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.

Acknowledgments

We acknowledge the help of the women and clinicians who participated in our study. We are especially indebted to Rita Johnson for her help with patient recruitment and for her role as the study's kindly grandmother, in all ways. We also appreciate the contribution of Jayesh Jariwala and the team at Applied Control Engineering, Inc., for software development. Additional thanks are offered to our colleagues at the What to Expect Foundation for supplying copies of Baby Basics and for their enthusiasm for the study. An earlier version of this article was presented at the International Conference on Communication in Healthcare, September 29–October 2, 2013, in Montreal, Canada, sponsored by the American Academy on Communication in Healthcare.