Abstract
ObjectiveGuidance to address health literacy often focuses on health education rather than tools to facilitate action, despite action being important for self-management. This study evaluated an online intervention informed by health literate design principles and behavior change theory to reduce unhealthy snacking.Methods440 participants were recruited online and randomized to an intervention: 1) Health-literate action plan (guided implementation intention); 2) Standard action plan (self-guided implementation intention); 3) Education (healthy snacking fact-sheet). The primary outcome was self-reported unhealthy snacking. Follow-up was at 1 month.Results373 participants (84.8%) completed follow-up. Half the sample had adequate health literacy (52%), and the other half had low (24%) or possibly low (25%) health literacy, as measured by Newest Vital Sign (NVS). At follow-up, lower health literacy was associated with more unhealthy snacks and there was no overall difference between intervention groups. However, participants with lower health literacy who used the health-literate action plan reported less unhealthy snacking compared to the standard action plan; the reverse was true for those with higher health literacy scores (b = 1.7, p = 0.03). People scoring 2 points below the mean NVS (M = 3.4, SD = 2.0) using the health-literate action plan reported eating 8 fewer serves of unhealthy snacks, whereas people scoring 2 points above the mean NVS reported eating 6 more serves of unhealthy snacks using the same tool.ConclusionsThese findings suggest that the universal precautions approach currently recommended for health information may be less effective for facilitating action than tailoring to health literacy level.Trial registrationANZCTR identifier: ACTRN12617001194358.
Highlights
Low health literacy is an important predictor of health inequality that is associated with worse health outcomes, including increased hospitalization, risk factors, chronic disease and mortality risk [1]
At follow-up, lower health literacy was associated with more unhealthy snacks and there was no overall difference between intervention groups
Participants with lower health literacy who used the health-literate action plan reported less unhealthy snacking compared to the standard action plan; the reverse was true for those with higher health literacy scores (b = 1.7, p = 0.03)
Summary
Low health literacy is an important predictor of health inequality that is associated with worse health outcomes, including increased hospitalization, risk factors, chronic disease and mortality risk [1]. Despite evidence that health literacy interventions can improve knowledge about a health issue, it is unclear to what extent this translates to improved behavior change such as selfmanagement [2,3,4,5]. Several theoretical models have incorporated this gap explicitly by partitioning behavior change into 2 phases: a phase that cultivates motivation and intentions, and a phase that promotes action [7,8,9,10,11] Important differences between these two phases are highlighted in recent reviews of interventions for self-management behaviors. These have emphasized the importance of strategies used in the action phase, such as self-monitoring, action planning and goal setting [12,13,14,15,16,17]
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