Abstract
This community-based participatory research (CBPR) project used a collaborative process to develop a culturally relevant workbook for parents of overweight children. We followed a mixed methods iterative process to assess clear communication using a CBPR approach. Materials were evaluated using readability tests, the Clear Communication Index (CCI), and the Suitability Assessment of Materials (SAM). In addition, we used surveys and focus groups to investigate parents’ perceptions and gather feedback from delivery staff using the workbook. While workbook materials maintained adequate grade reading levels, our iterative process and the use of CCI and SAM led to significant improvements in (a) clearly communicating the objectives of the program, (b) being culturally relevant, and (c) reaching a high satisfaction among users. These findings suggest that evaluative measures for written materials should move beyond readability and need to account for level of clarity and cultural appropriateness of messages. Furthermore, we found that that an iterative process to intervention’s material development using clear communication strategies while involving community members, parents, and research partners can lead to workbook materials that are culturally relevant to the target audience, and better communicate program objectives. Finally, this is a potentially generalizable process for improving clear communication of written health information materials.
Highlights
Health literacy (HL) among the general public has become progressively more important for public health because many aspects of health care depend on understanding written information and verbal instruction (McCormack et al, 2010)
Lower rates were found about the usability with parents indicating that they did not often use the workbook outside the classes (μ = 3.5/10, SD = 1.4), did not often use the goal setting and tracking sheets (μ = 3.4/10, SD = 1.5), or think they will often use the workbook after the program ended (μ = 2.8/10, SD = 1.6)
We have described an iterative and systematic formative evaluation using a community-based participatory research (CBPR) approach to develop, evaluate, and improve a childhood obesity workbook for parents of overweight children that used clear communication strategies to address key learning objectives
Summary
Health literacy (HL) among the general public has become progressively more important for public health because many aspects of health care depend on understanding written information and verbal instruction (McCormack et al, 2010). Many of the same populations at risk for limited HL suffer from disparities in health outcomes (Berkman et al, 2011; Mantwill, Monestel-Umaña, & Schulz, 2015). Not surprisingly, both low HL and childhood obesity disproportionately affect rural and low-income populations (Paasche-Orlow, Parker, Gazmararian, Nielsen-Bohlman, & Rudd, 2005; Zahnd, Scaife, & Francis, 2009), with children from parents with low HL having greater obesity risk (Chari, Warsh, Ketterer, Hossain, & Sharif, 2014; Sanders, Federico, Klass, Abrams, & Dreyer, 2009). It is critical to determine the degree to which written materials clearly and effectively communicate health information when adapting evidencebased childhood obesity interventions for families in health disparate communities.
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