This interdisciplinary study extends and strengthens the U.S. clinical care approach to health literacy by (1) proposing a theoretical framework that focuses on functional health literacy (FHL); (2) field testing an instrument for measuring FHL; and (3) investigating the impacts of home visitation on parental FHL. The theoretical framework incorporates Nutbeam's concept of health literacy as progressive levels of functional, interactive and reflective skills to measure FHL as corresponding progressive levels of health functioning. The intervention aimed to develop FHL as a personal asset through community-based health promotion efforts. The overarching goal, to enable parents to use health information and services in ways that maintain and promote health and so to exert greater control over family health and health actions, differs fundamentally from the clinical goal of overcoming deficient reading skill in patients in order to improve their health and ensure efficiency in the system.
In this action research project of the Home Visitors Research Network, six home visitation programs and one telephonic service implemented the Beginnings Guides Life Skills Development Curriculum to promote FHL and reflective functioning in disadvantaged parents during the prenatal to preschool period. Visitors collected data on the health functioning of 2532 parent/child pairs during up to 36 months of service, using the Life Skills Progression Instrument (LSP) and the Functional Health Literacy Measure (FHLM say film) derived from the LSP for this project. Parents demonstrated statistically significant improvement in FHL in periods as short as six months regardless of reading level. Results show that (1) home visitation promotes parental FHL; (2) it is possible to meaningfully measure FHL using the FHLM; (3) the public health model of health literacy promotion is practical for implementation, improves understanding of health literacy, and opens new directions for intervention. Reflection emerged as a literacy skill potentially as fundamental as reading ability to attaining and promoting functional health literacy. A national public health response to health literacy may be feasible through existing national networks of home visitation programs with short and long term benefits accruing to entire families over their lifetimes, to the healthcare system, and to the schools.
|School:||Union Institute and University|
|School Location:||United States -- Ohio|
|Source:||DAI-B 70/09, Dissertation Abstracts International|
|Subjects:||Public health, Health education, Health care management|
|Keywords:||Action research, Health literacy, Health literacy measurement, Health promotion research, Home visitation, Intervention, Program evaluation|
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