Download PDF
Am J Perinatol 2016; 33(13): 1242-1249
DOI: 10.1055/s-0036-1584540
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Examining the Role of Health Literacy in Optimizing the Care of Pregnant Women with Diabetes

Lynn M. Yee
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
,
Charlotte M. Niznik
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
,
Melissa A. Simon
2   Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
3   Department of Preventive Medicine and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
› Author Affiliations
Further Information

Publication History

15 March 2016

20 May 2016

Publication Date:
20 June 2016 (online)

Also available at
    Permissions and Reprints

Abstract

Diabetes during pregnancy is a substantial and growing public health problem disproportionately affecting women in racial/ethnic minority communities. Health literacy and numeracy are skills needed to function in the health care environment. By definition, health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Health literacy is increasingly recognized as an important mediator of health disparities in the United States, yet it has been rarely studied during pregnancy. Thus, this article aims to describe the problem of inadequate health literacy, outline the relationships between inadequate health literacy and poor health outcomes, and discuss diabetes-specific associations with health literacy. Although literacy has been insufficiently studied during pregnancy, a limited body of work suggests inadequate health literacy may be associated with lesser knowledge and self-care behaviors among pregnant women with diabetes. Health literacy-focused clinical “pearls” for the care of pregnant women with diabetes include: to use multiple educational modalities, to employ teach-back methods, to validate understanding, to provide specific and concrete counseling, and to offer focused, limited messaging. Lastly, future research directions regarding diabetes, health literacy, and pregnancy are addressed.

Keywords

health literacy - health numeracy - gestational diabetes mellitus - type 2 diabetes mellitus - health communication
 

