Effect of health literacy interventions on pregnancy outcomes: A systematic review

Zibellini, Jessica; Muscat, Danielle M; Kizirian, Nathalie; Gordon, Adrienne

doi:10.1016/j.wombi.2020.01.010

Cited by 39 publications

(38 citation statements)

References 29 publications

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“…To our knowledge, this is the first attempt to systematically summarize the effect of interventions to improve health and care in women with insufficient HL. The previous systematic reviews of the relationship between HL and women’s reproductive health [ 6 , 36 ] have identified a limited number of RCTs, and many lacked clarities as to whether the interventions were an HL intervention consistent with the definition [ 24 ]. A previous systematic review of the effect of HL interventions on pregnancy outcomes similarly identified a limited number of RCTs, with only 2 of the 13 assed by an HL screening tool in order to explore the impact of HL interventions on health outcomes [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

“…The previous systematic reviews of the relationship between HL and women’s reproductive health [ 6 , 36 ] have identified a limited number of RCTs, and many lacked clarities as to whether the interventions were an HL intervention consistent with the definition [ 24 ]. A previous systematic review of the effect of HL interventions on pregnancy outcomes similarly identified a limited number of RCTs, with only 2 of the 13 assed by an HL screening tool in order to explore the impact of HL interventions on health outcomes [ 24 ]. This review identified three new RCTs from the previous, indicating that there is possibly greater interest in the topic; however, identified HL interventions have important research gaps that have to be improved in future research.…”

Section: Discussionmentioning

confidence: 99%

“…Overall, there has been relatively little systematic research comparing the effectiveness of interventions, specifically with regards to any relationships between HL and health outcomes [ 23 , 24 ]. More evidence is needed to identify the optimal way to design interventions to decrease health disparities in women with low HL.…”

Section: Introductionmentioning

confidence: 99%

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Interventions to Improve Health among Reproductive-Age Women of Low Health Literacy: A Systematic Review

Vila‐Candel

Martínez-Arnau

Heras

et al. 2020

IJERPH

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Background: Limited or low health literacy (HL) has been associated with poor health outcomes, including inadequate self-caring and preventive behaviors. A few studies have systematically summarized the effect of interventions to improve reproductive health and care in women with insufficient HL. The main objective of the study was to investigate health care promotion interventions and examine their effectiveness on women with inadequate HL through a systematic review of randomized controlled trials (RCT). Methods: RCTs and quasi-experimental studies that assessed HL interventions to improve reproductive health of women with low HL were included. The study protocol was registered with PROSPERO (CRD42020137059). Results: Of the 292 records initially identified, a total of 6 articles were included for review. Five different HL screening tools were used. Four different interventions were included: educational intervention, communication skills, a multimedia interactive tool, and text adaptation to enhance reading comprehension. Not enough research practice has been conducted on the influence of interventions on HL, and thus, it is difficult to implement evidence-based interventions. Conclusions: Interventions aiming to benefit and improve HL should consider the complex web of intersectional determinants that end up shaping the opportunities of women to make optimal decisions regarding their health and care, and which may require attention to much more than clinical or service delivery factors.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Interventions to Improve Health among Reproductive-Age Women of Low Health Literacy: A Systematic Review

Vila‐Candel

Martínez-Arnau

Heras

et al. 2020

IJERPH

View full text Add to dashboard Cite

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“…However, there remain substantial gaps. In practice, health literacy interventions vary in terms of their study designs, measurement tools, and types of outcome measures [ 21 , 22 ]. Besides, there is a lack of specificity in the intervention targets (e.g., individual level, organizational level, community level), content (e.g., functional health literacy, interactive health literacy, critical health literacy), timing (e.g., antenatal, preschool, adolescence), and formats (e.g., universal, intensive, low-threshold).…”

Section: What Is Known Already?mentioning

confidence: 99%

“…Mounting evidence suggests that low health literacy is associated with adverse health outcomes [ 16 , 17 , 18 ], including frequent use of emergency care, prolonged hospital stays, and high mortality rates, which in turn lead to health disparities [ 19 ]. National and international health programs have shown promising outcomes (e.g., improved health knowledge, healthier behaviours, self-management of chronic illness, access to healthcare) when intervening to improve health literacy [ 20 , 21 , 22 ]. Most recently, the World Health Organization’s Shanghai Declaration on Promoting Health in the 2030 Agenda for Sustainable Development highlighted health literacy as an integral part of the skills developed over a lifetime and recognized it as a critical driver of achieving an equitable world [ 23 , 24 ].…”

