This is an application for a K23 for Dr. Claudia Lora, who proposes the first systematic examination of health literacy in Hispanics with chronic kidney disease (CKD). This award will allow Dr. Lora the resources and protected time to achieve her long-term career goal of becoming a successful, independent patient-oriented researcher focusing on health care disparities in Hispanics with CKD. While Hispanics currently comprise 15% of the population, they are projected to comprise a quarter of the US population by 2050, Hispanics with chronic kidney disease (CKD) are at increased risk of progression to end stage renal disease (ESRD) compared to non-Hispanic whites. Accordingly, a better understanding of the factors contributing to the progression of CKD in Hispanics is critical for reducing health disparities and developing therapeutic interventions. Health literacy is known to be associated with health behaviors and outcomes, but has not been well studied in the context of CKD. The potential for health literacy to affect patients'chronic disease management has been recognized by the Institute of Medicine, which in 2004, issued a call to action for research in health literac. Examining health literacy in Hispanics is of utmost importance because minorities and non-English speakers are more likely to have low functional health literacy than non-Hispanic whites. Low health literacy likely contributes to poor health outcomes in Hispanics with CKD through various mechanisms including disease knowledge, access to health care, and health behaviors. By understanding the relationship between health literacy and CKD, we may identify a therapeutic target in CKD progression. In view of the disproportionate burden of kidney disease in Hispanics, the proposed study will examine health literacy in a cohort of Hispanics with CKD.
The specific aims of the proposal are: 1) To examine health literacy as a predictor for progression of kidney disease in Hispanics with CKD;2) To examine health literacy as a predictor for cardiovascular events and progression of subclinical cardiovascular disease in Hispanics with CKD;and 3) To develop and field test a culturally sensitive, low-literacy, touch tablet application to improve knowledge of hypertension in Hispanics with CKD. The project contains novel concepts and strategies, and will result in the development of a new therapeutic intervention that could improve the health of Hispanics with CKD. The strengths of the proposal are the comprehensive career development plan, the experience and commitment of the mentoring team, and the strong institutional resources and support. In addition, the proposed research is innovative, addresses a growing public health problem, leverages the infrastructure of an ongoing NIH-funded cohort study, and will allow the applicant to gain the skills and experience needed to develop into an independent patient-oriented researcher.
Health literacy is known to influence health behaviors and outcomes, but has not been studied in Hispanics with predialysis chronic kidney disease (CKD). In view of the disproportionate burden of CKD in U.S. Hispanics, the mentored research has two overarching goals: 1) To examine health literacy as a predictor of CKD progression and cardiovascular outcomes in Hispanics with CKD and 2) To develop and pilot a low- literacy, touch tablet application to improve knowledge of hypertension in Hispanics with CKD, which will serve as the basis for a future R01 proposal. The proposed study will advance my research skills towards developing into an independent investigator and the knowledge gained has the potential to advance concepts that drive the field and thereby minimize health disparities in Hispanics with CKD.