Parental Literacy and Infant Health: An Evidence-Based Healthy Start Intervention

Is Timing of Enrollment Associated with Birth Outcomes? Findings from a Healthy Start Program in Kansas

Objective The Sedgwick County Healthy Babies Healthy Start (HBHS) program provides community-based services (including care coordination, interconception care and home visiting) aimed at reducing racial/ethnic disparities in poor birth outcomes. The purpose of this study is to assess the effectiveness of the Sedgwick County HBHS program by comparing the birth outcomes of program participants who enrolled prenatally and those who did not participate while pregnant. Methods In this retrospective cohort study, we used data drawn from the Sedgwick County HBHS program. The sample included 280 clients who were enrolled in the Sedgwick County HBHS program between September 2014 and December 2015. We performed logistic regression analyses to assess the associations between enrollee type (prenatal enrollee vs. interconceptional enrollee) and birth outcomes (low birth weight, preterm birth). Results The majority of the sample consisted of racial/ethnic minority women (32.1% non-Hispanic black, 31.8% Hispanic). After adjusting for covariates, women who enrolled in the Sedgwick County HBHS program prenatally were less likely than women who were not enrolled during pregnancy to have a preterm birth (OR 0.19, [CI 08, 0.43]) and deliver a low birth weight infant (OR 0.31, [CI 0.10, 0.97]). Conclusions for Practice Women, particularly minority women, who participate in the HBHS program experienced better birth outcomes than women who did not participate in the program during pregnancy. However, findings also suggest that interconceptional enrollees may stand to benefit from continued participation in the program.

Filling out the forms: Health literacy among the uninsured

This study addresses health literacy among patients at a free clinic in Syracuse, NY. Researchers conducted chart reviews of 600 patients and qualitative interviews with 22 patients and 7 providers. Most clinic patients had a high school, or higher, level education and no difficulty with reading comprehension. Nevertheless, a majority had at least some difficulty with comprehending and following through on health information. For many interviewees, the greatest difficulty was completing the required forms for entitlement programs. The findings demonstrate that low health literacy may occur even among well-educated patients and recommend that health literacy be assessed for all patients.

Community health agency administrators' access to public health data for program planning, evaluation, and grant preparation

The Affordable Care Act mandates that public health data be made available for community agency use. Having access to such data allows community agencies to tailor interventions, evaluations, and funding requests more effectively. This study, jointly undertaken by Syracuse University faculty and students with the New York State Perinatal Association, sought to understand community agencies' access to requests for governmental data, as well as to identify areas for improving data access. Results from this survey of administrators from 43 agencies in New York State found that only one-half of their requests for data were successful. Difficulties in obtaining access to needed data included fiscal and staffing constraints of the state-level agencies that house the data, as well as possible overinterpretation of confidentiality policies. In addition, some of community agency respondents reported that their staff lacked skills in data analysis and would benefit from training in epidemiology and quantitative evaluation.

Health literacy of mothers accessing child development services: a model of information use

This study aimed to explore how mothers use information in home therapy programs within child development services. A grounded theory study using semistructured interviews was conducted with 14 mothers of children aged 3-6 years accessing occupational therapy, physiotherapy and speech pathology services for developmental needs. A conceptual model of mothers' information use was developed. Findings showed that the mothers went through a cyclical process of information use and decision making: acquisition (collaboration, learning preferences), appraisal (understanding, relevance), application (capacity, resourcefulness) and review (evaluation, modification), with contextual factors including information characteristics, environment, personal characteristics and relationships. Mothers who used information effectively had a sense of confidence, control and mastery, and were empowered to apply information to make decisions and adapt their child's home therapy. This study adds to knowledge about health literacy, specifically how mothers interpret and use health-related information at home. Findings will enable health professionals to address families' unique health literacy needs and empower them to support their child's optimal development, functioning and participation at their stage of life.

An evidence-based public health approach to climate change adaptation

BACKGROUND

Public health is committed to evidence-based practice, yet there has been minimal discussion of how to apply an evidence-based practice framework to climate change adaptation.

OBJECTIVES

Our goal was to review the literature on evidence-based public health (EBPH), to determine whether it can be applied to climate change adaptation, and to consider how emphasizing evidence-based practice may influence research and practice decisions related to public health adaptation to climate change.

METHODS

We conducted a substantive review of EBPH, identified a consensus EBPH framework, and modified it to support an EBPH approach to climate change adaptation. We applied the framework to an example and considered implications for stakeholders.

DISCUSSION

A modified EBPH framework can accommodate the wide range of exposures, outcomes, and modes of inquiry associated with climate change adaptation and the variety of settings in which adaptation activities will be pursued. Several factors currently limit application of the framework, including a lack of higher-level evidence of intervention efficacy and a lack of guidelines for reporting climate change health impact projections. To enhance the evidence base, there must be increased attention to designing, evaluating, and reporting adaptation interventions; standardized health impact projection reporting; and increased attention to knowledge translation. This approach has implications for funders, researchers, journal editors, practitioners, and policy makers.

