Impact of Beginnings Pregnancy Guides on Maternal Health Literacy among Medicaid Patients in Group Prenatal Care
Steiner, Mary Kathleen
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Background: Maternal health literacy (MHL) represents the cognitive and social skills that determine the motivation and ability of mothers to gain access to, understand, and use information and services in ways that promote and maintain their health and that of their children. While the dominant viewpoint of health literacy is that it is dependent on reading proficiency, recent research suggests that reading proficiency is neither necessary nor sufficient to use information in ways that promote and maintain health. CenteringPregnancy (CP), a group prenatal care program, and Beginnings Pregnancy Guides (BG), pregnancy education materials, are hypothesized to promote maternal health literacy. Objectives: To document the feasibility and impacts of integrating MHL promotion into CP with and without BG, to document participants’ use and satisfaction with BG, and to validate the maternal health literacy self-assessment. Methods: A nonrandomized pretest-posttest control group study design was used to estimate the incremental effects of CP with BG versus CP alone. Participants at the experimental site received BG educational materials in addition to CP whereas the control site received CP without addition of BG. Data were collected through three methods: the Maternal Health Literacy Self-Assessment (MHL-SA), intervention group surveys, and semi-structured phone interviews with facilitators. McNemar’s test was performed on participants’ pre and post MHL-SA questions for both the intervention and control groups. The outcome in the intervention group was compared to the outcome in the control group using a Generalized Estimating Equation (GEE) to determine the impacts of integrating health literacy promotion into CP with and without BG. Results: Results indicated high levels of MHL at pretest and small increases at posttest. The most significant changes were in the health promotion domain, particularly in recognition of domestic violence. Changes attributable to BG were difficult to determine, because only 19% of participants read all or most of the BG booklets. Significant odds ratios were evenly distributed between the intervention and control groups signifying minimal impact of BG on MHL. Conclusions: The present study provides insights into interventions that can be enhanced to promote MHL. Findings indicate that it is feasible to integrate MHL promotion into CP with and without BG and that CP has the potential to promote MHL in the health promotion domain. More consistent exposure to BG across the duration of the program would provide more conclusive results of BG’s impact on MHL promotion.
- Health services