Considering Health Literacy, Health Decision Making, and Health Communication in the Social Networks of Vulnerable New Mothers in Hawai'i: A Pilot Feasibility Study

Int J Environ Res Public Health. 2020 Mar 31;17(7):2356. doi: 10.3390/ijerph17072356.


Health literacy is understudied in the context of social networks. Our pilot study goal was to consider this research gap among vulnerable, low-income mothers of minority ethnic background in the state of Hawai'i, USA. Recruitment followed a modified snowball sampling approach. First, we identified and interviewed seven mothers ("egos") in a state-sponsored home visiting program. We then sought to interview individuals whom each mother said was part of her health decision-making network ("first-level alters") and all individuals whom the first-level alters said were part of their health decision-making networks ("second-level alters"). Health literacy was self-reported using a validated item. A total of 18 people were interviewed, including all mothers (n = 7), 35% of the first-level alters (n = 7/20), and 36% of the second-level alters (n = 4/11). On average, the mothers made health decisions with 2.9 people (range: 1-6); partners/spouses and mothers/mothers-in-law were most common. One mother had low health literacy; her two first-level alters also had low health literacy. Across the full sample, the average number of people in individuals' health decision networks was 2.5 (range: 0-7); 39% of those interviewed had low health literacy. This can inform the design of future studies and successful interventions to improve health literacy.

Keywords: Filipino mothers; health communication; health literacy; low-income mothers; native Hawaiian mothers; social networks.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Decision Making*
  • Feasibility Studies
  • Female
  • Hawaii
  • Health Communication*
  • Health Literacy*
  • Humans
  • Mothers
  • Pilot Projects
  • Social Networking
  • Vulnerable Populations