Conditions and Dynamics That Impact Maternal Health Literacy among High Risk Prenatal-Interconceptional Women

Abstract

The purpose of the study was to describe conditions and dynamics in the lives of high-risk, low-income, Southern United States prenatal-interconceptional women (n = 37) in a home visiting program that promoted maternal health literacy progression. In the Life Course Health Development (LCHD) Model, conditions were risk and protective factors that impacted health. Dynamics drove the complex, epigenetic relationships between risk and protective factors. Maternal health literacy promotion helped participants address conditions and dynamics to create positive life changes. This research was a retrospective, mixed methods study of women's service records documenting care from prenatal admission to 24 months post-delivery. The Life Skills Progression Instrument (LSP) was scored to measure maternal health literacy progression. Ethnographic content analysis of visit notes triangulated with quantitative data enabled specificity of critical data elements. Subsequently, a complementary focus group was conducted with the Registered Nurse Case Managers (RNCM). Severe social conditions included devastating poverty, low educational achievement, transient housing, unstable relationships, incarceration, lack of continuous health insurance, and shortage of health care providers. Dynamics included severe psycho-social stressors, domestic violence, lack of employment, low income, low self-esteem and self-expectations, and social/family restraints upon women's intended positive changes. An important protective factor was the consistent, stable, evidence-informed relationship with the RNCM. Findings from the focus group discussion supported content analysis results.

Keywords: determinants of health; health disparities; health education; health interventions; health literacy; health promotion; social disadvantage.

Figure 1

Focus Group Questions. The recorder grouped and recorded RNCMs’ ranked responses with their input.

Figure 2

Exemplar: Health Consequences of Teen Pregnancy—A Dysfunctional Family Pattern. Intensive nursing care enabled this family to change to a more health-promoting family pattern.

Figure 3

Exemplar: Health Consequences of a Chaotic, Dysfunctional Family Pattern with Multi-Generational Poverty and Family Violence. Intensive nursing care enabled this family to change to a more health-promoting family pattern.

Figure 3

Exemplar: Health Consequences of a Chaotic, Dysfunctional Family Pattern with Multi-Generational Poverty and Family Violence. Intensive nursing care enabled this family to change to a more health-promoting family pattern.

Figure 4

Results of Focus Group with RNCMs. The focus group with the RNCM providers was a complementary research strategy that clarified and extended the content analysis.