Section: Introductionmentioning

confidence: 99%

Moving Health Literacy Research and Practice towards a Vision of Equity, Precision and Transparency

Guo

Okan

2020

IJERPH

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Over the past two decades, health literacy research has gained increasing attention in global health initiatives to reduce health disparities. While it is well-documented that health literacy is associated with health outcomes, most findings are generated from cross-sectional data. Along with the increasing importance of health literacy in policy, there is a lack of specificity and transparency about how to improve health literacy in practice. In this study, we are calling for a shift of current research paradigms from judging health literacy levels towards observing how health literacy skills are developed over the life course and practised in the real world. This includes using a life-course approach, integrating the rationale of precision public health, applying open science practice, and promoting actionable knowledge translation strategies. We show how a greater appreciation for these paradigms promises to advance health literacy research and practice towards an equitable, precise, transparent, and actionable vision.

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Association of Health Literacy Among Nulliparous Individuals and Maternal and Neonatal Outcomes

et al. 2021

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IMPORTANCE Health literacy is considered an important social determinant of health that may underlie many health disparities, but it is unclear whether inadequate health literacy among pregnant individuals is associated with adverse maternal and neonatal outcomes.OBJECTIVE To assess the association between maternal health literacy and maternal and neonatal outcomes among nulliparous individuals. DESIGN, SETTING, AND PARTICIPANTSThis was a secondary analysis of a large, multicenter cohort study of 10 038 nulliparous individuals in the US (2010)(2011)(2012)(2013). Participants underwent 3 antenatal study visits and had detailed maternal and neonatal data abstracted. Data analysis was performed from July to December 2019.EXPOSURES Between 16 and 21 weeks of gestation, health literacy was assessed using the Rapid Estimate of Adult Literacy in Medicine-Short Form, a validated 7-item word recognition test. In accordance with standard scoring, results were dichotomized as inadequate vs adequate health literacy. MAIN OUTCOMES AND MEASURESOn the basis of theoretical causal pathways between health literacy and health outcomes, a priori maternal and neonatal outcomes (determined via medical records) were selected for this analysis. Multivariable Poisson regression models were constructed to estimate the associations between health literacy and outcomes. Sensitivity analyses in which education was removed from models and that excluded individuals who spoke English as a second language were performed. RESULTSOf 9341 participants who completed the Rapid Estimate of Adult Literacy in Medicine-Short Form, the mean (SD) age was 27.0 (5.6) years, and 2540 (27.4%) had publicly funded prenatal care. Overall, 1638 participants (17.5%) had scores indicative of inadequate health literacy. Participants with inadequate health literacy were more likely to be younger (mean [SD] age, 22.9 [5.0] vs 27.9 [5.3] years), have less educational attainment (some college education or greater, 1149 participants [73.9%] vs 5279 participants [94.5%]), have publicly funded insurance (1008 participants [62.2%] vs 1532 participants [20.0%]), and report they were a member of an underrepresented racial or ethnic group (non-Hispanic Black, 506 participants [30.9%] vs 780 participants [10.1%]; Hispanic, 516 participants [31.5%] vs 948 participants [12.3%]) compared with those with adequate health literacy. Participants who had inadequate health literacy had greater risk of cesarean delivery (adjusted risk ratio [aRR], 1.11; 95% CI, 1.01-1.23) and major perineal laceration (aRR, 1.44; 95% CI, 1.03-2.01). The adjusted risks of small-for-gestational-age status (aRR, 1.34; 95% CI, 1.14-1.58), low birth weight (aRR, 1.33; 95% CI, 1.07-1.65), and 5-minute Apgar score less than 4 (continued) Key Points Question Is maternal health literacy associated with maternal and neonatal health outcomes? Findings In this cohort study of 10 038 nulliparous individuals, those with inadequate health literacy had greater odds of cesarean delivery, major perineal lacerations, and ne...

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Effect of health literacy interventions on pregnancy outcomes: A systematic review

Cited by 39 publications

References 29 publications

Interventions to Improve Health among Reproductive-Age Women of Low Health Literacy: A Systematic Review

Interventions to Improve Health among Reproductive-Age Women of Low Health Literacy: A Systematic Review

Moving Health Literacy Research and Practice towards a Vision of Equity, Precision and Transparency

Association of Health Literacy Among Nulliparous Individuals and Maternal and Neonatal Outcomes

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