Healthy People 2010 defines health literacy (HL) as """"""""the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions."""""""" Low HL, which may affect 25-33% of adults in the US, is associated with poor disease-related knowledge and health status, and recently has been identified as a factor in medication compliance. Its impact on the management of cardiovascular disease has not yet been determined. This proposal describes a career development plan designed to prepare the applicant for success as an independent clinical investigator examining the impact of health literacy on cardiovascular care and outcomes, with attention to medication compliance. The candidate's more immediate goals include developing expertise in the factors that influence cardiovascular medication compliance, a broader perspective on the issues surrounding health literacy, and additional skills in research methodology and statistical analysis. To meet these goals, the proposed training plan integrates advanced multidisciplinary coursework with continuing medical education courses and a mentored research experience. The environment is extremely supportive, as Emory University has established an infrastructure through K12 and K30 funding to develop and train patient-oriented investigators. Grady Memorial Hospital, site of the proposed research, was home to many of the original studies on health literacy. The Mentor and Co-Mentor are dedicated clinical investigators with expertise in cardiovascular prevention, outcomes research, and health literacy. The applicant has also assembled an Advisory Committee with vast experience in medication compliance, health literacy, and research methodology. The research component consists of three projects related to health literacy and cardiovascular medication compliance - 1) a training program to improve physicians' medication counseling skills and communication with low-literate patients, 2) an investigation of the association of health literacy with medication compliance among patients hospitalized for unstable angina, and 3) a randomized controlled trial to improve medication compliance through a low-literate patient education intervention. If successful, the proposed research could serve as a model for other interventions to improve compliance and cardiovascular care, particularly among low-literate and underserved populations.
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