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Community-Based Intervention Part 1

2010 Health Literacy Annual Research Conference
Sandra Smith

The purpose of the study I’m going to tell you about was to evaluate a community-based intervention that aimed to promote functional health literacy in parents during the prenatal to preschool period.

We implemented the health promotion model of health literacy intervention that Don Nutbeam talked about this morning.   We took an activist approach to promote FHL in parents as a personal and community asset that enables a person to use info & svs in ways that enhance health.  We aimed to develop the asset through health promotion activities, notably health education and skills development including direct assistance to personalize info and apply it in context for personal benefit. 

We reasoned that MCH home visitation programs could be an effective channel to promote FHL due to visitors’ uniqueaccess, trusting relationships, and usual HEd & skills development activities. HVs are nurses, social workers and paraprofessionals. They work in national networks – EHS, NHS, PAT, HFA- and in state systems and independent programs. These programs aim to promote MCH & school readiness. Home visitors typically make 1-4 visits per mo lasting 1-2 hrs over a period of 6 mo to 5 yrs.  They currently reach 500,000 families annually.  The Obama administration is supporting expansion of these programs.

We reasoned further that parents in home visitation are new healthcare decision makers for growing families. They are using significant health services, often for the first time. Their pregnancy and early parenting experience produces high readiness to learn and change.  As a population, they are characterized by poverty, low education, low literacy, and limited access to care – a recipe for low HL. 
Our research Q  was “What are the short term and intermediate outcomes from implementation of a home-based intervention that aims to promote FHL in a diverse population of disadvantaged parents?”

We implemented the intervention in these 6 home visiting programs. You’ll note they represent different models of home visiting and various geographic areas. The sites serve urban, suburban, rural populations.

Here you can see the robust diversity of our study population of over 2500 parent/child pairs.  32% African American; 18% Latina; 28% Caucasian; 20% unknown or missing
We trained 66 HVs to assist parents to personalize and apply info on pregnancy, prenatal care, early child development & parenting. They used these HEd materials - BG to pregnancy and early parenting and also worked with info from providers and other sources. The materialsarewritten at a 4grade level in Eng, 3  grade in Sp. They exemplify the published guidelines for health info intended for Medicaid beneficiaries. And they are demonstrated suitable & satisfying for both college educated and under-educated parents.

HVs learned reflective practices, notably reflective questioning, to develop parents’ interactive and reflective skills.  Literacy scholars categorize Interaction and reflection (also referred to as critical reflection or critical literacy – the term DN used this AM.)  I&R are advanced literacy skills & advanced HL skills.  … Basic literacy skills – Reading & numeracy, are used to understand info. I& R are used to make meaning from info and apply it in context.  Lit scholars have referred to R as the mind’s strongest glue, and the 4th R: reading, ‘riting, ‘rithmatic and reflection.

Interactive & reflective skills also are the foundation for the kind of responsive parenting on which optimal child development depends, particularly language and literacy development. So efforts to promote parents’ advanced HL skills might have multi-generational effects.

We field tested the intervention in a 2yr quasi-experimental multi-group cohort study using multiple waves of measurement and geographic comparison groups. We also used a matching process to create a comparison group within the cohort.
We operationalized HL as one of MFL.  Nutbeam talked about FL this morning as basic literacy skills that enable a person to function in society.  I look at FL a little differently. Where DN refers to basic skills only, I include the array of skills.  

Check back for part 2 tomorrow...
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