CONCLUSIONS

The current approach to EBPH can, with modifications, support climate change adaptation activities, but there is little evidence regarding interventions and knowledge translation, and guidelines for projecting health impacts are lacking. Realizing the goal of an evidence-based approach will require systematic, coordinated efforts among various stakeholders.

Pregnancy and birth outcome improvements for American Indians in the Healthy Start project of the Inter-Tribal Council of Michigan, 1998-2008

American Indians living in Michigan experience disproportionately high rates of infant mortality. This 11-year (1998-2008) cohort study evaluated impacts of a Healthy Start (HS) program administered by the Inter-Tribal Council of Michigan (ITCM) on perinatal outcomes. Women who enrolled in ITCM's HS program ("exposed") were compared with non-enrolled ("unexposed") for four outcomes: low birth weight (LBW), small for gestational age, preterm birth, and inadequate prenatal care. To classify exposed and unexposed women and their children, Michigan vital records data were linked with HS enrollment records to identify participants and non-participants among all American Indian births. Logistic regression was used to calculate odds ratios for the four outcomes of interest. Analyses were stratified for high and low access to care based on Medically Underserved Area (MUA) designation for a woman's county of residence. Of 4,149 American Indian births during the period, 872 were to women who enrolled prenatally in HS. Although unstratified analysis showed no differences between HS participants and non-participants, stratified analyses demonstrated that participants from MUA counties had decreased odds of LBW and inadequate prenatal care. Results suggest that in MUA counties where participants and non-participants are at similar risk for poor outcomes, HS may be reducing barriers and improving outcomes. In non-MUA counties participants had similar outcomes as non-participants. These results may reflect a wider disparity in risk factors between the two groups in non-MUA counties. The complex interplay among need, access, and benefit complicates analyses and suggests the importance of more in-depth and focused studies.

Describing adolescent breastfeeding environments through focus groups in an urban community

PURPOSE

Breastfeeding is a potential solution to improve health outcomes for adolescent mothers and infants. Adolescence is a risk factor for low breastfeeding rates and is associated with a higher risk for perinatal complication. This study investigated facilitators and barriers to adolescent breastfeeding initiation and duration in an urban setting.

METHODS

Four, 1-hour focus groups were conducted. Twenty-nine (N = 29) adolescent mothers and pregnant adolescents participated and described attitudes toward breastfeeding, attitudes among family and friends, current knowledge, and barriers and facilitators for breastfeeding.

RESULTS

Four themes emerged, including the following: behavioral histories of breastfeeding, community assets, social support, and barriers. Participants identified positive histories and community resources such as local hospitals and social services as facilitators. Lifestyle, independence, lack of support from family and primary care providers, social stigma/embarrassment, and difficulty with breastfeeding techniques were described as barriers.

CONCLUSION

A comprehensive and integrated primary care and public health community effort is needed to support and improve adolescent breastfeeding. Further examination of integrated interventions focused on adolescent breastfeeding behaviors through an environmental approach is needed.

Understanding the impact of health literacy on women's health

Low health literacy negatively affects a woman's health knowledge, preventive behavior, ability to navigate the health care system, and ability to care for her children. Interventions to increase a woman's heath literacy include written education materials with proper reading level and design, clear communication, and education to increase health knowledge, self-efficacy, and self-advocacy skills. Health literacy should also be incorporated in nursing education programs.

Parental understanding of infant health information: health literacy, numeracy, and the Parental Health Literacy Activities Test (PHLAT)

OBJECTIVE

To assess parental health literacy and numeracy skills in understanding instructions for caring for young children, and to develop and validate a new parental health literacy scale, the Parental Health Literacy Activities Test (PHLAT).

METHODS

Caregivers of infants (age <13 months) were recruited in a cross-sectional study at pediatric clinics at 3 academic medical centers. Literacy and numeracy skills were assessed with previously validated instruments. Parental health literacy was assessed with the new 20-item PHLAT. Psychometric analyses were performed to assess item characteristics and to generate a shortened, 10-item version (PHLAT-10).

RESULTS

A total of 182 caregivers were recruited. Although 99% had adequate literacy skills, only 17% had better than ninth-grade numeracy skills. Mean score on the PHLAT was 68% (standard deviation 18); for example, only 47% of caregivers could correctly describe how to mix infant formula from concentrate, and only 69% could interpret a digital thermometer to determine whether an infant had a fever. Higher performance on the PHLAT was significantly correlated (P < .001) with education, literacy skill, and numeracy level (r = 0.29, 0.38, and 0.55 respectively). Caregivers with higher PHLAT scores were also more likely to interpret age recommendations for cold medications correctly (odds ratio 1.6, 95% confidence interval 1.02, 2.6). Internal reliability on the PHLAT was good (Kuder-Richardson coefficient of reliability = 0.76). The PHLAT-10 also demonstrated good validity and reliability.

CONCLUSIONS

Many parents do not understand common health information required to care for their infants. The PHLAT and PHLAT-10 have good reliability and validity and may be useful tools for identifying parents who need better communication of health-related instructions.