Core Health Messages: A User-Focused Health Literacy Initiative
Bonnie Braun, PhD, Elisabeth Maring, PhD, Linda Aldoory, PhD, Mili Duggal, MPH
University of Maryland Extension, Department of Family Science and Herschel S. Horowitz Center for Health Literacy
Introduction
What We Know
About Rural Mothers
• Poorer health outcomes
• Limited availability and
access to health services
• Inadequate health
insurance coverage
• Low levels of health
literacy
What We Don’t Know
About Rural Mothers
• How they respond to
health messages
• Level of understanding of
health messages
• How they act in response
to messages
• Preferred channels of
receiving messages
Health literacy principles suggest that health information must be:
• User-focused
• Easy to understand and act on
• Culturally appropriate
• Emotionally appealing
• Scientifically sound
Research and Intervention Goal
The goal of this research was to determine characteristics of health
messages and channels of delivery that are preferred by rural,
low-income mothers. Empowerment Theory guided the study.
Actively develop
health messages
Perceive
control over
one’s life
Feel
empowered to
make good
decisions
Selected Results
Methods
Take Action
Participants
• Ethnically diverse mothers (African American, Asian American,
Hispanic, Native American, and White) living in rural communities in
eight states
• Primary caregivers of at least one child between the ages of 0 -12
• Income 185% or less than the federal poverty line
We conducted 8 focus groups with 36 mothers and 78 interviews.
Mothers discussed what elements in a health message mattered most
to them and responded to questions about:
What kind of person in the
message do you want
speaking to you?
Healthcare
Worker
N = 78
•
•
•
•
Their own health and their health literacy
Perceived sense of control
Appeal of test health messages
Preferences for receipt of health messages
Research team created dental health and food security health
messages that were tested. Mothers created physical health
messages.
Transcripts were analyzed by a team of qualitative analysts. External
reviewers confirmed the analysts’conclusions. The coding scheme
follows:
37
47%
4
5%
37
48%
No Person
How much should the
message be about your
busy life or feeling lack
of control? *
18
33%
0
0%
Mom, Friend,
Known
Individual
Empathy
37
67%
No
Empathy
* Interviews only
Template©
Preferred message characteristics were converted into a template.
Template can be used by health professionals and educators to
develop messages. Sample template features dental health.
Medium amount of content
Open Coding (OC)
• Stage 1-OC: Created initial codebook using Focus Group Protocol
question to develop codes
• Stage 2-OC: Individual teams added codes with subthemes based
on assigned transcriptions
Axial Coding (AC)
• Stage 1-AC: Individual coders from each team shared coding and
came to agreement
• Stage 2-AC: Two teams shared coding with each other to develop
axial codebook.
Selective Coding (SC)
• Stage 1-SC: Reviewers assessed the codes with a Rubric.
Review team consisted of internal and external consultants.
• Stage 2-SC: Reporting - Tell story of Rural Health Messages
In mother’s voice citing an authority figure:
“my dentist told me…”
Positive – what good can happen after you do the action
Tells a short story or includes simple steps that the
mothers find easy to do
Empathetic about their busy life:
“I am always busy and pinched for money”
FINAL MESSAGE: Hi, I’m Mary. I have two kids and I am
always busy and pinched for money! I want my children to
be healthy. I don’t want my kids to have cavities like I did.
Our dentist told me that my kids might get cavities if they
don’t drink water with fluoride and use toothpaste with
fluoride. I’ve been buying bottled water and toothpaste
with fluoride added to prevent cavities.
Acknowledgements: “This project was supported by the Rural Health and Safety Education Competitive Program of the USDA Cooperative State Research, Education and Extension Service, grant number 2010 – 46100 – 21791. “ Partners include: University of Massachusetts,
Amherst, Washington State University, University of Maryland Extension, Rural Maryland Council, Maryland Rural Health Association, University of Maryland School of Public Health, Herschel S. Horowitz Center for Health Literacy And 14 Rural Families Speak state research teams.