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Center for Health Literacy Promotion Blog

2 Reasons & 4 Ways for MCH Home Visitation Programs to Promote Parents’ Health Literacy

Parental Health Literacy: The cognitive and social skills that determine the motivation and ability of parents to gain access to, understand, and use information and services in ways that promote and maintain their health and that of their children*. At Beginnings Guides and the Center for Health Literacy Promotion, we focus on Maternal Health Literacy, that is, what mothers actually do for personal and child health with the information and services available to them, or said another way, how mothers integrate health info and services into their daily lives.
 
Reason #1  Skills for effective parenting also are skills for health literacy.
Literacy and health literacy are foundational to the goals of home visitation and to parents’ goals for their families. Conversely, low literacy and low health literacy are barriers to home visiting and family goals. Cognitive skills for health literacy are the 3Rs (reading, ‘riting and ’rithmatic),basic literacy skills needed to participate in society (e.g. employment, healthcare), utilize community resources,  and promote school readiness. Social skills for health literacy are interaction and reflection. Home visitors will recognize these skills as the foundation for
attachment and bonding and responsive parenting.
 
Way #1:  Add local literacy enhancing services to your list of community partners.
Consider adult basic education, English Language Learning, public library programs, GED programs, and tutoring services.  Plan with them a collaborative process to refer parents speaker or teacher to help integrate health education into local literacy programs. Use the Beginnings Pregnancy Guide or Parent’s Guide as curriculum to simultaneously address literacy/health literacy and health education. Or focus a session or series of sessions on the Key Messages.                  
 
Way #2 Identify parents with low literacy skills. You can use the ELF, a 3-question screen that produces a proxy REALM (Rapid Estimate of Adult Literacy in Medicine) score without a potentially embarrassing and alienating literacy test. Or use this 1- question screen: “How many books to you have?” Observation or self-report of owning 10 or more adult or child books indicates adequate literacy. 
 
Way #3 Learn to ask reflective questions. Reflective questions (RQs) or “Teaching  by Asking” develops interactive and reflective skills –  the social skills at the foundation of both health literacy and parenting. RQ’s require the parent to think about facts, events, behaviors; link to feelings,consequences, knowledge, experience; and formulate a positive, purposeful response.; in short, to Think, Link and Respond.
 
Reason #2 Home visitors’ usual efforts can promote health literacy. Health literacy is promoted through health education, skills development and direct assistance to use info and services for health. So, when visitors are equipped with knowledge of health literacy and some simple strategies, usual health education and skills development efforts to promote attachment and bonding, responsive parenting, and school readiness can also promote functional health literacy.                  
 Way #4  Offer direct assistance to use info and services for health. This part may be new to home visitors. Training is available to help programs integrate assistance to make meaning from information and apply it in context into health education activities. This may be as simple as inviting the parent to read aloud and highlight a pertinent paragraph from Beginnings Guides and then talking about it together. Reading aloud takes learning deeper faster because it uses multiple senses.  Or direct assistance might be reviewing with the parent materials obtained at a doctors’ visit, such as an appointment slip for the next visit. Ensure the parent can find the time and date; enter the appointment on a calendar. Then discuss what needs to happen to keep the appointment (transportation, childcare, time off work), and what questions s/he wants to ask the doctor.
 
Notes & References *Adapted from the definition of maternal health literacy in Renkert, S. & Nutbeam, D. (2001). Opportunities to improve maternal health literacy through ante-natal education: An exploratory study. Health Promotion International, 16, 381–388.
 
Stay tuned for more reasons and ways to promote health literacy in home visitation.
 
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L.E. (1991). Rapid assessment of literacy levels of adult primary care patients. Family Medicine,
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Bennett, I.M., Robbins, S. & Haecker, T. (2003). Screening for low literacy among adult
caregivers of pediatric patients. Family Medicine, 35, 585-590
 
Slade A, Grienenberger J, Bernbach E, Levy D & Locker A.( 2005). Maternal reflective functioning,
attachment, and the transmission gap: a preliminary study.Attachment and Human Development
7(3):283-98. Wallace, L. S., Rogers, E. S., Roskos, S. E., Holiday, D. B. & Weiss, B. D. (2005).
Brief report: Screening items to identify patients with limited health literacy skills. Journal of
General Internal Medicine, 21, 874–877.
 
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