The influence of patient literacy or numeracy (math) skill on the implementation of clinical self-care recommendations in patients with end-stage renal disease is not known. Large knowledge gaps exist in understanding the basic mechanisms by which patients incorporate, interpret and apply health-related information in the daily care of complex chronic diseases. My primary long term goals are : 1). to explore the determinants and barriers of self-care behaviors in patients with kidney disease, specifically the role of literacy/numeracy and 2). to systematically develop and evaluate educational interventions targeted for low literacy/numeracy patients to increase participation in self-care and improve clinical outcomes. End-stage renal disease requires intensive management by both provider and patient. In chronic hemodialysis (CHD), patient self-care behaviors include adherence to dietary and fluid restrictions, obtaining prescribed dialysis therapy, vascular access care, adherence to complex medication regimes and management of comorbid diseases. Participation in self-care by CHD patients is often low and has been associated with an increased mortality risk. Low health literacy is common affecting over 90 million people in the U.S., and has been associated with lower knowledge of chronic disease and lower adherence. We hypothesize that literacy and numeracy are important determinants of self-care behaviors and clinical outcomes in CHD patients. The primary research goals of this application are: 1). to develop methods to describe literacy and numeracy skills and associated characteristics of CHD patients, 2). to determine the association of low literacy/numeracy with knowledge, self-efficacy, and participation in CHD self-care behaviors and clinical outcomes, and 3). to evaluate the impact of a provider intervention, targeted to patients with low literacy, on self-care behaviors and clinical outcomes. The proposed research will result in fundamental knowledge and new methodology to identify and measure mechanisms and barriers of self-care in CHD patients, which will enable the design and implementation of patient-centered, educational, and adaptive interventions to improve adherence to self-care recommendations. Importantly, this experience will provide the candidate with a new and advanced methods skill-set that will enable her to develop into a successful independent investigator well equipped for significant contributions to improving the care of patients with kidney disease.

Agency
National Institute of Health (NIH)
Institute
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
5K23DK080952-05
Application #
8245105
Study Section
Diabetes, Endocrinology and Metabolic Diseases B Subcommittee (DDK)
Program Officer
Rankin, Tracy L
Project Start
2008-04-01
Project End
2014-03-31
Budget Start
2012-04-01
Budget End
2014-03-31
Support Year
5
Fiscal Year
2012
Total Cost
$172,341
Indirect Cost
$12,766
Name
Vanderbilt University Medical Center
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
004413456
City
Nashville
State
TN
Country
United States
Zip Code
37212
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Maripuri, Saugar; Penson, David F; Ikizler, T Alp et al. (2011) Outpatient versus inpatient observation after percutaneous native kidney biopsy: a cost minimization study. Am J Nephrol 34:64-70

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