Date Presented 03/26/20
This scoping review found 27 articles relating health literacy to EI. Analysis resulted in multiple themes, including a need for training to improve communication skills of EI providers, revision of written EI materials needed to increase effectiveness, and recommendations for making the EI system more accessible. Use of health-literacy principles by OT practitioners working in EI programs could improve access, utilization, and child outcomes for families.
Primary Author and Speaker: Catherine Leslie
Additional Authors and Speakers: Jillian Crehan
PURPOSE: The purpose of this scoping review was to investigate and synthesize the literature on health literacy as it relates to early intervention (EI), Part C of the Individuals with Disabilities Education Act.
BACKGROUND: Many American parents do not have the health literacy skills needed to navigate our health care system, including accessing the early intervention system. EI programs provide services, such as occupational therapy, to children with developmental delays or disabilities, who should receive EI services as early as possible to maximize health outcomes. Research to assess the health care experience of families trying to access and use the EI system is vital. This scoping review considered parents’ individual health literacy, and the health literacy of the EI system, including system accessibility, providers’ communication skills, and accessibility of materials. These health literacy components can influence child health outcomes, especially in care of newborns and young children with special healthcare needs.
METHOD: This scoping review followed the PRISMA extension for scoping reviews (2018). The research question was: What is the current state of the literature on health literacy as it applies to early intervention? PubMed, CINAHL and Google Scholar were searched with key words, including health literacy, accessibility, communication, early intervention, IDEA Part C, developmental delay, and developmental disabilities. Inclusion criteria: focus on health literacy (parents, EI providers, materials, or the EI system), and early intervention; and published in English after EI was put into law in 1986 through February of 2019. The search strategy located 3,927 documents, then 501 duplicates were removed. Based on title and abstract review, 3,180 articles were removed for not meeting inclusion criteria. Full-text review of 246 remaining articles resulted in 27 articles meeting inclusion criteria, which were analyzed and themes identified.
RESULTS: The findings of the 27 included articles were organized by health literacy component: parent health literacy (n = 4), materials (n = 8), EI providers (n = 6), and EI system (n = 15). Some studies addressed more than one component. Themes related to parent or provider health literacy: the relationship between use of EI services and parent health literacy; communication challenges between families and EI providers; and recommendations for training to increase EI provider communication skills. Themes related to materials: optimizing family participation by increasing accessibility of written materials; limiting jargon; and providing materials in family’s preferred language. Themes related to accessibility of EI system: implementing referral tracking systems to ensure completion of referral process; and improving quality of information about EI provided by medical staff.
CONCLUSION: Research on the interaction between health literacy and early intervention is limited. Use of health literacy principles could improve families’ ability to successfully access and participate in early intervention services to maximize health outcomes for their child. EI providers, including occupational therapists, can be health literate by using evidence-based communication strategies to ensure families can use provided information effectively. Finally, the EI system can be more health literate by ensuring that enrollment into EI services is an easy, accessible process.
IMPACT STATEMENT: Understanding by occupational therapy practitioners of the impact of health literacy in the early intervention setting is important to both practice and policy to ensure equal access and utilization of EI services for all families. Health literacy concepts should be applied in all health care settings.
References
Raver, S. A., & Childress, D. C. (2015). Early education and intervention for children from birth to three. In S. A. Raver & D. C. Childress (Eds.), Family-centered early intervention (pp. 2–30). Baltimore: Paul H. Brookes.
Tricco, AC, Lillie, E, Zarin, W, O’Brien, KK, Colquhoun, H, Levac, D, Moher, D, Peters, MD, Horsley, T, Weeks, L, Hempel, S et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018,169(7):467-473. doi:10.7326/M18-0850.
IOM (Institute of Medicine). 2004. Health literacy: A prescription to end confusion. Washington, DC: The National Academies Press.