  • References

  • 1 ACOG Committee on Practice Bulletins--Obstetrics. Practice bulletin no. 137: gestational diabetes mellitus. Obstet Gynecol 2013; 122 (2 Pt 1) 406-416
    CrossrefPubMedSearch in Google Scholar
  • 2 ACOG Committee on Practice Bulletins. Practice bulletin no. 60, March 2005. Pregestational diabetes mellitus. Obstet Gynecol 2005; 105 (3) 675-685
    CrossrefPubMedSearch in Google Scholar
  • 3 Dewalt DA, Berkman ND, Sheridan S, Lohr KN, Pignone MP. Literacy and health outcomes: a systematic review of the literature. J Gen Intern Med 2004; 19 (12) 1228-1239
    CrossrefPubMedSearch in Google Scholar
  • 4 Osborn CY, Cavanaugh K, Wallston KA , et al. Health literacy explains racial disparities in diabetes medication adherence. J Health Commun 2011; 16 (Suppl. 03) 268-278
    CrossrefPubMedSearch in Google Scholar
  • 5 Kutner M, Greenberg M, Jin Y, Paulsen C. The Health Literacy of America's Adults: Results from the 2003 National Assessment of Adult Literacy (NCES 2006–483). Washington, DC: National Center for Education Statistics; 2006
    Search in Google Scholar
  • 6 Advocacy Priorities . Health disparities: American Diabetes Association. Available online at http://www.diabetes.org/advocacy/advocacy-priorities/health-disparities.html . Accessed March 13, 2016
    PubMed
  • 7 Nielsen-Bohlman L, Panzer AM, Kindig DA. Committee on Health Literacy. Health Literacy: A Prescription to End Confusion. Washington, DC: The National Academies Press; 2004
    Search in Google Scholar
  • 8 American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 585: Health literacy. Obstet Gynecol 2014; 123 (2 Pt 1) 380-383
    CrossrefPubMedSearch in Google Scholar
  • 9 Ancker JS, Kaufman D. Rethinking health numeracy: a multidisciplinary literature review. J Am Med Inform Assoc 2007; 14 (6) 713-721
    CrossrefPubMedSearch in Google Scholar
  • 10 Golbeck AL, Ahlers-Schmidt CR, Paschal AM, Dismuke SE. A definition and operational framework for health numeracy. Am J Prev Med 2005; 29 (4) 375-376
    CrossrefPubMedSearch in Google Scholar
  • 11 Nutbeam D. Health literacy as a public health goal: A challenge for contemporary health education and communication strategies into the 21st century. Health Promot Int 2000; 15(3): 259-267
    CrossrefPubMedSearch in Google Scholar
  • 12 Rowlands G. Health literacy and public health: a framework for developing skills and empowering citizens. Perspect Public Health 2012; 132 (1) 23-24
    CrossrefPubMedSearch in Google Scholar
  • 13 Parker RM, Wolf MS. Health literate equates to patient-centered. J Health Commun 2015; 20 (12) 1367-1368
    CrossrefPubMedSearch in Google Scholar
  • 14 Health communication and health information technology . Healthy People 2020. Available online at www.healthypeople.gov/2020/topics-objectives/topic/health-communication-and-health-information-technology/objectives#4512 . Accessed March 11, 2016
    PubMed
  • 15 Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med 2011; 155 (2) 97-107
    CrossrefPubMedSearch in Google Scholar
  • 16 Kutner M, Greenberg E, Jin Y, Paulsen C. The Health Literacy of America's Adults: Results From the 2003 National Assessment of Adult Literacy (NCES 2006–483). Washington, DC: U.S. Department of Education; 2006
    Search in Google Scholar
  • 17 Duggan L, McCarthy S, Curtis LM , et al. Associations between health literacy and beliefs about medicines in an Irish obstetric population. J Health Commun 2014; 19 (Suppl. 02) 106-114
    CrossrefPubMedSearch in Google Scholar
  • 18 Baker DW, Parker RM, Williams MV, Clark WS. Health literacy and the risk of hospital admission. J Gen Intern Med 1998; 13 (12) 791-798
    CrossrefPubMedSearch in Google Scholar
  • 19 Mancuso CA, Rincon M. Impact of health literacy on longitudinal asthma outcomes. J Gen Intern Med 2006; 21 (8) 813-817
    CrossrefPubMedSearch in Google Scholar
  • 20 Schillinger D, Grumbach K, Piette J , et al. Association of health literacy with diabetes outcomes. JAMA 2002; 288 (4) 475-482
    CrossrefPubMedSearch in Google Scholar
  • 21 Wolf MS, Knight SJ, Lyons EA , et al. Literacy, race, and PSA level among low-income men newly diagnosed with prostate cancer. Urology 2006; 68 (1) 89-93
    PubMedSearch in Google Scholar
  • 22 Lindau ST, Basu A, Leitsch SA. Health literacy as a predictor of follow-up after an abnormal Pap smear: a prospective study. J Gen Intern Med 2006; 21 (8) 829-834
    CrossrefPubMedSearch in Google Scholar
  • 23 Scott TL, Gazmararian JA, Williams MV, Baker DW. Health literacy and preventive health care use among Medicare enrollees in a managed care organization. Med Care 2002; 40 (5) 395-404
    CrossrefPubMedSearch in Google Scholar
  • 24 Dolan NC, Ferreira MR, Davis TC , et al. Colorectal cancer screening knowledge, attitudes, and beliefs among veterans: does literacy make a difference?. J Clin Oncol 2004; 22 (13) 2617-2622
    CrossrefPubMedSearch in Google Scholar
  • 25 Altin SV, Stock S. Impact of health literacy, accessibility and coordination of care on patient's satisfaction with primary care in Germany. BMC Fam Pract 2015; 16 (1) 148
    CrossrefPubMedSearch in Google Scholar
  • 26 Estrada CA, Martin-Hryniewicz M, Peek BT, Collins C, Byrd JC. Literacy and numeracy skills and anticoagulation control. Am J Med Sci 2004; 328 (2) 88-93
    CrossrefPubMedSearch in Google Scholar
  • 27 Rothman RL, Housam R, Weiss H , et al. Patient understanding of food labels: the role of literacy and numeracy. Am J Prev Med 2006; 31 (5) 391-398
    CrossrefPubMedSearch in Google Scholar
  • 28 Lipkus IM, Samsa G, Rimer BK. General performance on a numeracy scale among highly educated samples. Med Decis Making 2001; 21 (1) 37-44
    PubMedSearch in Google Scholar
