This revised application for an NICHD Mentored Patient-Oriented Research Career Development Award (K23) seeks support to develop a program of research related to social factors contributing to disparities in maternal-child health. In particular, I am interested in identifying obstacles to preventive pediatric care for preterm infants related to maternal low literacy. While low literacy is common in populations with high rates of preterm birth and has been associated with poor care utilization in other settings little to nothing is known about the role of literacy in the utilization of pediatric care. This research is designed to lay the groundwork for a community based intervention to reduce obstacles to effective pediatric care utilization faced by women with low literacy. The proposed course of study includes: 1) an educational component, and 2) a research plan to be carried out through three linked studies. Study 1 is an analysis of a prospective study of low income, inner-city women following a preterm birth (<35 weeks gestation;n=700). The goal of this study is to examine the association between maternal literacy and preventive pediatric care (well child visits and Up to Date vaccination status) as well as to assess potential mediators of this association. Study 2, with the same population, will utilize qualitative methods to clarify factors identified in Study 1 and uncover new obstacles to care from the perspective of the mothers. Study 3 utilizes the findings of the preceding work to develop a community based intervention to modify the obstacles identified in Studies 1 and 2. A home visiting model used widely to deliver services to low income women and their infants will be adapted to include health and literacy instruction to address the identified obstacles to pediatric care utilization. The educational component focuses on specific areas of advanced social science methodology, statistical methods, and the assessment of adult literacy, as well as the design of intervention trials, which are needed for the planned research studies and subsequent independent research career. This work will result in an R01 intervention study proposal to be submitted in the fourth year. The proposed research represents a unique opportunity to study the role of low literacy and pediatric care utilization in a setting in which the benefits of effective utilization are clear and well defined. The results of this work will also have important implications for understanding the role of literacy in health care utilization for the larger group of term infants.
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