Abstract
Introduction: Health literacy refers to the ability to access, describe, evaluate, and apply health information to make informed decisions with the goal of promoting health and preventing illness. Although scant, the existing evidence on maternal literacy and breastfeeding suggests that higher levels of health literacy are associated with increased commencement and continuation of breastfeeding. This is significant due to its importance to the health of mothers and infants.
Objectives: The objective of this study was to identify the current definitions and measures of health literacy or maternal literacy found in the literature, to determine how to best define and measure breastfeeding health literacy based on this research.
Methods: A literature review was conducted in 3 phases. Data collection involved keywords on databases including CINAHL, Medline (EBSCO), and the Omni search engine on the OTU online library. Inclusion criteria that needed to be met by articles was inclusion of definitions or scales to measure health or maternal literacy, and effects on breastfeeding. Phase 1 identified articles that satisfied the inclusion criteria. Articles were organized into a table where conceptual and operational definitions were described. Phase 2 involved critical evaluation of the articles to identify common definitions and scales, in which a conceptual health literacy framework could be identified. Based on the conceptual health literacy framework identified, phase 3 consisted of research to determine additional measures in the literature for the outstanding framework domains. The findings allowed for recommendations to be created on how to best define and measure breastfeeding health literacy.
Results: Phase 1 identified ten articles, which defined or measured breastfeeding health literacy. Phase 2 selected a published framework on health literacy to use to guide the conceptual and operational definitions. The selected framework consisted of four domains that were adapted to breastfeeding health literacy: fundamental health literacy includes basic reading, writing, and numeracy skills; science literacy incorporates parents’ levels of competence with how and why breastfeeding is done; civic literacy recognizes influence of governmental and societal norms and policies that encourage formula-feeding vs. breastfeeding; cultural literacy which involves influences of partner and family support. Nine articles from phase 1 provided three measures of fundamental health literacy, including the TOFHLA, NVS, and REALM-SF. Phase 3 led to two additional conceptual domains being added to the framework, which included: critical health literacy or advanced social and cognitive skills used to correctly apply breastfeeding information and maternal literacy confidence during breastfeeding. Five articles were identified which described measures for the following five domains. The CBKS to address science literacy, IIFAS for civic literacy, BPSS for cultural literacy, HLQ for critical health literacy, and the Breastfeeding Self-Efficacy Scale for health literacy confidence.
Conclusions: This completed literature review provides recommendations on definitions and validated measures that can be used and applied for breastfeeding health literacy. Health care practitioners and stakeholders can find these useful in clinical practice to determine parents’ breastfeeding health literacy and in assisting them in meeting their breastfeeding goals.
