FHL is a measure of a patient?s ability to function in the healthcare setting that takes into account literacy (reading comprehension of healthcare instructions) and numeracy (ability to understand and act on numerical instructions). The goal of this research and training program is to provide the applicant with the tools necessary to become an independent investigator and a leader in the fields of health communication, FHL, and chronic disease management. Building on his training and experience in primary care internal medicine, quality improvement, and research among underserved populations, the applicant proposes to develop additional skills through: 1) interaction with a multidisciplinary mentorship team that includes national experts in health communication, FHL, diabetes, and health services research; 2) tutorials and rigorous coursework designed to expand his theoretical and methodological knowledge and skills; and 3) a series of focused, supervised research projects. Prior research has demonstrated that low FHL is prevalent among minorities, the elderly, and patients with chronic conditions. Despite the extensive self-management demands placed on patients with chronic diseases, little is known about the extent to which FHL impacts health outcomes among chronic disease patients, or about strategies to enhance care for those with low FHL. The research proposed in this application will utilize GCRC resources to examine whether FHL problems are associated with worse clinical outcomes among patients with Type 2 diabetes, and explore health communication strategies to improve care for diabetes patients with low FHL.
The specific aims of the proposed research are to: 1) perform a cross-sectional study to examine the association between FHL, self-management, and glycemic control among Type 2 diabetes patients; 2) to evaluate, as part of a funded prospective study on automated telephone disease management (ATDM), the acceptability and reliability of an ATDM system among patients with Type 2 diabetes and low FHL; and 3) perform a randomized, controlled trial (with wait-list controls) to evaluate the impact of a tailored physician communication training on visit-related recall among patients with Type 2 diabetes and low FHL. The UCSF, with its extensive resources for health related research, provides an excellent environment for the applicant to pursue research and training. The applicant?s sponsor and mentorship team have vast experience in the relevant disciplines and will be critical to the applicant?s development as an independent researcher with a focus on improving the health of vulnerable patients with chronic diseases.

National Institute of Health (NIH)
National Center for Research Resources (NCRR)
Mentored Patient-Oriented Research Career Development Award (K23)
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Application #
Study Section
National Center for Research Resources Initial Review Group (RIRG)
Program Officer
Wilde, David B
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Fiscal Year
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University of California San Francisco
Internal Medicine/Medicine
Schools of Medicine
San Francisco
United States
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Schillinger, Dean; Handley, Margaret; Wang, Frances et al. (2009) Effects of self-management support on structure, process, and outcomes among vulnerable patients with diabetes: a three-arm practical clinical trial. Diabetes Care 32:559-66
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Schillinger, Dean; Hammer, Hali; Wang, Frances et al. (2008) Seeing in 3-D: examining the reach of diabetes self-management support strategies in a public health care system. Health Educ Behav 35:664-82
Swenson, Sara L; Rose, Monica; Vittinghoff, Eric et al. (2008) The influence of depressive symptoms on clinician-patient communication among patients with type 2 diabetes. Med Care 46:257-65
Bhandari, Vijay Kumar; Wang, Frances; Bindman, Andrew B et al. (2008) Quality of anticoagulation control: do race and language matter? J Health Care Poor Underserved 19:41-55

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