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Community-Based Intervention Part 2

2010 Health Literacy Annual Research Conference...continued
Sandra Smith

The theory of MFL says that literacy always is used for some practical purpose or function.   Everyone in 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 to measure FHL.  This FHcL S  rates a parent’s use of healthcare & info.  FScL Slide FScL S rates parents’ management of personal and child health at home. These scales show good internal consistency, high inter-rater reliability and  good criterion validity using several skills development measures and concurrent service utilization records. We analyzed results by reading level, age and race-ethnicity to determine who improved.  We also assessed effects of attrition.

Overall, parents demonstrated statistically significant improvement in FHL in the first 6 mo of service and continued to improve at a slower rate over time.


Parents achieved improvement regardless of reading ability. In fact, parents with lower estimated baseline reading level made the greatest gains.   

Teens started at a major disadvantage.  And they made significant gains in the first 6 mo of service to achieve parity with their older counterparts.

All ethnicities improved --in different patterns. We are still investigating the differences.

Home 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. 


These 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. The 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. 

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