Health Literacy and Depression in the Context of Home Visitation

Abstract

We explored health literacy in parents as an underlying construct that develops through social interaction and reflection and involves an array of skills that enable a parent to manage personal and child health and healthcare. We hypothesized that depression impairs health literacy and impedes efforts to promote health literacy through home visitation. We analyzed an AHRQ/NIH database of 2,572 parent/child dyads compiled in a 2006–2008 quasi-experimental six-site nationwide study using multiple waves of measurement and a matched comparison group. Cohort families participated in home visitation programs augmented to develop parents’ reflective skills. Visitors monitored depression, health- and healthcare-related practices, and surrounding family conditions at baseline and 6-month intervals for up to 36 months using the Life Skills Progression instrument. We examined differences in initial depression ratings for demographic subgroups and explored patterns of change in health literacy among depressed versus not-depressed parents. Correlation analysis showed that at each of four assessments better depression scores were consistently and positively correlated with use of information and services (r = 21–22, P < .001) and with self-management of personal and child health (r = 42–49, P < .001). Overall, parents made significant improvements in health literacy (P < .001). As expected, depressed parents demonstrated lower baseline health literacy scores than not-depressed parents; however, they achieved greater gains (P < .001). While depression is linked with lower parental health literacy, after 1 year of enhanced home visitation, vulnerable parents were better able to manage personal and family health and healthcare, especially if depressed. Enhanced home visitation could be an effective channel to develop health literacy as a life skill, and to improve depression.

Data-driven maternal health literacy promotion and a postscript on its implications

“…Figure 1 shows that progress continued throughout the study period with different patterns of change consistent with earlier findings [32].…”

“…Participating programs, parents and the intervention are described in detail elsewhere [32]. Briefly, of 2395 socio-economically disadvantaged primary caregivers in our database, 98.5% are mothers.…”

“…In other words, they monitored changes in the degree to which mothers produced the theoretically identified consequences of increased health literacy: improvement in health services utilization, risk behaviors, and selfcare [36]. Two previously validated scales derived from the LSP assess different aspects of maternal health literacy [30,32].…”

Design matters in home visiting improvement

“…This low incidence of new onset depression could be attributed to failed screening and recognition of depression on the home visitors' part, but it has also been documented in the literature that enhanced home visitation may prevent the onset of depression, mitigate depression in others, and prevent moderate depression symptoms from becoming chronic. 19 Thus, it is possible that the data produced in this study reflect previous studies' findings which point to potential for home visiting to protect against parental depression.…”

“…16,17 Additionally, maternal health, depression and interpersonal relationships have been analyzed. [18][19][20][21][22] Home visitor by profession is of significant focus in the literature, with analyses of community lay persons, paraprofessionals and residents providing varied outcomes. 23,24 Interestingly, the majority of strategic plans outlined in the literature have not yet been implemented, evaluated or analyzed in recent research.…”