Seniors' health literacy, beliefs and asthma self-management

描述（由申请人提供）：本研究的总体目标是调查老年哮喘患者的健康素养、健康信念和自我护理行为之间的关系。老年人更多地参与慢性病的自我管理，可以改善这一弱势群体的健康状况。有证据表明，健康素养是疾病自我管理的重要媒介。这一观察结果对于老年人尤其重要，因为他们的健康知识普及不足和认知障碍的比例过高。不幸的是，大多数旨在促进识字率低的成年人更好地自我管理疾病的干预措施只取得了有限的成果。这些干预措施的失败以及其他观察结果表明，将卫生知识普及与自我管理联系起来的途径仍然不明确。疾病特异性健康信念和药物信念可能沿着这条路径。我们发现哮喘专用药物与哮喘成人健康信念之间存在很强的相关性，我们的初步数据表明，健康素养低的老年人更有可能具有预测自我管理行为较差的哮喘信念。这些研究结果表明，健康和药物的信念可能介导健康素养的自我管理的影响。该应用程序汇集了具有健康素养，疾病特定健康信念和老年人哮喘综合专业知识的调查人员，以扩大对健康素养影响健康行为并最终影响老年哮喘患者健康结果的途径的理解。我们提出了三个目标：（1）确定老年哮喘患者健康素养与哮喘自我管理行为的关联;（2）确定老年哮喘患者健康素养与哮喘特异性疾病和药物信念的关联;（3）使用结构方程模型确定将健康素养和哮喘特异性健康信念与自我管理行为联系起来的因果途径。我们将对500名60岁及以上的英语和西班牙语成人持续性哮喘患者进行纵向研究，这些患者来自纽约市的西奈山医院和伊利诺伊州芝加哥的西北纪念医院的社会经济和种族多样的市中心初级保健实践。将在基线、3个月和12个月时进行访谈。这项研究将扩大对健康素养影响老年人慢性病自我管理的机制的理解，同时确定具体的，可修改的信念，减轻低健康素养对老年哮喘患者哮喘自我管理的影响，创造一个机会，以改善高度脆弱人群的哮喘结果。研究结果将为西北团队开发的低识字率哮喘干预措施的改进提供信息。我们计划继续这项西奈山-西北大学的合作，并进行后续的R 01应用，以在多中心试验中测试修改后的方法。公共卫生相关性：本研究的目的是了解健康素养和对慢性病的信念如何相互作用，影响老年人自我管理慢性病的能力。该研究将在纽约市和芝加哥（IL）进行，并将涉及500名60岁或以上慢性哮喘患者的访谈。研究结果将扩大我们对健康素养的理解，并为教育老年哮喘患者管理疾病的最佳方法提供新的见解。

DESCRIPTION (provided by applicant): The overall objective of this study is to investigate the association between health literacy, health beliefs, and self-care behaviors among older adults with asthma. Greater engagement of older adults in self-management of their chronic diseases can improve health outcomes in this vulnerable population. Evidence suggests that health literacy is an important mediator of disease self-management. This observation is especially important for the elderly who experience disproportionately higher rates of inadequate health literacy and cognitive impairment. Unfortunately, most interventions aimed at promoting better disease self-management among low-literacy adults achieve only modest gains. The failure of these interventions, and other observations, show that the pathways linking health literacy to self-management remain poorly defined. Disease-specific health beliefs and medication beliefs may lie along this pathway. We have found a strong association between asthma-specific medication and health beliefs among adults with asthma, and our preliminary data suggest that older adults with low health literacy are more likely to have asthma beliefs that predict poor self- management behaviors. These findings indicate that health and medication beliefs may mediate health literacy's impact on self-management. This application brings together investigators with combined expertise in health literacy, disease specific health beliefs, and asthma in aging adults, to expand understanding of the pathways through which health literacy affects health behaviors and ultimately, health outcomes in older asthmatics. We propose to address three aims: (1) to determine the association of health literacy with asthma self-management behaviors among older asthmatics; (2) to determine the association of health literacy with asthma-specific disease and medication beliefs among older asthmatics; (3) to determine the causal pathways linking health literacy and asthma- specific health beliefs with self-management behaviors, using structural equation modeling. We will conduct a longitudinal study of 500 English and Spanish-speaking adults, ages 60 years and older with persistent asthma, recruited from the socioeconomically and racially diverse inner-city primary care practices of Mount Sinai Hospital in New York City, NY and the Northwestern Memorial Hospital in Chicago, IL. Interviews will occur at baseline, 3 and 12 months. This study will expand understanding of the mechanisms through which health literacy influences chronic disease self-management in older adults and concurrently identify specific, modifiable beliefs that mitigate the effects of low-health literacy on asthma-self management in older asthmatics, creating an opportunity to improve asthma outcomes in a highly vulnerable population. Study findings will inform refinement of a low-literacy asthma intervention developed by the Northwestern Team. We plan to continue this Mount Sinai-Northwestern collaboration with a follow-up R01 application to test the modified approach in a multi-site trial. PUBLIC HEALTH RELEVANCE: The objective of this study is to understand how health literacy and beliefs about chronic disease interact to affect older adults' ability to self-manage their chronic illness. The study will be conducted in New York City and Chicago, IL, and will involve interviews of 500 patients, 60 years or older with chronic asthma. The study findings will expand our understanding of health literacy and provide new insights into best methods for educating older asthmatics about managing their disease.