Low literacy is widespread and particularly prevalent among low-income and minority groups, the same groups in which asthma morbidity is excessive. Inattention by clinicians to the literacy and related health literacy of patients may result in ineffective communication and subsequent poor patient self-management. Some aspects of health literacy such as understanding numerical concepts may be particularly important. We recently developed and validated an asthma-specific numeracy questionnaire (ANQ). We found that many adults do not understand the numerical concepts embedded in standard asthma education. Those with low ANQ scores were also more likely to have had hospitalizations and ED visits for asthma. The initial aims of this application are to use the participants and outcomes of the parent R01 HL073932 to conduct a cohort study to examine the association of (Specific Aim 1) a standard health literacy instrument and (Specific Aim 2) ANQ with adherence to inhaled steroids (measured electronically), asthma control (FEV1), and asthma-related quality of life in adults with moderate or severe asthma. The parent R01 HL073932 addresses another barrier to successful asthma care involving patient-clinician interaction. It is a randomized controlled trial comparing the effect of a behavioral individualized intervention, problem-solving (PS) with standard asthma education (Attention Control (AC)), on these same outcomes. PS seeks to empower lowincome and minority asthmatic adults and allows clinicians to take account of the social context of these patients'lives. Exploratory Aim 3 will examine the interaction between literacy and PS versus AC interventions. We will use focus groups of patients and clinicians to refine the ANQ as a brief individualized assessment for clinicians. We will then develop and pilot an intervention to test whether ANQ-based individualized interventions result in improved adherence and asthma outcomes (Specific Aim 4). This will lead to subsequent research applications to test whether ANQ-based interventions alone or combined with PS results in better asthma outcomes and adherence. That is, we anticipate that both PS and ANQ will lead to simple brief additive or synergistic ways for clinicians to assess patients and tailor information. My Overarching Research Goal is examine barriers to asthma care that operate at the interface between patient and clinician and that may differentially affect members of ethnic and racial minority groups with my ultimate goal being to design and implement ways to reduce such health disparities. This K02 application will allow me to continue along my current trajectory to become an independent investigator focusing on strategies directed at both clinicians and patients. By enhancing current collaborations, building others, and participating in relevant research working groups, I will create a team of expert collaborators in health and literacy, education, bioenqineerinq (directed at behavior measurement), and behavioral medicine
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