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Home > Scientific AreasSocial & Cultural Factors in Health > Health Literacy


Health Literacy PARs

Understanding and Promoting Health Literacy


National Institutes of Health (NIH) - Turning Discovery Into Health


Health literacy, “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions” (Ratzan & Parker, 2000; cf. Parker & Ratzan, 2010), includes not only the ability to read, interpret and write prose (print literacy), but also the ability to use quantitative information (numeracy), and to speak and listen effectively (oral literacy).  Together these skills are needed to understand and act appropriately on health information and in health care interactions. Limited health literacy is a wide spread problem. Over a third of adults in the United States—77 million people—would have difficulty with common health tasks, such as following directions on a prescription drug label or adhering to a childhood immunization schedule using a standard chart (US DHHS, 2010).

A growing body of evidence links low health literacy with poor health outcomes, including limited ability to take medications appropriately, poor ability to interpret labels and health messages, greater use of emergency care, and higher hospitalization rates (AHRQ, 2004; 2011). In the past, the onus of these poor health outcomes was largely attributed to patients and consumers, but more current thinking recognizes that health literacy is a dynamic systems issue that involves both the health information presented and the health care system navigated (Koh, Berwick, Clancy, Baur, Brach, Harris & Zerhusen, 2012; see also Johnson, Baur, & Meissner, 2011).


Links to current PARs


NIH Institute-specific interests to understand and promote health literacy

Several NIH Institutes and Offices support the health literacy initiative. Each PAR supports R01, R03, and R21 applications, respectively.  Note that each PAR lists a discrete set of NIH Institutes and Offices that support; be certain to check each PAR’s Components of Participating Organizations list to be certain that your proposed research project relates to one of those NIH components.

Additionally, applications should relate both to the general objectives of the PAR and to the specific research interests of at least one participating organization. Applications that address generic health literacy issues without clear relationships to specific interests of at least one sponsoring organization may not secure funding regardless of the score received through the peer review process.  Consequently, researchers should review this list of each organization’s research interests and examples. Additional research areas are welcome; prospective applicants should contact the relevant program director listed below (and/or in each FOA’s in Section VII) prior to preparing an application.


NATIONAL CANCER INSTITUTE (NCI)

Division of Cancer Control and Population Sciences (DCCPS)

DCCPS aims to reduce the risk, incidence, and deaths from cancer and enhance the quality of life for cancer survivors.  Its research program seeks to ensure that the products of cancer control research are effectively applied in all segments of the population.  The Division conducts and supports an integrated program of the highest quality genetic, epidemiologic, behavioral, social, and surveillance cancer research.
NCI is interested in the development and testing of interventions designed to promote behavioral change, facilitate decision-making and patient empowerment, and enhance patient-centered cancer care.  NCI is particularly interested in health literacy research in the following areas:  Web 2.0 and Health Information Technology (e.g., use of Electronic Medical Records, mHealth and social media-based interventions), multi-level/systems interventions, context-based interventions, and innovative analytic strategies to understand and promote health literacy.  Facing a changing communication landscape whereby health information has become increasingly ubiquitous, NCI supports research to identify and assess opportunities to promote cancer control goals through new and innovative communication channels and approaches.

NCI also encourages research that addresses priority populations (e.g., low-income groups, older individuals, low English proficiency/immigrant communities, and individuals with disabilities and chronic conditions). Research that contributes to the reduction of cancer disparities would be of great interest.

Central to these activities is the approach individuals, health care systems, health plans, and communities take to understand, process, and act on health information to reduce the cancer burden in the areas of tobacco use, primary and secondary cancer prevention, energy balance, sun protection, cancer survivorship and end-of-life care, patient-provider communication, patient navigation, health care access, and the health care system.  Applicants are encouraged to consult DCCPS’s Research Funding Priorities web page: http://cancercontrol.cancer.gov/brp/funding.html

Wen-ying Sylvia Chou, PhD, MPH
Program Director
Behavioral Research Program
Division of Cancer Control and Population Sciences
National Cancer Institute/NIH
Telephone: (301) 435-2842
Email: chouws@mail.nih.gov


NATIONAL INSTITUTE OF BIOMEDICAL IMAGING AND BIOENGINEERING (NIBIB)

The National Institute of Biomedical Imaging and Bioengineering is dedicated to improving health by leading the development and accelerating the application of biomedical technologies. NIBIB will consider applications that are relevant to its core mission and which study and promote bioengineering and clinical imaging literacy to improve outcomes. Areas of study which would be of interest to the Institute include: technologies and tools to advance the study of health literacy, disparities in the outcome of technology-based preventative and/or intervention strategies and health literacy as a variable in the adoption and impact of biomedical technologies.

