TY - JOUR

T1 - Improving health literacy responsiveness to reduce ethnic and social disparity in stillbirth and infant health

T2 - A cluster randomized controlled effectiveness trial of the MAMAACT intervention

AU - Rasmussen, Trine Damsted

AU - Nybo Andersen, Anne Marie

AU - Ekstrøm, Claus Thorn

AU - Jervelund, Signe Smith

AU - Villadsen, Sarah Fredsted

N1 - Publisher Copyright: © 2023 The Authors

PY - 2023

Y1 - 2023

N2 - Objective: The MAMAACT intervention aims to reduce ethnic and social disparities in stillbirth and infant death by improving communication between pregnant women and midwives regarding warning signs of pregnancy complications. This study evaluates the effect of the intervention on pregnant women's health literacy (two domains from the Health Literacy Questionnaire) and complication management — interpreted as improved health literacy responsiveness among midwives. Design: Cluster randomized controlled trial, 2018–2019. Setting: 19 of 20 Danish maternity wards. Participants: Cross-sectional survey data were collected using telephone interviews (n = 4150 pregnant women including 670 women with a non-Western immigrant background). Intervention: A six-hour training session for midwives in intercultural communication and cultural competence, two follow-up dialog meetings, and health education materials for pregnant women on warning signs of pregnancy complications — in six languages. Main outcome measures: Differences in mean scores at post-implementation of the domains Active engagement with healthcare providers (Active engagement) and Navigating the healthcare system from the Health Literacy Questionnaire, and differences in the certainty of how to respond to pregnancy complication signs between women in the intervention and control group. Results: No difference was observed in women's level of Active engagement or Navigating the healthcare system. Women from the intervention group were more certain of how to respond to complication signs: Redness, swelling, and heat in one leg: 69.4 % vs 59.1 %; aOR 1.57 (95 % CI 1.32–1.88), Severe headache: 75.6 % vs 67.3 %; aOR 1.50 (95 % CI 1.24–1.82), and Vaginal bleeding: 97.3 % vs 95.1 %; aOR 1.67 (95 % CI 1.04–2.66). Conclusion: The intervention improved women's certainty of how to respond to complication signs, but was unable to improve pregnant women's health literacy levels of Active engagement and Navigating the healthcare system, likely due to barriers related to the organization of antenatal care. A reorganization of antenatal care and a care model sensitive to diversity within the entire healthcare system might help reduce disparities in perinatal health. Trial registration: ClinicalTrials.gov identifier: NCT03751774.

AB - Objective: The MAMAACT intervention aims to reduce ethnic and social disparities in stillbirth and infant death by improving communication between pregnant women and midwives regarding warning signs of pregnancy complications. This study evaluates the effect of the intervention on pregnant women's health literacy (two domains from the Health Literacy Questionnaire) and complication management — interpreted as improved health literacy responsiveness among midwives. Design: Cluster randomized controlled trial, 2018–2019. Setting: 19 of 20 Danish maternity wards. Participants: Cross-sectional survey data were collected using telephone interviews (n = 4150 pregnant women including 670 women with a non-Western immigrant background). Intervention: A six-hour training session for midwives in intercultural communication and cultural competence, two follow-up dialog meetings, and health education materials for pregnant women on warning signs of pregnancy complications — in six languages. Main outcome measures: Differences in mean scores at post-implementation of the domains Active engagement with healthcare providers (Active engagement) and Navigating the healthcare system from the Health Literacy Questionnaire, and differences in the certainty of how to respond to pregnancy complication signs between women in the intervention and control group. Results: No difference was observed in women's level of Active engagement or Navigating the healthcare system. Women from the intervention group were more certain of how to respond to complication signs: Redness, swelling, and heat in one leg: 69.4 % vs 59.1 %; aOR 1.57 (95 % CI 1.32–1.88), Severe headache: 75.6 % vs 67.3 %; aOR 1.50 (95 % CI 1.24–1.82), and Vaginal bleeding: 97.3 % vs 95.1 %; aOR 1.67 (95 % CI 1.04–2.66). Conclusion: The intervention improved women's certainty of how to respond to complication signs, but was unable to improve pregnant women's health literacy levels of Active engagement and Navigating the healthcare system, likely due to barriers related to the organization of antenatal care. A reorganization of antenatal care and a care model sensitive to diversity within the entire healthcare system might help reduce disparities in perinatal health. Trial registration: ClinicalTrials.gov identifier: NCT03751774.

KW - Antenatal care

KW - Cluster randomized trial

KW - Complex interventions

KW - Health literacy

KW - Immigrants

KW - Midwives

U2 - 10.1016/j.ijnurstu.2023.104505

DO - 10.1016/j.ijnurstu.2023.104505

M3 - Journal article

C2 - 37267853

AN - SCOPUS:85161042985

VL - 144

JO - Nursing

JF - Nursing

SN - 0020-7489

M1 - 104505

ER -