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2 Reasons & 4 Ways for MCH Home Visitation Programs to Promote Parents’ Health Literacy

Parental Health Literacy: The cognitive and social skills that determine the motivation
and ability of parents to gain access to, understand, and use information and services
in ways that promote and maintain their health and that of their children*. At Beginnings
Guides and the Center for Health Literacy Promotion, we focus on functional health
literacy, that is, what people actually do for personal and child health with the
information and services available to them, or said another way, how people integrate
health info and services into their daily lives.

Reason #1  Skills for effective parenting also are skills for health literacy. Literacy and
health literacy are foundational to the goals of home visitation and to parents’ goals for
their families. Conversely, low literacy and low health literacy are barriers to home visiting
and family goals. Cognitive skills for health literacy are the 3Rs (reading, ‘riting and ’rithmatic),
basic literacy skills needed to participate in society (e.g. employment, healthcare), utilize
community resources,  and promote school readiness. Social skills for health literacy are
interaction and reflection. Home visitors will recognize these skills as the foundation for
attachment and bonding and responsive parenting.

Way #1:  Add local literacy enhancing services to your list of community partners.
Consider adult basic education, English Language Learning, public library programs, GED
programs, and tutoring services.  Plan with them a collaborative process to refer parents
speaker or teacher to help integrate health education into local literacy programs. Use the
Beginnings Pregnancy Guide orParent’s Guide as curriculum to simultaneously address
literacy/health literacy and health education. Or focus a session or series of sessions on
the Key Messages.                  

Way #2 Identify parents with low literacy skills. You can use the ELF, a 3-question screen
that produces a proxy REALM (Rapid Estimate of Adult Literacy in Medicine) score without a
potentially embarrassing and alienating literacy test. Or use this 1- question screen: “How
many books to you have?” Observation or self-report of owning 10 or more adult or child books
indicates adequate literacy. 

Way #3Learn to ask reflective questions. Reflective questions (RQs) or “Teaching  by Asking”
develops interactive and reflective skills –  the social skills at the foundation of both health literacy
and parenting. RQ’s require the parent to think about facts, events, behaviors; link to feelings,
consequences, knowledge, experience; and formulate a positive, purposeful response.; in short, to

Reason #2 Home visitors’ usual efforts can promote health literacy. Health literacy is
promoted through health education, skills development and direct assistance to use info and
services for health. So, when visitors are equipped with knowledge of health literacy and some
simple strategies, usual health education and skills development efforts to promote attachment
and bonding, responsive parenting, and school readiness can also promote functional health
literacy.                  

Way #4  Offer direct assistance to use info and services for health. This part may be new
to home visitors. Training is available to help programs integrate assistance to make meaning
from information and apply it in context into health education activities. This may be as simple
as inviting the parent to read aloud and highlight a pertinent paragraph from Beginnings Guides
and then talking about it together. Reading aloud takes learning deeper faster because it uses
multiple senses.  Or direct assistance might be reviewing with the parent materials obtained at
a doctors’ visit, such as an appointment slip for the next visit. Ensure the parent can find the
time and date; enter the appointment on a calendar. Then discuss what needs to happen to keep
the appointment (transportation, childcare, time off work), and what questions s/he wants to ask
the doctor.

Notes & References *Adapted from the definition of maternal health literacy in Renkert, S. &
Nutbeam, D. (2001). Opportunities to improve maternal health literacy through ante-natal
education: An exploratory study. Health Promotion International, 16, 381–388.

Stay tuned for more reasons and ways to promote health literacy in home visitation.

Davis, T.C., Crouch, M.A., Long, S.W., Jackson, R. H., Bates, P. George, R.B. & Bairnsfather,
L.E. (1991). Rapid assessment of literacy levels of adult primary care patients. Family Medicine,
23, 433-435.

Bennett, I.M., Robbins, S. & Haecker, T. (2003). Screening for low literacy among adult
caregivers of pediatric patients. Family Medicine, 35, 585-590

Slade A, Grienenberger J, Bernbach E, Levy D & Locker A.( 2005). Maternal reflective functioning,
attachment, and the transmission gap: a preliminary study.Attachment and Human Development
7(3):283-98. Wallace, L. S., Rogers, E. S., Roskos, S. E., Holiday, D. B. & Weiss, B. D. (2005).
Brief report: Screening items to identify patients with limited health literacy skills. Journal of
General Internal Medicine, 21, 874–877.
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