  • 29 Berikai P, Meyer PM, Kazlauskaite R, Savoy B, Kozik K, Fogelfeld L. Gain in patients' knowledge of diabetes management targets is associated with better glycemic control. Diabetes Care 2007; 30 (6) 1587-1589
    CrossrefPubMedSearch in Google Scholar
  • 30 Rothman R, Malone R, Bryant B, Horlen C, DeWalt D, Pignone M. The relationship between literacy and glycemic control in a diabetes disease-management program. Diabetes Educ 2004; 30 (2) 263-273
    CrossrefPubMedSearch in Google Scholar
  • 31 Schillinger D, Barton LR, Karter AJ, Wang F, Adler N. Does literacy mediate the relationship between education and health outcomes? A study of a low-income population with diabetes. Public Health Rep 2006; 121 (3) 245-254
    CrossrefPubMedSearch in Google Scholar
  • 32 Peters E, Hibbard J, Slovic P, Dieckmann N. Numeracy skill and the communication, comprehension, and use of risk-benefit information. Health Aff (Millwood) 2007; 26 (3) 741-748
    CrossrefPubMedSearch in Google Scholar
  • 33 Rothman RL, Montori VM, Cherrington A, Pignone MP. Perspective: the role of numeracy in health care. J Health Commun 2008; 13 (6) 583-595
    CrossrefPubMedSearch in Google Scholar
  • 34 Bailey SC, Brega AG, Crutchfield TM , et al. Update on health literacy and diabetes. Diabetes Educ 2014; 40 (5) 581-604
    CrossrefPubMedSearch in Google Scholar
  • 35 Sudore RL, Mehta KM, Simonsick EM , et al. Limited literacy in older people and disparities in health and healthcare access. J Am Geriatr Soc 2006; 54 (5) 770-776
    CrossrefPubMedSearch in Google Scholar
  • 36 Cavanaugh K, Wallston KA, Gebretsadik T , et al. Addressing literacy and numeracy to improve diabetes care: two randomized controlled trials. Diabetes Care 2009; 32 (12) 2149-2155
    CrossrefPubMedSearch in Google Scholar
  • 37 Gazmararian JA, Parker RM, Baker DW. Reading skills and family planning knowledge and practices in a low-income managed-care population. Obstet Gynecol 1999; 93 (2) 239-244
    PubMedSearch in Google Scholar
  • 38 Yee LM, Simon MA. The role of health literacy and numeracy in contraceptive decision-making for urban Chicago women. J Community Health 2014; 39 (2) 394-399
    CrossrefPubMedSearch in Google Scholar
  • 39 You WB, Wolf M, Bailey SC , et al. Factors associated with patient understanding of preeclampsia. Hypertens Pregnancy 2012; 31 (3) 341-349
    CrossrefPubMedSearch in Google Scholar
  • 40 Endres LK, Sharp LK, Haney E, Dooley SL. Health literacy and pregnancy preparedness in pregestational diabetes. Diabetes Care 2004; 27 (2) 331-334
    CrossrefPubMedSearch in Google Scholar
  • 41 Ehrenthal DB, Maiden K, Rogers S, Ball A. Postpartum healthcare after gestational diabetes and hypertension. J Womens Health (Larchmt) 2014; 23 (9) 760-764
    CrossrefPubMedSearch in Google Scholar
  • 42 Yee LM, McGuire JM, Taylor SM, Niznik CM, Simon MA. Social and environmental barriers to nutrition therapy for diabetes management among underserved pregnant women: a qualitative analysis. J Nutr Educ Behav 2016; 48 (3) 170-180.e1
    CrossrefPubMedSearch in Google Scholar
  • 43 Yee LM, McGuire JM, Taylor SM, Niznik CM, Simon MA. “I was tired of all the sticking and poking”: Identifying barriers to diabetes self-care among low-income pregnant women. J Health Care Poor Underserved 2015; 26 (3) 926-940
    CrossrefPubMedSearch in Google Scholar
  • 44 Carolan M. Diabetes nurse educators' experiences of providing care for women, with gestational diabetes mellitus, from disadvantaged backgrounds. J Clin Nurs 2014; 23 (9–10) 1374-1384
    CrossrefPubMedSearch in Google Scholar
  • 45 Carolan M, Gill GK, Steele C. Women's experiences of factors that facilitate or inhibit gestational diabetes self-management. BMC Pregnancy Childbirth 2012; 12: 99
    CrossrefPubMedSearch in Google Scholar
  • 46 American Diabetes Association. (4) Foundations of care: education, nutrition, physical activity, smoking cessation, psychosocial care, and immunization. Diabetes Care 2015; 38 (Suppl): S20-S30
    CrossrefPubMedSearch in Google Scholar
  • 47 Saade GR. Pregnancy as a window to future health. Obstet Gynecol 2009; 114 (5) 958-960
    CrossrefPubMedSearch in Google Scholar
  • 48 Retnakaran R. Glucose tolerance status in pregnancy: a window to the future risk of diabetes and cardiovascular disease in young women. Curr Diabetes Rev 2009; 5 (4) 239-244
    CrossrefPubMedSearch in Google Scholar
  • 49 Chamberlain C, O'Mara-Eves A, Oliver S , et al. Psychosocial interventions for supporting women to stop smoking in pregnancy. Cochrane Database Syst Rev 2013; 10: CD001055
    PubMedSearch in Google Scholar
  • 50 You WB, Wolf MS, Bailey SC, Grobman WA. Improving patient understanding of preeclampsia: a randomized controlled trial. Am J Obstet Gynecol 2012; 206 (5) 431.e1-431.e5
    CrossrefPubMedSearch in Google Scholar
  • 51 Yee LM, Wolf M, Mullen R , et al. A randomized trial of a prenatal genetic testing interactive computerized information aid. Prenat Diagn 2014; 34 (6) 552-557
    CrossrefPubMedSearch in Google Scholar
  • 52 Brega A, Barnard J, Mabachi N , et al. AHRQ Health Literacy Universal Precautions Toolkit, Second Edition. Rockville, MD: Agency for Healthcare Research and Quality; 2015
    Search in Google Scholar
  • 53 Gwynn KB, Winter MR, Cabral HJ , et al. Racial disparities in patient activation: Evaluating the mediating role of health literacy with path analyses. Patient Educ Couns 2016; E-pub ahead of print
    PubMedSearch in Google Scholar
  • 54 Paasche-Orlow MK, Wolf MS. Evidence does not support clinical screening of literacy. J Gen Intern Med 2008; 23 (1) 100-102
    CrossrefPubMedSearch in Google Scholar
  • 55 Text4baby. Available online at www.text4baby.org . Accessed June 3, 2015
    PubMed