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The aims of this proposed research are to: ? 1.) Determine the extent to which the children of mothers with low health literacy differ from the children of mothers without low health literacy in meeting established pediatric preventive care and immunization guidelines including the timing and number of well-child visits and receipt of vaccinations. ? 2.) Determine the extent to which predisposing, enabling, and need factors are associated with appropriate use of pediatric preventive care and adherence to immunization guidelines. ? 3.) Determine whether or to what extent maternal health literacy mediates the relationship between identified predisposing, enabling and needs factors and outcomes of appropriate use of pediatric preventive care and adherence to immunization guidelines ? 4.) Determine whether or to what extent maternal health literacy moderates the relationship between the identified predisposing, enabling and needs factors and the outcomes of appropriate use of pediatric preventive care and adherence to immunization guidelines. ? ? We will compare mothers with and without low health literacy to identify any additional maternal factors, such as low socioeconomic status, reduced access and barriers to care, and health promotion understanding, that are differentially associated with maternal health literacy. ? We plan to determine if maternal health literacy mediates the relationship between variables such as race, ethnicity, socioeconomic status and underutilization of pediatric preventive care. ? ? We will explore whether maternal health literacy moderates the relationship between factors such as race, ethnicity and socioeconomic status, and preventive pediatric health care quality indicators. ? Exploring the association between health literacy and the use of pediatric preventive care, as well the potential mediating and moderating effects of health literacy will allow us to gather information that will guide us in the development of targeted interventions. ? ? We will examine a sample of low-income, inner city women who enrolled prenatally as participants in a series of linked observational studies, and completed surveys that assessed demographic and socioeconomic factors corresponding to factors of predisposing, enabling, and need. ? ? We will evaluate the impact of health literacy on self-reported utilization of services. We will also link these data with Medicaid claims data in order to assess variations in adherence to recommendations for pediatric preventive care and adherence to immunization guidelines. ? ? Using mixed quantitative and qualitative research methods in conjunction with primary and secondary data sources, provides a unique opportunity to address important gaps in the research literature and to evaluate the circumstances under which maternal literacy impacts pediatric preventive health care utilization and pediatric health outcomes in the """"""""real world"""""""". ? ? Examining the mediating and moderating influences of health literacy in the context of predisposing, enabling, and need factors will provide a foundation on which to identify specific at risk populations, and appropriately target health literacy interventions that have the potential to decrease disparities in utilization of pediatric healthcare in highly vulnerable populations. ? ? ?