Examples of NIBIB-supported health literacy research areas could include, but are not limited to:

  • Assessment of appropriate technologies to improve disease management (e.g., culturally appropriate point-of-care diagnostics, simple language for self-administered STD tests, easy-to-use home health monitors, etc.)

  • Research that improves communication between radiologists and patients to improve diagnosis

  • Software, databases and other technological improvements that strengthen health literacy

  • Telehealth and mobile health technologies that enhance health literacy

Brenda Korte, PhD
National Institute of Biomedical Imaging and Bioengineering/NIH
Telephone: (301) 402-1231
Email: kortebr@mail.nih.gov


EUNICE KENNEDY SHRIVER NATIONAL INSTITUTE ON CHILD HEALTH AND HUMAN DEVELOPMENT (NICHD)

NICHD is interested in health literacy to improve the health of pregnant women, infants, children, adults, families, communities, and populations. To determine whether your proposed project meets NICHD's interests, contact,

Lynne Haverkos, MD, MPH
Medical Officer
Child Development and Behavior Branch
Eunice Kennedy Shriver National Institute of Child Health and Human Development/NIH
Telephone: (301) 435-6881
Email: haverkol@mail.nih.gov


NATIONAL INSTITUTE ON DEAFNESS AND OTHER COMMUNICATION DISORDERS (NIDCD)

NIDCD conducts and supports research and research training on disorders of hearing and other communication processes, including diseases affecting hearing, balance, smell, taste, voice, speech, and language through cooperation and collaboration with professional, academic, commercial, voluntary, and philanthropic organizations concerned with research and training that is related to deafness and other communication disorders, disease prevention and health promotion, and the special biomedical and behavioral problems associated with people having communication impairments or disorders. NIDCD also supports efforts to create devices that substitute for lost and impaired sensory and communication function and supports the ongoing collection and dissemination of information to health professionals, patients, industry, and the public on research findings in these areas. In response to this FOA, NIDCD is especially interested in research addressing health literacy with a goal of improving health outcomes for individuals with communication disorders.

In addition, applicants are encouraged to view the NIDCD National Strategic Plan, Priority Area 4: Improving Outcomes for Human Communication: http://www.nidcd.nih.gov/about/plans/2012-2016/Pages/2012-2016-Strategic-Plan-Full.aspx.  All researchers considering applying are encouraged to contact

Amy Donahue, Ph.D.
Division of Scientific Programs
National Institute on Deafness and Other Communication Disorders/NIH
Telephone: (301) 402-3458
Email: donahuea@nidcd.nih.gov


NATIONAL INSTITUTE OF DENTAL AND CRANIOFACIAL RESEARCH

Despite remarkable improvements in the oral health of many, not everyone in the nation has benefited equally. Oral, dental and craniofacial conditions remain among the most common health problems for low-income, disadvantaged, disabled and institutionalized individuals across the life span. Dental caries, periodontal disease, and oral and pharyngeal cancer are of particular concern.  The NIDCR supports health literacy research as it applies to better understanding and preventing oral diseases and conditions, and reducing oral health disparities.   Such studies may require multidisciplinary research teams, community engagement, and approaches that integrate oral health literacy into multiple levels of influence including the individual, educational, care delivery and community settings.

The NIDCR supports health literacy interventional research designed to have a meaningful impact on caries, oral and pharyngeal cancer, periodontal disease, or oral health related quality of life and that influences action.  Such health literacy research should be grounded in behavioral and social theory and should explore mechanisms of action. The NIDCR supports research that utilizes new technologies and approaches that are culturally appropriate and sustainable, and that can be utilized by individuals, caregivers and health care providers. Please note that the NIDCR does not accept applications that include clinical trials in response to trans-NIH-FOAs.  Applicants proposing health literacy clinical trials should refer to the following NIDCR websites: http://www.nidcr.nih.gov/clinicaltrials/ and http://grants.nih.gov/grants/guide/pa-files/PAR-11-338.html)”

Investigators are strongly encouraged to refer to NIDCR’s Strategic Plan and contact the Program Official.
Ruth Nowjack-Raymer, MPH, PhD
Director, Health Disparities Research Program
Center for Clinical Research
National Institute of Dental and Craniofacial Research/NIH
Phone: 301-594-5394
E-mail: Ruth.Nowjack-Raymer@nih.gov


NATIONAL INSTITUTE OF DIABETES & DIGESTIVE & KIDNEY DISEASES (NIDDK)

NIDDK is particularly interested in research that tests novel interventions or approaches to address health literacy and improve health outcomes in NIDDK relevant diseases http://www2.niddk.nih.gov. All researchers are encouraged to contact a NIDDK Program Officer (http://www2.niddk.nih.gov/AboutNIDDK/NIDDKStaff/biosketches) to discuss their research in advance to submission to assure it aligns with the mission of the Institute and is well suited for this R01 funding announcement.

