Low health literacy affects more than 90 million adults in the United States and undermines the best efforts of physicians and nurses to provide high quality care - at an estimated cost of $73 billion per year (Institute of Medicine, 2003). Low health literacy also contributes to poor individual and collective public health, greater susceptibility to diseases, and complex emergencies such as bioterrorism. In response to this problem, Healthcare Technologies and Methods (HTM) proposes to develop an innovative and practical "Patient- Tailored Health Literacy Improvement System" and test its feasibility in Phase I. Initially, this novel system will be targeted to advance health literacy and improve self-care for older people in home health care with Type II diabetes. Later, expansion to other health venues and medical conditions is anticipated. This Patient-Tailored Health Literacy Improvement System will be comprised of: (1) A new multidimensional health literacy screening tool using an integrated ecological model, (2) A questionnaire that helps patients identify their preferred learning modality, and (3) Health education materials that are tailored for each patient's health literacy level and preferred learning modality (e.g., paper, Internet, video and interactive voice response [IVR]). The tailored health education materials will be efficiently and automatically assembled for various health literacy levels. In the Phase I feasibility study, Inova VNA Home Health nurses will administer the screening tool and learning modality questionnaire. Based on the results, they will distribute tailored health education materials (topic: dietary self management) to 30 patients ages 60 and over, who are newly diagnosed with Type II diabetes. HTM will determine the nurses'and patients'satisfaction with the system and suggestions with pre- and post-study questionnaires. HTM also will measure patients'knowledge of the specified health subject with pre- and post-study knowledge tests. In Phase II, HTM will refine the screening tool, modality questionnaire and self-care education materials based on Phase I experiences. In addition, HTM will develop tailored materials for additional aspects of diabetes self- care. Equipped with the improved and expanded system, HTM will conduct a randomized controlled trial with an appropriate number of subjects (based on a power analysis) to validate the screening tool and measure improvements in patients'self-care knowledge and health outcomes. After completion of Phase II, HTM envisions commercializing a system that is efficient and practical for clinical practice and can be continuously adapted and expanded for use by English-speaking and non English-speaking patients. HTM estimates that the company can achieve annual licensing revenues of $10 million - $15 million within five to seven years. PUBLIC HEALTH RELEVANCE: Patient-Tailored Health Literacy Improvement System Low health literacy contributes to a variety of problems including poor individual and collective public health, greater susceptibility to diseases and complex emergencies such as bioterrorism. Because more than half of adults in the U.S. find it difficult to understand health information - health plan coverage, read medication instructions, or understand public health warnings, our nation is not nearly as healthy or as safe as it needs to be. By proposing a new system to advance health literacy, this research project is addressing a $73 billion problem which is at the foundation of our nation's public health system and national security.