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:

Public Health Relevance

Improving patient health literacy through their chronic disease management skills and knowledge may be an effective strategy reducing health disparities. In this project we will build on our work in health literacy and computer-delivered interventions to create a new intervention to reduce health disparities by improving health literacy and chronic disease management among African-American, Hispanic, and non-Hispanic whites.

National Institute of Health (NIH)
National Institute on Minority Health and Health Disparities (NIMHD)
Research Project (R01)
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Special Emphasis Panel (ZRG1)
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Berzon, Richard
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Nova Southeastern University
Schools of Osteopathic Medicine
Fort Lauderdale
United States
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Jacobs, Robin J; Ownby, Raymond L; Acevedo, Amarilis et al. (2017) A qualitative study examining health literacy and chronic illness self-management in Hispanic and non-Hispanic older adults. J Multidiscip Healthc 10:167-177
Ownby, Raymond L; Acevedo, Amarilis; Waldrop-Valverde, Drenna et al. (2017) A Mobile App for Chronic Disease Self-Management: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 6:e53