Maternal Health Literacy Progression Among Rural Perinatal Women

Abstract

This research examined changes in maternal health literacy progression among 106 low income, high risk, rural perinatal African American and White women who received home visits by Registered Nurse Case Managers through the Enterprise Community Healthy Start Program. Maternal health literacy progression would enable women to better address intermediate factors in their lives that impacted birth outcomes, and ultimately infant mortality (Lu and Halfon in Mater Child Health J 7(1):13–30, 2003; Sharma et al. in J Natl Med Assoc 86(11):857–860, 1994). The Life Skills Progression Instrument (LSP) (Wollesen and Peifer, in Life skills progression. An outcome and intervention planning instrument for use with families at risk. Paul H. Brookes Publishing Co., Baltimore, 2006) measured changes in behaviors that represented intermediate factors in birth outcomes. Maternal Health Care Literacy (LSP/M-HCL) was a woman’s use of information, critical thinking and health care services; Maternal Self Care Literacy (LSP/M-SCL) was a woman’s management of personal and child health at home (Smith and Moore in Health literacy and depression in the context of home visitation. Mater Child Health J, 2011). Adequacy was set at a score of (≥4). Among 106 women in the study initial scores were inadequate (<4) on LSP/M-HCL (83 %), and on LSP/M-SCL (30 %). Significant positive changes were noted in maternal health literacy progression from the initial prenatal assessment to the first (p < .01) postpartum assessment and to the final (p < .01) postpartum assessment using McNemar’s test of gain scores. Numeric comparison of first and last gain scores indicated women’s scores progressed (LSP/M-HCL; p < .0001) and (LSP/M-SCL; p < .0001). Elevated depression scores were most frequent among women with <4 LSP/M-HCL and/or <4 LSP/M-SCL. Visit notes indicated lack or loss of relationship with the father of the baby and intimate partner discord contributed to higher depression scores.

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

“…This has not been achieved by information improvement initiatives in child health [8]. Further, previous LSP studies showed reductions in disparities related to age [30] and mental health [16,32].…”

“…Mobley and colleagues [16] found that rural mothers with low MHL scores had problems with housing and transportation. This finding suggested that the social determinants of health (SDoH) might be significant factors in MHL.…”

“…Advanced HL skills developed even where functional skills were weak. Focus on developing interactive and critical skills, especially reflection, through a collaborative, mother-directed, problem-focused process consistently improved MHL scores [7,12,16,30].…”

“…Two studies [16,32] found that depressed mothers improved their MHL scores in part by obtaining treatment for depression, demonstrating increased understanding of information and services, and increased control over actions and decisions affecting the dyad's health. Another study found MHL also empowered service providers in three Parents as Teachers programs [7].…”

“…Non-scientist service providers working in uncontrolled home and community environments demonstrated ability to collect quality data, interpret and use it to personalize intervention for specific individuals and circumstances. Paraprofessionals [7,30], social workers [12], and nurse case managers [16] were shown to be effective catalysts to MHL improvement.…”