Low health literacy in parents has been linked to increased obesity risk for their children. When providing information to patients with low health literacy, teach-back (TB) and teach-to-goal (TTG) methods are recommended, but no studies have examined the degree to which TB/TTG strategies can be implemented with fidelity in community-based programs. A study was conducted to determine if type of delivery staff (community or research) is related to implementation fidelity; the degree to which TB/TTG methods are necessary for parent/caregiver understanding of childhood obesity learning objectives; and if baseline parent/caregiver health literacy level is related to support call response. Ninety-four families with overweight/obese children aged 8-12 years were enrolled in a pilot childhood obesity intervention that included 6 bi-weekly parent/caregiver support calls integrating TB/TTG methods into a 5 A's approach. Research partners (n=2) delivered all calls in Wave 1. During Waves 2 and 3, community staff (n=5) delivered a majority of calls with training and support from research staff. ). Average completion rate across calls was 62% and did not differ according to participant health literacy level. Community partners were more likely than research partners to complete calls with participants (68% versus 57%), but this trend was not significant. Both research and community partners adhered to call scripts with high fidelity (97% versus 98%). A significant main effect of health literacy level on TB/TTG performance was found for Call 1 and Call 3 during Wave 1 and for Call 1 during Waves 2 and 3 of iChoose (p<0.05, 0.01, and 0.05). An interaction effect of health literacy level and question number was found for Call 3 during Wave 1 only (p<0.05). For all calls in which TB/TTG performance differed significantly by health literacy level, participants with adequate health literacy were found to have better performance. Following the program, participants expressed they felt satisfied and comfortable with follow-up calls (9.1 (2.0) and 9.5 (1.2) on a 10-point scale), while agreeing that calls helped improve their eating and PA habits (8.1 (2.6) and 7.5 (2.7)) and helped them learn class material better (8.1 (2.7)). Trained community partners were able to deliver the same support call content with similarly high fidelity, completion, and acceptability. Although participant baseline health literacy level had less impact on the need for TB/TTG and on program perception than we anticipated, our findings open up different possibilities to utilize these strategies while using precious resources more efficiently. / Master of Science / Low health literacy – meaning a limited capacity to access and understand basic health information that is needed to make suitable health decisions – has been linked to a plethora of poor health behaviors and outcomes, including increased obesity risk for the children of low health literate parents. When sharing information to patients with low health literacy, teach-back (TB) and teach-to-goal (TTG) methods are recommended in which health care professionals ask patients to repeat instructions or explain key concepts using their own words and then re-instruct patients as needed until they master these concepts. No studies thus far have examined the degree to which TB/TTG strategies can be implemented with fidelity – meaning adherence to protocol and competence in delivery – in community-based programs. A study was conducted to determine if type of delivery staff (community or research) is related to implementation fidelity; the degree to which TB/TTG methods are necessary for parent/caregiver understanding of learning objectives in a program to improve health-related behaviors; and if baseline parent/caregiver health literacy level is related to support call response. Ninety-four families with overweight/obese children aged 8-12 years were enrolled in a pilot childhood obesity intervention that included 6 bi-weekly parent/caregiver support calls integrating TB/TTG methods into an evidenced-based 5 A's approach for behavioral change. Research partners delivered all calls in Wave 1 of the pilot trial, while community staff delivered a majority of calls during Waves 2 and 3 with ongoing training and support from research staff. Average completion rate across calls was 62% and did not differ according to participant health literacy level. Community partners were more likely than research partners to complete calls with participants (68% versus 57%), but this difference was not significant (it may have been due to chance). Both research and community partners followed guided call scripts with high fidelity. The health literacy level of participants at the start of the program was associated with TB/TTG performance during calls, but this effect was limited to only a few calls. In all of these instances, participants with the higher level of health literacy (adequate) were found to have better TB/TTG performance. Following the program, participants expressed they felt satisfied and comfortable with follow-up calls, while agreeing that calls helped improve their eating and physical activity habits and helped them learn class material better. Trained community partners were able to deliver the same support call content with similarly high fidelity, completion, and acceptability. Although participant baseline health literacy level had less impact on the need for TB/TTG and on program perception than we anticipated, our findings open up different possibilities to utilize these strategies while using precious resources more efficiently.
| Identifer | oai:union.ndltd.org:VTETD/oai:vtechworks.lib.vt.edu:10919/75047 |
| Date | 15 February 2017 |
| Creators | Hou, Xiaolu |
| Contributors | Human Nutrition, Foods, and Exercise, Estabrooks, Paul A., Zoellner, Jamie M., You, Wen, Hill, Jennie L. |
| Publisher | Virginia Tech |
| Source Sets | Virginia Tech Theses and Dissertation |
| Detected Language | English |
| Type | Thesis |
| Format | ETD, application/pdf |
| Rights | In Copyright, http://rightsstatements.org/vocab/InC/1.0/ |
Page generated in 0.0028 seconds