Providing simplified health information designed for parents with low health literacy helps all families in childhood obesity treatment programs regardless of their ability to understand health information, according to a new study.
After receiving the same streamlined health information and instruction during a childhood obesity treatment program in the Dan River region of Virginia and North Carolina, families with low and high healthy literacy rates saw similar improvements in body mass index, a common measure of obesity, for the entire family.
Designing childhood obesity programs for families with limited health literacy is critical to their success, according to the University of Virginia School of Medicine researchers who led the study. Approximately 1 in 3 U.S. parents or caregivers have low health literacy, meaning they have limited ability to understand basic health information needed to make appropriate health decisions for themselves and their children.
"Parents with lower health literacy also have children with poorer health outcomes," said Jamie Zoellner, PhD, the study's co-principal investigator and a researcher in UVA's Department of Public Health Sciences. "However, few childhood obesity treatment programs incorporate design features and treatment strategies that meet the health literacy needs of parents."
Making Health Information Easier to Understand
The three-month program in the Dan River area focused on behavioral strategies aimed at improving healthy eating and physical activity. Instruction included six small-group family classes, six telephone support calls, 24 exercise sessions and six newsletters for children, along with parent and child workbooks. The researchers designed the materials and teaching sessions with the assumption that all participants may have difficulty reading, comprehending and acting on health information.
"Regardless of health literacy status, everyone can benefit from simplified health information, reduced literacy demands of program components, reinforcement of key messages and practice activities that promote skill development and self-management," Zoellner said.
For example, all written materials were at a fifth-grade reading level, and instructors used verbal teach-back methods - which ask participants to restate in their own words or demonstrate what they were taught - to ensure they understood the information they were receiving.
This approach led to similar positive outcomes for families with low and high health literacy levels. Along with improvements in body mass index, children and adults also reduced their consumption of sugar-sweetened drinks. Children of all health literacy levels also saw improvements in quality of life, while adults saw improvements in physical activity levels as well as fruit and vegetable consumption.
The only exception was in the amount of screen time for children. While children from low health literacy families reported having more screen time both before and after the program, the gap in screen time between low health literacy and high health literacy families narrowed after families participated in the program.
A six-month version of the childhood obesity treatment program, called iChoose, is now being tested in the Dan River region.
The study has been published in the journal Preventing Chronic Disease and was conducted by researchers from UVA, University of Nebraska Medical Center, Virginia Tech, University of North Carolina at Chapel Hill and the Children's Healthcare Center in Danville. The research team included co-principal investigator Paul Estabrooks, Jennie Hill, Wen You, Donna Brock, Madlyn Frisard, Ramine Alexander, Fabiana Silva, Bryan Price, Ruby Marshall and Zoellner.
Funding for the study was provided by the National Institute on Minority Health and Health Disparities, grant R24MD008005, and the Virginia Tech Fralin Translational Obesity Research Center.