JMIR Publications

ABSTRACT

Background:

Parental health literacy is important to children's health and development, especially in the first three years. However, few studies have explored effective intervention strategies to improve parental literacy.

Objective:

This study aimed to determine the effectiveness of a WeChat official account (WOA)-based intervention on parental health literacy of primary caregivers of children under three years.

Methods:

This cluster randomized controlled trial was conducted in all 13 community health centers (CHCs) in Minhang District, Shanghai, China, between April 2020 and April 2021. Each CHC was randomly allocated to either the intervention or control group through random sequence generation. A total of 1332 (746 in the intervention group and 586 in the control group) caregiver-child dyads from the 13 CHCs were recruited. Caregivers in the intervention group received a series of purposely designed video clips via a social media WOA, supplemented with reading materials from other trusted online sources. The contents of the video clips were designed according to the health literacy model proposed by the World Health Organization European Region. Caregivers in the control group received printed materials similar to the intervention group. All the participants were followed up for nine months. Both groups could access routine child health services as usual during follow up. Health literacy was assessed online for both groups before and after the intervention. The primary outcome was the total score of parental health literacy measured by a validated instrument, the Chinese Parental Health Literacy Questionnaire of Children 0 to 3 years old. The instrument has two components: physical parental health literacy and psychological parental health literacy. Secondary outcomes included parenting behaviors, children's anthropometry and health outcomes. Generalized linear mixed model (GLMM) was used for data analyses.

Results:

After the nine-month intervention, caregivers in the intervention group reported higher scores for overall and psychological parental health literacy (β:2.37,95%CI:0.06~4.67, P=0.04; and β:1.62,95%CI:0.16~3.09, P=0.03), while there was no difference in physical parental health literacy score between the two groups (β:0.54,95%CI: -0.57~1.65, P=0.34). The intervention group also reported a higher rate of exclusive breastfeeding (EBF) at 6 months (49.2% vs. 31.9%, β:0.71, 95%CI:0.02~1.41, P=0.04), and a higher awareness rate of Vitamin D (VD) supplementation for infants under 6 months (76.7% vs 70.5%, β:0.32, 95%CI:0.02~0.61, P=0.03).

Conclusions:

A WOA-based intervention program significantly improved parental health literacy, EBF at 6 months, and awareness of VD supplementation for infants under 6 months. Clinical Trial: Chinese Clinical Trial Registry (# ChiCTR2000031711); https://www.chictr.org.cn/showproj.aspx?proj=51740