of busy private practitioners who have little opportunity to provide or support for additional interventions. A promising strategy for providing health literacy interventions in busy or limited-resource setting is to provide them through automated computer-based applications. Information technology-based interventions to promote health literacy have the potential for being readily available on desktop computers or over the Internet. E-health applications may be an important strategy for addressing health disparities (Office of Disease Prevention and Health Promotion, 2006). Once created, costs for their continued maintenance and deployment can be low. They could thus be a cost-effective strategy for addressing health literacy issues in persons with HIV infection (Brown, Vanable, & Eriksen, 2008), but have not been widely developed or validated. As one group (Wolf et al., 2007a) has suggested, "New advances in multimedia technology could be used to better disseminate patient education . . ." (p. 259). The purpose of the study proposed in this application is to create a computer-based and automated application that will provide individually-tailored health literacy education to persons with HIV infection. After development this application will be tested with 100 persons currently on antiretroviral treatment who will be recruited from a local clinic. They will participate in three sessions at four week intervals during the study. The effectiveness of the intervention will be assessed by examining participants' medication and disease-related knowledge and awareness of problem solving skills before and after the training intervention and four weeks later. Self-report and electronically-monitored adherence in the four weeks before and after the intervention will also be assessed. The outcome of this study will be an automated tailored information application to improve health literacy in those coping with HIV infection. PHS 398/2590 (Rev. 11/07) Page Continuation Format Page PUBLIC HEALTH RELEVANCE: Health literacy is a critically important public health problem related to treatment success in HIV+ persons. The application proposed in this application will address this problem by creating a computer-based health literacy teaching application that can readily be deployed on the Internet. PHS 398/2590 (Rev. 11/07) Page Continuation Format Page