Impact of Maternal Health Literacy Training on the Knowledge of Women who have been Homeless

IntroductionThere are numerous barriers related to accessing quality healthcare, especially for populations of low education level and low socioeconomic status, as well as those of minority status (1). One critical barrier is low health literacy. Health literacy is a widespread and important problem in the United States, where it is estimated that approximately 90 million people are affected by low health literacy (between 21% and 23% of the entire population) (1,2). Ultimately, this results in an estimated economic burden of $58 billion per year in the United States alone (3). Health literacy has been defined as . . the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions" (3). The World Health Organization expands on this definition by stating that the ability to read and understand health information consists of more than general knowledge, but empowers a person and leads them to a more successful and consistent relationship with the healthcare system (4). Patients with good health literacy are much more likely to show-up for doctors' visits and continue to make educated and appropriate decisions surrounding their health decisions, whereas those with lower literacy levels are hospitalized more and have worse health outcomes (1, 5). Most people take for granted the effortless task of reading and understanding all of the information at a medical visit, but those with low literacy often understand very little and implement either poor or no treatment plans as a result (6).A more specific focus within the realm of health literacy is maternal health literacy that focuses on the health knowledge of the mother and how this knowledge specifically affects her child's health outcomes. Renkert defines maternal health literacy as "the cognitive and social skills that determine the motivation and ability of women to gain access to, understand, and use information in ways that promote and maintain their health and the health of their children" (7).Health experts acknowledge that the overall health of a child often depends on his or her mother's understanding of basic health information, such as the importance of up-to-date vaccines, prenatal care, and other preventative practices (8,9). Mismanaged health conditions, exposure to environmental toxins, poor diets, and smoking (both while pregnant and afterwards), can cause one's child significant harm, including physical and intellectual disabilities, low birth weight and potentially many health problems later in life (10,11). Ferguson (6) states that many women have their first experience with the health care system when they become pregnant, and it is problematic when this is compounded by low health literacy, because it impacts the child's health prenatally and after the birth (6). Studies show that women with low maternal health literacy are less prepared, overall, for a pregnancy, since there are higher rates of unplanned pregnancies and less preventative measures taken, including a lower prevalence of folic acid consumption and less pre- conception meetings with their doctors (12). Many women, in general, are unaware of environmental factors that can potentially harm their fetus or baby, especially those of low literacy (6,11). Unfortunately, when women with low literacy rates do meet with their doctors and fail to understand what is being said to them, they are often reluctant to admit their confusion and often hide their reading deficiencies, which only exacerbates the problem (13,14).Low maternal health literacy further confounds the situation for vulnerable populations, resulting in potentially adverse health outcomes for the mothers and their children. However, studies exist that show that an improvement in maternal health literacy is possible, which can help to break the cycle of disadvantage and disability and reduce environmental health disparities (15). …