Dang. I just discovered another bias in my thinking.
A belief I picked up on the way to a research degree? Knowledge someone taught me? Not sure. It's one of those things everyone just knows- well everyone in US research: US studies are better. Higher quality. More relevant.
I made this uncomfortable, but horizon-widening discovery while working on a scoping review to find out what is reported in the literature about the impact of maternal health literacy on maternal-child health in the 0 to 3 period (pregnancy to child's third birthday) in the US. The review includes only US studies; in part, because that's the defined task. But I wonder if we would have set that limit anyway.
The short answer to our US research question is: Not much. Most studies of parents' health literacy are meditational analyses that explore how one variable (usually a low reading test score) affects a second variable (most often understanding of condition-specific information or utilization of services). If we distinguish maternal health literacy from parents' health-related literacy, the number of US studies can be counted on one hand. More on that useful distinction another time.
Interventions to improve health literacy are not so rare
US literature reviews agree that health literacy intervention studies remain rare, especially community based studies geared to diverse low literacy audiences. True in America, but…
I've found and saved, but excluded from the current review, papers from Iran, Zambia, Ghana, Uganda, Paraguay, Madagascar, Nigeria…..These reports are about community based interventions to improve maternal health literacy in medically underserved poverty populations. The interventions are designed to be feasible in low-resource settings. These studies from low and middle income countries are likely to be quite relevant and informative for many low and middle income American counties where literacy levels are low, cultures are diverse, access to information and services is limited, and poverty defines every day life for mothers and children.
Lesson learned: those who have the problem are most likely to know the solution. We have a corner on resources, but not on scholarship and useful knowledge.