NIH: Understanding and Promoting Health Literacy

Sponsor: The National Institutes of Health (NIH)

The Department of Health and Human Services, in its Healthy People 2010 initiative, defines health literacy 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.” (Please see: http://www.healthypeople.gov/document/HTML/Volume1/11HealthCom.htm)

Low health literacy is a wide spread problem, affecting more than 90 million adults in the United States (Institute of Medicine, 2004), where 43% of adults demonstrate only the most basic or below-basic levels of prose literacy (U.S. Department of Education, 2005). Low health literacy results in patients’ inadequate engagement in, and benefit from, health care advances as well as medical errors. Low health literacy is likely to be a major contributor of adverse health outcomes (Agency for Healthcare Research and Quality, 2004; AMA, 1999; Baker, Gazmararian, Williams, Scott, Parker, Green, Ren, & Peel, 2002; Baker, Parker, Williams, & Clark, 1998). Research has linked low or limited health literacy with such adverse outcomes as poorer self-management of chronic diseases, less healthy behaviors, higher rates of hospitalizations, and overall poorer health (Gazmararian, Baker, Williams, Parker, Scott, Green, Fehrenbach, Ren, & Koplan, 1999; Schillinger, Grumbach, Piette, Wang, Osmond, Daher, Palacios, Sullivan, & Bindman, 2002; Williams, Parker, Baker, Pitkin, Coates, & Nurss, 1995).

Health literacy is a complex phenomenon that involves individuals, families, communities and systems. For instance, consumers, patients, caregivers, or other laypersons may vary with respect to:

• Access (e.g., to audience-appropriate information, media or professionals);
   

• Skills (e.g., to gather and comprehend health information; to speak and share personal information about health history and symptoms; to act on information by initiating appropriate follow-up visits and conveying understanding back to the information source; to make decisions about basic healthy behaviors, such as healthy eating and exercise; to engage in self-care and chronic disease management);
   

• Knowledge (e.g., of health and medical vocabulary, concepts such as “risk”, the organization and functioning of healthcare systems);
   

• Abilities (e.g., sensory, communication, cognitive or physical challenges or limitations);
   

• Features of health care providers and public health systems (e.g., the communication skills of health professionals, platforms employed for patient education, built environments and signage);
   

• Demographics (e.g., developmental or life stage, cultural, linguistic or educational differences that affect health beliefs, knowledge and communication)

Too often people with the greatest health burdens have limited access to relevant health information. In part, this is due to individuals’ limited abilities to fully interpret and understand complex health terminology and instructions. Limited numeracy can also impede the ability to make personal decisions related to risk, risk avoidance, and risk reduction. For instance, to follow health care instructions, patients need to be able to comprehend written and oral prescription instructions, directions for self-care, and plans for follow-up tests and appointments.

The complex and cumbersome ways health information often is presented also contribute to the problem. Health care professionals may not communicate effectively with individuals with limited levels of literacy. For instance, achieving informed consent for treatment is difficult when health care personnel cannot explain biological processes or treatment procedures in simplified language and patients cannot interpret health information. These situations hamper the effectiveness of health professionals’ efforts to prevent, diagnose and treat medical conditions, and limit many health care consumers’ abilities to make important health care decisions.

Specific Objectives

Several institutes and offices within AHRQ, CDC and NIH have joined together to support this initiative. Applications should be relevant to both the general objectives of the FOA and to the specific research interests of at least one of the participating organizations. Applications that address generic health literacy issues, but do not delineate clear relationships to the specific interests of at least one of the sponsoring organizations may not secure funding.

Researchers are strongly encouraged to review the general illustrative examples of topics relevant to health literacy provided below, as well as the specific research interests of the participating organizations supporting this announcement. Applications should address health promotion, injury or disease prevention, treatment or management of injuries, diseases or health conditions, and/or the improvement of health or health care outcomes within specific populations (e.g., children, the elderly, low income or vulnerable or underserved populations).

The research must involve at least one of the following:

• Health literacy, or one of its many components, as a key outcome;
   

• Health literacy as a key explanatory variable for some other outcome;
   

• Methodological or technological improvement to strengthen research on health literacy; and/or
   

• Prevention and/or intervention strategies that focus on health-literacy
   

• Studies to develop, or evaluate, the readability or utility of specific materials that are intended for single uses or single audiences are not responsive to this program announcement unless these investigations are integral to testing a significant research hypothesis related to health literacy.

Approaches:

A wide variety of research approaches are encouraged under this Program Announcement:

• Basic research that investigates or describes the nature of health literacy and the magnitude of health literacy problems
   

• Applied research addressing issues pertinent to health literacy practices (e.g., systems level interventions) and research-in-practice (e.g., active potential end users participate as supportive research partners);
   

• Develop theoretical models, refine research constructs, improve methods and measurements, and establish causal relationships (e.g., between low health literacy and lack of effective health promotion);
   

• Evaluation research that develops and tests the effectiveness of interventions, or adapts and tests existing programs (including those that are implemented by health care systems and systems outside of health care), to reduce low health literacy and its adverse consequences.
   

• Secondary analyses of existing datasets as well as meta-analytic studies
   

• Multilevel, multidisciplinary, interdisciplinary, and transdisciplinary research is encouraged, especially studies that incorporate individual, family, community and societal mediators of health literacy in childhood and adulthood, or state-of-the-art health communication theory and knowledge.

Amount: Because the nature and scope of the proposed research will vary from application to application, it is anticipated that the size and duration of each award will also vary. Although the financial plans of the Institutes and Centers (ICs) provide support for this program, awards pursuant to this funding opportunity are contingent upon the availability of funds and the submission of a sufficient number of meritorious applications.

The total project period for an application submitted in response to this funding opportunity may not exceed 2 years. Although the size of award may vary with the scope of research proposed, it is expected that applications will stay within the budgetary guidelines for an exploratory/developmental project; direct costs are limited to $275,000 over an R21 two-year period, with no more than $200,000 in direct costs allowed in any single year. Applicants may request direct costs in $25,000 modules, up to the total direct costs limitation of $275,000 for the combined two-year award period. NIH grants policies as described in the NIH Grants Policy Statement will apply to the applications submitted and awards made in response to this FOA.

Deadline:

Letters of Intent Receipt Date(s): April 24, 2007; December 24, 2007; August 22, 2008; April 24, 2009; December 24, 2010
Application Submission/Receipt Date(s): May 24, 2007; January 24, 2008; September 24, 2008; May 25, 2009; January 25, 2010
Expiration/Closing Date: January 26, 2010

For further information, please visit: http://grants.nih.gov/grants/guide/pa-files/PAR-07-018.html