Effect of mothers' health literacy on early childhood allergy prevention behaviours: results from the KUNO-Kids health study

Abstract

Background: Parents can engage in several behaviours with regard to early childhood allergy prevention (ECAP). These can be related to diet of mother/child and the modification of the home environment; not all of them are justified by current evidence. Previous studies showed that parental health literacy (HL) is related to favourable health behaviours directed at the child. This study aimed to investigate the causal effect of mothers' HL on ECAP behaviours and to test different moderators of this effect.

Methods: One thousand six hundred sixty-two mothers participating in the KUNO-Kids health study in the area of Regensburg, Germany were surveyed on HL (assessed via the health care scale of the Health Literacy Survey-EU questionnaire, HLS-EU-Q47) and ECAP behaviours implemented during pregnancy and the child's first year of life. Patterns in ECAP behaviours were identified by latent class analysis. Multinomial regression modelling was performed with HL as exposure, ECAP as outcome variable, allergy risk, parental competence and bonding, anxiety and depression as moderators as well as potentially confounding variables.

Results: We identified three classes of ECAP behaviours (class 1: "breastfeeding " N = 871; class 2: "allergen-avoidance " N = 490; class 3: "mixed behaviours " N = 301). In univariable as well as fully adjusted regression models, compared to class 1, class 2 was negatively, and class 3 was not associated with HL. None of the tested moderating variables altered the association between HL and ECAP significantly.

Conclusions: We found an effect of mothers' HL on ECAP behaviours: lower HL of mothers increased allergen-avoiding behaviour directed at their child, while decreasing the chance of exclusive breastfeeding. Improving HL could contribute to the implementation of recommended ECAP behaviours in families, especially to the reduction of allergen-avoiding behaviours.

Keywords: Child; Cohort study; Early childhood allergy prevention; Health behaviour; Health literacy; Mothers.

Fig. 1

Directed acyclic graph representing the independent effect of exposure HL on outcome ECAP, adjusted for number of children, migration background and social status, and modification of this effect by stress, allergy risk, anxiety and depression. The graph was drawn using the online application DAGitty (https://www.dagitty.net/)

Fig. 2

Results of latent class analysis: class 1 “breastfeeding” (N = 871), class 2 “allergen-avoidance” (N = 490), class 3 “mixed behaviours” (N = 301). Variables included in LCA: fish as part of mothers’ diet during pregnancy (≥ 1 per week vs. < 1 per week); duration of exclusively breastfeeding (≥ 4 months vs. no breastfeeding/ < 4 months); regular feeding of hydrolysed infant formula (hydrolysed formula vs. other formula); child’s age of introduction of any solid foods (4–6 months vs. < 4 months/ > 6 months); allergy prevention related avoidance of feeding specific foods in the child’s diet during the first year of life (yes vs. no); fish as part of solid foods during the child’s first year of life (≥ 1 per week vs. < 1 per week); feeding of farm milk (yes vs. no); exposure to tobacco smoke (yes vs. no); measures for reducing house dust mites (yes (any) vs. no).