Health literacy levels in women at risk of gestational diabetes mellitus attending antenatal services in University Hospital Galway

Abstract

Introduction The 2011 population study on health literacy found that 40% of the Irish population had inadequate health literacy. There has been little research in Ireland and internationally on health literacy in pregnancy. This research explores health literacy levels in women at risk of gestational diabetes (GDM).

Methods Pregnant women at risk of GDM were interviewed on the day of their oral glucose tolerance test (OGTT) at University Hospital Galway. Both functional health literacy and general health literacy, using the Newest Vital Sign (NVS) (U.K.) and the Health Literacy Survey Questionnaire respectively, were measured. Socio-demographic parameters and clinical data were captured from a participant questionnaire and from data sourced from hospital electronic databases. Pregnancy outcomes were collected from the hospital maternity database and results of the OGTT were sourced from the hospital laboratory database. Results There were 297 participants, of which 30 (10.3%) were diagnosed with GDM. Limited functional health literacy was found in 75 participants (25.3%) and limited general health literacy in 113 participants (38%). Household income, parental ethnic background, education attainment and social status were predictors of limited health literacy (p<0.05). A higher percentage of mothers with adequate functional health literacy took pre-pregnancy folic acid compared with mothers with limited functional health literacy, 67.8% versus 53.5% (p=0.04). Results indicated that 16.7% (12 of 75) of pregnant women with limited functional health literacy were diagnosed with GDM compared with 6.2% (18 of 222) of pregnant women with adequate functional health literacy. This did not reach statistical significance (p = 0.6). Following adjustment for confounders functional health literacy was no longer significantly associated with pre-pregnancy folic acid. There were no significant associations found between general health literacy and pregnancy-related factors or adverse pregnancy outcomes.

Conclusions This study confirms that limited health literacy is present in a significant proportion of pregnant women at risk of GDM. It also indicates a social gradient in health literacy in this population. Further studies are required to better define the relationship of health literacy in this cohort and the role of confounders. This study provides prevalence data that can be used to inform the design of these studies. Inclusion of screening questions or short subjective measures of health literacy may identify an accurate and practical test to screen for limited health literacy in this population.