Christine Hunter, Ph.D., ABPP
Director, Behavioral Research
Division of Diabetes, Endocrinology, and Metabolic Diseases
National Institute of Diabetes and Digestive and Kidney Diseases/NIH
Phone: (301) 594-4728
Email: hunterchristine@niddk.nih.gov


NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES (NIEHS)

NIEHS’s mission is to discover how the environment impacts people in order to promote healthier lives.  The Institute’s vision is to provide leadership for innovative research that improves public health by preventing disease and disability. As part of the research process, NIEHS supports a full spectrum of community-engaged research projects. Communication and dialogue among all research partners is central to effective community-engaged research. However, such communication requires that community residents, healthcare professionals, and decision-makers understand the connection between environmental factors and health and have the ability and capacity to act on this knowledge to prevent, mitigate or regulate exposures. This understanding is environmental health literacy. Given the increased focus on community engagement in environmental health science (EHS) research and the ongoing communication of environmental health information more broadly, NIEHS is interested in supporting research that addresses the following key areas:

Environmental Health Literacy (EHL): Develop and/or validate approaches for measuring and increasing stakeholder’s EHL (understanding of the links between environmental exposures and health outcomes). Examples of research topics include:

  • Behavioral research to understand how stakeholders process, understand, and act upon environmental health information.

  • Research that examines best approaches to build the EHL capacity of health professionals to incorporate environmental health concepts into their clinical practice (including the impact of socioeconomics, education and the built environment as well as environmental exposures). 

Risk Communication: Examine methods and strategies that improve health literacy by communicating the complexity and amount of uncertainty and risks of negative health outcomes such as those associated with gene-environmental interactions, epigenetics or cumulative exposures. Examples of research topics include

  • Research that identifies and tests underlying factors for effective communication of EHS research findings of relevance to local communities in culturally relevant language and delivery modalities.

  • Research that tests the effectiveness of targeted approaches to communicate uncertainties regarding the accumulation or interaction of multiple exposures.

  • Research that identifies and tests communication approaches that impact understanding of the connection between environmental exposures and negative health outcomes. For example, research that examines the timing of message dissemination, who delivers the message, how it is delivered, cultural constraints, and resource needs.

  • Research that elucidates how individuals and communities understand preliminary or conflicting research findings, and understand and contextualize media messages on the risks of particular exposures.

Environmental Health Messaging:  Identify and assess the effectiveness of existing EHS messaging strategies and determine what formats are appropriate and culturally sensitive to deliver environmental health messages. Research could include: 

  • Research to examine how people use new social media to communicate environmental health messages, to collect exposure data or other information, or to deliver EH-related interventions.

  • Research to assess the validity of specific approaches for successful environmental health messaging and improvements in EHL with culturally distinct populations.

Symma Finn, Ph.D.
National Institute of Environmental Health Sciences/NIH
Phone: (919) 541-4258      
Email: finns@niehs.nih.gov


NATIONAL INSTITUTE OF MENTAL HEALTH (NIMH)

NIMH’s interest in health literacy is focused on the following:

  • Research to determine whether and how improved health literacy among clients and their families leads to improved access to, receipt of and adherence to high quality treatment and services for mental illnesses and comorbid conditions (e.g. chronic medical conditions, infectious diseases, substance abuse, obesity, tobacco use, etc.).

  • Research to determine whether and how improved health literacy among providers and staff leads to improved clinical decision-making resulting in positive outcomes for mental disorders, reduction in health risk behaviors and improvement in outcomes for comorbid medical conditions.

  • Research to determine the most efficient and effective means of integrating effective health literacy interventions within treatment and preventive services that lead to improved patient outcomes.

  • Research on improving access to and quality of mental health literacy services for vulnerable populations, including women, adolescents, racial/ethnic minorities, and those with other co-occurring disorders (such as mental health, substance abuse, infectious disease) that demonstrate improved self-care, self-advocacy, and care-seeking behaviors, and reducing or eliminating health disparities among these populations.

  • Research on the relationship between health literacy and mental illness comorbidities or HIV disease (with its related behavioral and CNS manifestations) on patient outcomes


Denise Juliano-Bult, M.S.W.  (for most research areas)
Division of Services and Intervention Research
National Institute of Mental Health
Telephone: (301)443-1638
Email: djuliano@mail.nih.gov 

David M. Stoff, Ph.D. (for HIV/AIDS-related research)
Division of AIDS Research
National Institute of Mental Health
Telephone: (301) 443-4625
Email: dstoff@mail.nih.gov


NATIONAL INSTITUTE ON MINORITY HEALTH AND HEALTH DISPARITIES (NIMHD)

NIMHD is primarily interested in projects that address health literacy in one or more health disparity populations, which include racial/ethnic minority populations (African Americans, Hispanics/Latinos, Asian Americans, American Indians/Alaska Natives, Native Hawaiians and other Pacific Islanders), socioeconomically disadvantaged populations, and rural populations.

