Think of health literacy as an array of skills that enable a person
to use information and services to enhance health. Using information
for health implies ability to obtain, process and understand the
information; and beyond that, to make meaning from it and apply it in
context for personal benefit. Using information further implies
motivation – attitudes and beliefs that generate the interest and
passion required for decision making, action, and especially for change.
Think of a health literate mother as one who can:
· Express her needs (say what is wrong or missing; describe symptoms,
· Describe her best possible desired outcome (say what she wants)
· Articulate her concerns (say what is in the way, what she fears)
· Notice supports (say what is helping, what has worked, who will help)
· Participate in decision-making (ask questions, weigh options, consider consequences)
· Take action toward achieving the desired outcome
(move baby step by baby step toward her vision of personal and family health)
To promote a mother’s health literacy means to empower her to
exert increasing control over her personal and family health.
In my research, home visitors who were trained to recognize signs
of depression in mothers and infants/toddlers were further trained
to use reflective questioning to enable a mother to express her needs,
describe her desired outcome, articulate her concerns and supports,
formulate a purposeful response, and take planned action – that is to
promote maternal health literacy.
A surprisingly high proportion of depressed mothers practicing
reflection with the home visitors sought treatment for their
depression. In a sample of 704 mothers who participated in home
visitation for 12-18 months, 101 (14%) were depressed throughout
the service period; of these 69% were in treatment at least some of the
time. Compare that to previous reports of 20% of persistent cases
obtaining treatment. Of parents who developed symptoms during
service (n= 50, 9%), 62% obtained treatment (n= 31), exceeding a
previously reported rate of a 13.5% for emergent cases.
Seeking treatment for one’s own depression demonstrates multiple
health literacy skills (e.g.) obtaining, reading and understanding
information; planning, problem solving, appointment making,
decision making, action-taking). It demonstrates motivation
strong enough to overcome depression and multiple barriers
to care (e.g. stigma; lack of insurance, transportation, child care).
These skills and motivations are the makings of an “activated patient”
taking responsibility for her health and her child’s health. They are the
marks of a health literate mother. Promoting a person’s health literacy
means empowering them to use information and services to exert increasing
control over their health and its determinants.
Institute of Medicine. (2004). Health literacy: A prescription to end confusion.
Committee on Health Literacy, Board of Neuroscience and Behavioral Health.
Nielsen-Bohlman, A.M. & Kendig, D.A. (Eds.). (2004). Washington, DC: National
Nutbeam, D. (1998). Health promotion glossary. Health Promotion International,
Nutbeam, D. (2008). The evolving concept of health literacy. Social Science &
Medicine, 67, 2072-2078.
Weiss, B.D., Francis, L., Senf, J.H., Heist, K. & Hargraves, R. (2006). Literacy
education as treatment for depression in patients with limited literacy and depression.
Journal of General Internal Medicine, 21, 823–828.