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Depressed mothers in home visitation significantly improve their health literacy

My article published by MCH Journal.
Full text free online

Both depressed and not-depressed parents achieved significant improvements in health
literacy with 12-18 months participation in a home visiting program trained in reflective
practice.  Depressed parents made the greatest gains to nearly catch up with their
not-depressed counterparts.  The overall rate of depression decreased significantly, but
slightly. Still, we saw a 29% reduction in untreated depression and a smaller than expected
rate of new cases developed during service.  Mothers made major improvements in health
literacy, even where improvement in depression was minor.  These findings, published
online Dec 2, 2011 by the Maternal and Child Health Journal, call into question some widely
held beliefs and break new ground in health literacy research.   Free full text article

Both low health literacy and depression have been considered barriers to using adult
and child healthcare services.  And home visitors and supervisors have reported that
depression interferes with their ability to deliver home visitation services.  However,
mothers in my study demonstrated increased understanding and utilization of child
sick care and preventive services, and a notable increase in their use of mental health
services, demonstrating improved health literacy.

Health Literacy can be Promoted
As far as I can tell, this is the first reported implementation of the health promotion 

Home Visitation can Lead a National Response to Health Literacy & Depression
We chose MCH home visitors as the channel to promote parents’ health literacy for several
reasons which are strengthened by the roll out to the Affordable Care Act:

• Parents participating in home visitation are new healthcare decision makers for growing
at- risk families. Successful efforts can benefit entire families through their lifetimes
with short and long-term benefits to the healthcare system and to the schools.
• As a population, home visited families are characterized by low income, low education,
low literacy and limited access to healthcare. Most of these families will gain access under
health reform and will need significant support to obtain the benefits of newly available
• Home visitors’ unique access, frequent extended encounters, and long term trusting
relationships position them to observe and to influence the complex interaction of multiple
factors that determine parents’ health literacy, which are not readily visible or modifiable
in a clinical setting.
• Health education and skills development, primary methods for promoting health literacy,
are usual activities of home visitation, so we could integrate health literacy promotion into
their current practices.

• There is an existing national infrastructure of home visiting programs, which is expanded
to all the States and Territories under health reform.  Therefore, it is increasingly feasible
to mount a national response to health literacy through home visitation.

Special thanks to National Library of Medicine and NW Regional Library of Medicine at
University of WA for funding this work and our next study on how parents’ health literacy
affects child development.

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