Areas of specific interest for NIMHD include, but are not limited to:

  • Projects that evaluate strategies to improve patient health literacy through improved patient-provider communication, including strategies that involve family members in medical decision-making.

  • Projects that evaluate strategies to enhance the communication skills of providers to promote health literacy in diverse patient populations.

  • Projects that evaluate strategies to improve health literacy at the family- or community-level.

  • Analysis or evaluation of the impact of local, state, or national health or other policies on health literacy.

  • Projects that enhance the capacity of individuals/communities to be educated consumers of different sources of health information.

  • Projects that evaluate the effectiveness of different modalities of information dissemination (e.g., broadcast media, social media, smartphone applications, peer education, etc.) in diverse populations.

Across topic areas, projects that examine the specific linkage between health literacy and health outcomes are strongly encouraged.

Jennifer Alvidrez, PhD
Program Official
National Institute on Minority Health and Health Disparities/NIH
Telephone: (301) 594-9567
Email: alvidrezjl@mail.nih.gov



NATIONAL INSTITUTE OF NURSING RESEARCH (NINR)

The mission of NINR is to promote and improve the health of individuals, families, communities, and populations. The Institute supports and conducts clinical and basic research and research training on health and illness across the lifespan to build the scientific foundation for clinical practice, prevent disease and disability, manage and eliminate symptoms caused by illness, and improve palliative and end-of-life care. NINR interest in Understanding and Promoting Health Literacy is consistent with our current strategic plan. Applicants are strongly encouraged to review our strategic plan and contact us prior to submitting your letter of intent. NINR's areas of interests for this FOA include,

  • Acute & Long-Term Care, End-of-Life, Training

  • Child & Family Health, & Health Disparities

  • Immunology, Infectious Disease, &Chronic Disorders

  • Neuroscience, Genetics, & SymptomManagement

Paul A. Cotton, PhD, RD
Program Director, Office of Extramural Programs
National Institute of Nursing Research/NIH
Telephone: (301) 402-6423
Email: Paul.Cotton@nih.gov


NATIONAL LIBRARY OF MEDICINE

NLM is interested in research relating to the ways information technology can be used to help health disparity populations or minority and other underrepresented populations make informed decisions about their health. Research topics of interest include computerized health literacy tools for information organization, visualization and decision-making. For any proposed project to be competitive for NLM funding, an evaluation component must be included that assesses validity and reliability of findings, or efficacy of a proposed intervention.

Alan VanBiervliet, Ph.D
Division of Extramural Programs
National Library of Medicine/NIH
Telephone: (301) 594-4882
Email: alan.vanbiervliet@nih.gov


References

Agency for Healthcare Research and Quality (AHRQ). (2004). Literacy and health outcomes: Evidence reports/technology assessments, No. 87.  Rockville, MD: AHRQ.

Agency for Healthcare Research and Quality (AHRQ). (2010). Health literacy interventions and outcomes: An updated systematic review: Evidence reports/technology assessments, No. 199. Rockville, MD: AHRQ.

Johnson, S.E., Baur, C., & Meissner, H.I. (2011). Back to basics: Why basic research is needed to create effective health literacy interventions. Journal of Health Communication, 16:S3, 22-29.

Koh, H.K., Berwick, D.M., Clancy, C.M., Baur, C., Brach, C., Harris, L.M. & Zerhusen, E.G. (2012). New federal policy initiatives to boost health literacy can help the nation move beyond the cycle of costly “crisis care.” Health Affairs (Millwood), 31, 434-443. Doi: 10.1377/hlthaff.2011.1169.

Parker, R., & Ratzan, S.C. (2010). Health literacy: A second decade of distinction for Americans. Journal of Health Communication, 15:S2, 20-33.

Ratzan, S.C., & Parker, R M. (2000). Introduction. In C. R. Selden, M. Zorn, S. C. Ratzan, & R. M. Parker. (Eds.), National Library of Medicine current bibliographies in medicine: Health literacy. NLM Pub. No. CBM 2000-1. Bethesda, MD: National Institutes of Health, U.S. Department of Health and Human Services.

US Department of Health and Human Services (US DHHS), Office of Disease Prevention and Health Promotion. (2009). National action plan to improve health literacy.  Washington, DC: US DHHS.

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