Health literacy among pregnant women in a lifestyle intervention trial: protocol for an explorative study on the role of health literacy in the perinatal health service setting

Abstract

IntroductionPregnancy is a vulnerable period that affects long-term health of pregnant women and their unborn infants. Health literacy plays a crucial role in promoting healthy behaviour and thereby maintaining good health. This study explores the role of health literacy in the GeMuKi (acronym for ‘Gemeinsam Gesund: Vorsorge plus für Mutter und Kind’—Strengthening health promotion: enhanced check-up visits for mother and child) Project. It will assess the ability of the GeMuKi lifestyle intervention to positively affect health literacy levels through active participation in preventive counselling. The study also explores associations between health literacy, health outcomes, health service use and effectiveness of the intervention.Methods and analysisThe GeMuKi trial has a hybrid effectiveness–implementation design and is carried out in routine prenatal health service settings in Germany. Women (n=1860) are recruited by their gynaecologist during routine check-up visits before 12 weeks of gestation. Trained healthcare providers carry out counselling using motivational interviewing techniques to positively affect health literacy and lifestyle-related risk factors. Healthcare providers (gynaecologists and midwives) and women jointly agree on Specific, Measurable, Achievable Reasonable, Time-Bound goals. Women will be invited to fill in questionnaires at two time points (at recruitment and 37th−40th week of gestation) using an app. Health literacy is measured using the German version of the Health Literacy Survey-16 and the Brief Health Literacy Screener. Lifestyle is measured with questions on physical activity, nutrition, alcohol and drug use. Health outcomes of both mother and child, including gestational weight gain (GWG) will be documented at each routine visit. Health service use will be assessed using social health insurance claims data. Data analyses will be conducted using IBM SPSS Statistics, version 26.0. These include descriptive statistics, tests and regression models. A mediation model will be conducted to answer the question whether health behaviour mediates the association between health literacy and GWG.Ethics and disseminationThe study was approved by the University Hospital of Cologne Research Ethics Committee (ID: 18-163) and the State Chamber of Physicians in Baden-Wuerttemberg (ID: B-F-2018-100). Study results will be disseminated through (poster) presentations at conferences, publications in peer-reviewed journals and press releases.Trail registrationGerman Clinical Trials Register (DRKS00013173). Registered pre-results, 3rd of January 2019, https://www.drks.de

Understanding Determinants of Pregnant Women’s Knowledge of Lifestyle-Related Risk Factors: A Cross-Sectional Study

“…The questionnaire was developed as part of the GeMuKi (acronym for ‘Gemeinsam Gesund: Vorsorge plus für Mutter und Kind’—Strengthening health promotion: enhanced check-up visits for mother and child) project, the host trial, which provides counselling on lifestyle topics in addition to regular antenatal care. Details on the project and its design can be found elsewhere [ 31 , 32 ]. According to the definition of health literacy provided by Sorensen et al (2012), knowledge is a contributing factor to health literacy [ 33 ].…”

“…The questionnaire development process resulted in eight questions in total, which can be answered on a ‘Yes/No/Don’t know’ scale [ 31 ]. Table 1 provides an overview of the items that make up the questionnaire.…”

Health engagement: a systematic review of tools modifiable for use with vulnerable pregnant women

“…Testing of health-promoting interventions, delivered in the absence of relationship-based care, has been proposed to improve perinatal outcomes. 57 While health promotion is an important part of quality maternity care, the provision of motivational counselling around social risk factors does not necessarily translate into women acting on advice. A trusting provider-woman relationship is foundational to pregnant women's willingness and ability to engage.…”

Preventive Counseling in Routine Prenatal Care—A Qualitative Study of Pregnant Women’s Perspectives on a Lifestyle Intervention, Contrasted with the Experiences of Healthcare Providers

“…After each counseling session, the participants received a reminder (push notification) of their lifestyle goals in their GeMuKi-Assist app. Further details on the GeMuKi trial and the GeMuKi intervention can be found elsewhere [33,34,42]. The GeMuKi trial was designed as a hybrid effectivenessimplementation trial, meaning that data on effectiveness and implementation were collected simultaneously [43].…”