Maternal health literacy progression among rural perinatal women

Sandra C. Mobley, Suzanne Dixson Thomas, Donald E. Sutherland, Jodi Hudgins, Brittany L. Ange, Maribeth H. Johnson

Research output: Contribution to journalArticlepeer-review

25 Scopus citations


This research examined changes in maternal health literacy progression among 106 low income, high risk, rural perinatal African American and White women who received home visits by Registered Nurse Case Managers through the Enterprise Community Healthy Start Program. Maternal health literacy progression would enable women to better address intermediate factors in their lives that impacted birth outcomes, and ultimately infant mortality (Lu and Halfon in Mater Child Health J 7(1):13-30, 2003; Sharma et al. in J Natl Med Assoc 86(11):857-860, 1994). The Life Skills Progression Instrument (LSP) (Wollesen and Peifer, in Life skills progression. An outcome and intervention planning instrument for use with families at risk. Paul H. Brookes Publishing Co.; Baltimore, 2006) measured changes in behaviors that represented intermediate factors in birth outcomes. Maternal Health Care Literacy (LSP/M-HCL) was a woman's use of information, critical thinking and health care services; Maternal Self Care Literacy (LSP/M-SCL) was a woman's management of personal and child health at home (Smith and Moore in Health literacy and depression in the context of home visitation. Mater Child Health J, 2011). Adequacy was set at a score of (≥4). Among 106 women in the study initial scores were inadequate (<4) on LSP/M-HCL (83 %), and on LSP/M-SCL (30 %). Significant positive changes were noted in maternal health literacy progression from the initial prenatal assessment to the first (p <.01) postpartum assessment and to the final (p <.01) postpartum assessment using McNemar's test of gain scores. Numeric comparison of first and last gain scores indicated women's scores progressed (LSP/M-HCL; p <.0001) and (LSP/M-SCL; p <.0001). Elevated depression scores were most frequent among women with <4 LSP/M-HCL and/or <4 LSP/M-SCL. Visit notes indicated lack or loss of relationship with the father of the baby and intimate partner discord contributed to higher depression scores.

Original languageEnglish (US)
Pages (from-to)1881-1892
Number of pages12
JournalMaternal and child health journal
Issue number8
StatePublished - Oct 1 2014


  • Health literacy
  • Healthy Start
  • Home visitation
  • Infant mortality
  • Intermediate factors
  • Life Skills Progression Instrument
  • Maternal health literacy
  • Perinatal case management

ASJC Scopus subject areas

  • Epidemiology
  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology
  • Public Health, Environmental and Occupational Health


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