title: Empowering Women's Prenatal Communication: Does Literacy Matter?
abstract: This study was designed to evaluate the impact of an interactive computer program developed to empower prenatal communication among women with restricted literacy skills. A total of 83 women seeing 17 clinicians were randomized to a computer-based communication activation intervention (Healthy Babies Healthy Moms [HBHM]) or prenatal education (Baby Basics [BB]) prior to their prenatal visit. Visit communication was coded with the Roter Interaction Analysis System, and postvisit satisfaction was reported. Participants were on average 24 years of age and 25 weeks pregnant; 80% were African American. Two thirds scored ≤8th grade on a literacy screener. Women with literacy deficits were more verbally active, disclosed more medical and psychosocial/lifestyle information, and were rated as more dominant by coders in the HBHM group relative to their counterparts in the BB group (all ps < .05). Clinicians were less verbally dominant and more patient centered with literate HBHM relative to BB group women (p < .05); there was a similar, nonsignificant trend (p < .1) for lower literate women. Clinicians communicated less medical information and made fewer reassurance statements to lower literate women in the HBHM relative to the BB group (p < .05). There was a trend toward lower visit satisfaction for women with restricted literacy in the HBHM relative to the BB group (p < .1); no difference in satisfaction was evident for more literate women. The HBHM intervention empowered communication of all women and facilitated verbal engagement and relevant disclosure of medical and psychosocial information of women with literacy deficits. Satisfaction, however, tended to be lower for these women.
authors.affiliation: a Department of Health, Behavior, and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA.
authors.forename: Debra L
authors.initials: DL
authors.lastname: Roter
authors.affiliation: b Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health , Rockville , Maryland , USA.
authors.forename: Lori H
authors.initials: LH
authors.lastname: Erby
authors.affiliation: c Department of Preventive and Community Health , George Washington University , Washington , District of Columbia , USA.
authors.forename: Rajiv N
authors.initials: RN
authors.lastname: Rimal
authors.affiliation: a Department of Health, Behavior, and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA.
authors.forename: Katherine C
authors.initials: KC
authors.lastname: Smith
authors.affiliation: a Department of Health, Behavior, and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Larson
authors.affiliation: d Department of Family Medicine and Community Health, Perelman School of Medicine , University of Pennsylvania , Philadelphia , Pennsylvania , USA.
authors.forename: Ian M
authors.initials: IM
authors.lastname: Bennett
authors.affiliation: a Department of Health, Behavior, and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA.
authors.forename: Katie Washington
authors.initials: KW
authors.lastname: Cole
authors.affiliation: a Department of Health, Behavior, and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA.
authors.forename: Yue
authors.initials: Y
authors.lastname: Guan
authors.affiliation: e Johns Hopkins Childrens Center, Johns Hopkins School of Medicine , Baltimore , Maryland , USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Molloy
authors.affiliation: f Department of Gynecology and Obstetrics , Johns Hopkins School of Medicine , Baltimore , Maryland , USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Bienstock
mesh_terms: D000293:Adolescent; D000328:Adult; D003142:Communication; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000067010:Literacy / Q000706:statistics & numerical data*; D010353:Patient Education as Topic / Q000379:methods*; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D010817:Physician-Patient Relations; D011209:Power, Psychological; D011247:Pregnancy; D011295:Prenatal Care; D015397:Program Evaluation; D014584:User-Computer Interface; D055815:Young Adult