2. Improved maternal health literacy was associated with higher uptake of postpartum checkups and vaccinations and improved outcomes related to mastitis, constipation, weight, and uterine and diaper dermatitis
Evidence assessment level: 1 (very good)
Study overview: The period after birth is a critical time, as it affects the well-being of mother and child, and is a time when many pregnancy- and birth-related complications can occur. Previous studies have suggested that many birth and postpartum health outcomes are influenced by maternal health literacy (MHL), which refers to women’s ability to access, understand, and use information to maintain their own health and the health of their children. Those with a lower level of MHL may have more challenges in obtaining and using information, which may lead to negative health outcomes in the post-partum period. Several teaching strategies can be used to improve health literacy. This study examined the use of the teach-back method, where after a healthcare provider explains information, the patient repeats it in their own words with feedback from the provider. In this randomized controlled trial, both study groups had no significant difference in terms of baseline MHL, but those who received the teach-back method had significantly higher levels of MHL and better postpartum behavior regarding exclusive breastfeeding. The teach-back group also had higher uptake of 42-day postpartum checkups and vaccinations and better health outcomes, including: acute mastitis, postpartum constipation, weight, incidence of uterine subinvolution, and diaper dermatitis. This study shows the importance of MHL and that methods such as the teach-back method can have a beneficial influence on the well-being of both mothers and children.
Click here to read the study in BMC Pregnancy and Childbirth
Relevant Reading: Understanding and Meeting Women’s Needs in the Postpartum Period: The Perinatal Maternal Health Promotion Model
In depth [randomized controlled trial]: This randomized controlled trial included 298 women with limited maternal health literacy (LMHL), who per score of 27 or fewer points on baseline measures of the Perinatal Maternal Health Literacy Scale (PMHLS). Women were assigned to either the control or teach-back group by flipping a coin at random. Women from the teach-back group and the control group received three educational sessions, each discussing different health issues. Both groups shared the same educational content with the exception that the teach-back group had to repeat what they had learned in their own words, with possible corrections from the teachers if necessary. For each training session, women may have been grouped with different peers and different trainers to reduce peer and trainer bias. Maternal Health Literacy (MHL) was measured at baseline and 42 days postpartum using the PMHLS. Postnatal health behaviors and maternal and infant health outcomes were also measured. After the training sessions, both groups had significantly higher PMHLS scores (20.5 to 26.5 for the teach-back group) [z = − 9.820, p < 0.001]20 to 21 for the control group [z = − 7.073, p < 0.001]). Half of the women in the teach-back group had scores higher than 27 42 days after giving birth, a significantly higher percentage than the control group (64 women versus 11, x2= 53,971, p< 0.001). The teach-back group had significantly better behavior after the birth in terms of exclusive breastfeeding and 42-day postpartum checkup. Maternal health outcomes, including uterine subinvolution, acute mastitis, postpartum constipation, overweight, and diaper dermatitis were significantly lower in the teach-back group. Limitations of this study include the fact that participants could not be blinded and the population was limited to a tertiary care hospital in a moderately developed region, making it difficult to generalize the results. This study highlights the importance of MHL for maternal and infant outcomes and that effective teaching methods are beneficial. Future studies are needed to determine the cost-effectiveness of these teaching methods, long-term effects, and patient experience.Picture: PD
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