2010 Health Literacy Annual Research Conference...continued
of MFL says that
literacy always is used for some practical
purpose or function.
the room has many functional literacies at different levels of proficiency.
Each of your functional literacies
enables you to participate / function in some social context. I agree with audience commentator this
morning who suggested that “advanced” skills can make up for low basic
skills. For example, computer literacy is a functional literacy that enables you to send email,
produce a document, maybe Tweet.
Perhaps without reading the manual.
Similarly, FHLenables individuals to participate in healthcare and to take care
of themselves and others; to exert increasing control over their health and its
determinants. Even with limited
understanding of medical terms.
We measured FHL at initiation of home
visits, every 6 mo and at close of service for up to 36 months. We used Linda Wollesen’s Life Skills Progression
instrument – the LSP. The LSP has
been in use by HV programs for 10 yrs.
It was published by Brookes in 2006. The instrument is not completed by
parents. Rather, it synthesizes the HVs’ formal and informal assessments,
observations and interviews conducted over the last 6 mo period. Comparison of
sequential measures shows progress/regression over time.
I derived 2 scales from the LSP
measure FHL. This FHcL S rates a parent’s use of healthcare &
FScL S rates
parents’ management of personal and child health at home.
show good internal consistency
and good criterion validity
using several skills development measures and concurrent service utilization records
We analyzed results by reading level, age and
to determine who improved. We also assessed effects of attrition.
parents demonstrated statistically significant improvement in FHL in the first
6 mo of service and continued to improve at a slower rate over time.
achieved improvement regardless of reading ability. In fact, parents with lower
estimated baseline reading level made the greatest gains.
started at a major disadvantage. And
they made significant gains in the first 6 mo of service to achieve parity with
their older counterparts.
ethnicities improved --in different patterns. We are still investigating the
visiting seems to have greatest impact
on lower functioning parents. The target score -- indicating adequate to
optimal functioning-- is >4.
88% of mothers who entered svc with a score of 3 improved their use of
healthcare; comparedto 63% of those
with entry score of 4.
Analysis of the Healthy Start cohort
showed that attrition of lower functioning parents did not differ from
attrition of higher functioning parents. Nor did attrition change the
proportion of parents who demonstrated improvement over time.
Comparison of matched parents
confirmed these findings and indicated improvements were not due to community
events or to simple maturation.
findings suggest that the health promotion model of HL intervention is
practical for implementation using home visiting; accessible, attractive,
persuasive materials; and reflective practices focused on developing interactive
and reflective skills.
intervention is profiled as a Quality
Innovation on the AHRQ Innovations Exchange.
We concluded that HVs can promote FHL and empower parents to better manage personal and
family health & healthcare.
I want to
leave you with a possibility to ponder…. It may be feasible to mount a national response to HL through the
existing networks of home visitation programs, with immediate and long term
benefits accruing to entire families over their lifetimes, and to the
healthcare system, and the schools.