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More Reasons and Ways to Promote Health Literacy in Home Visitation

Reason #3   Health literacy is used most often at home

Most health/medical information is digested, understood and applied (or not) at home in
the context of family and everyday real life circumstances. While health literacy typically
is discussed in the context of healthcare encounters and documents, most health-related
decisions are made at home. Most medications and treatments are administered at home.
Preventive actions and health promoting practices happen at home.

Home visitors’ unique access to families at home and trusting relationships built through
frequent encounters (1 to 4 per month for 1-2 hours) over an extended period (6 to 36
months) position visitors to observe and influence the interaction of multiple factors
functional health literacy. These factors are not readily visible in healthcare settings and
are difficult to address in brief, often stressful episodic encounters.

Way # 5  Lead a reflective conversation to link info to experience

Healthcare professionals appropriately focus on reducing barriers to effective use of
health/medical information and services by improving information and provider-patient
communication. Home visitors’ complement and leverage these systems-level efforts by
directly assisting parents to personalize the information and use it to maintain or
improve personal and family health.

Mary was given information about maternal depression at her son Ralph’s well baby checkup.
She read it and understood the words, but did not connect the information to herself. A few
days later, when Mary’s home visitor asked her about Ralph’s checkup, Mary showed her the
depression info. The visitor had previously noted depressive symptoms in Mary and recognized
a teachable moment. She engaged Mary in a reflective conversation around the information.
She asked, “Have you experienced any of these signs of depression?” “Why do you think those
feelings started when they did?” “How does the baby respond to you when you’re feeling so sad?”
“What have you tried to feel better?”

Mary came to recognize her own depression and its impact on her child. She decided to take
a daily walk with the baby to relieve stress, a “baby step” toward improving her health and
supporting baby Ralph’s healthy development. Mary’s health literacy increased when, with
the assistance of the home visitor, she was able to personalize the information, to see what it
meant for her in her situation. Through interaction and reflection with the visitor, Mary linked
the new information about depression to her own experience and her child’s behaviors, so the
info became knowledge.She formulated a positive response, a health action that with the visitor’s
ongoing support became a health-promoting practice. In the process, Mary gained knowledge and
built her health literacy and parenting skills (interaction and reflection). She discovered herself
as a problem solver and a health manager. She developed a deeper understanding of the concept
of self-care as a way to enhance her child’s health.

Mary’s home visitor gave no additional information; she gave no advice, offered no solutions.
Rather, she asked a few reflective questions, stood by while Mary figured out for herself what she
should do, and then supported her in doing it. The home visitor empowered Mary to use information
and services to enhance health. That’s promoting functional health literacy.

A true teacher is one who makes you aware of what you already have and encourages you to use it.
A true teacher will not do it for you. Instead they sit with you as you figure out how to do it for
yourself.”  Iyanla Vanzant, Until Today
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