A mixed methods approach to measuring and profiling parental health literacy in the UK

Abstract

Background

Parental health literacy plays a critical role in child health and wellbeing, yet there is limited UK-based evidence on how to measure and respond to it effectively, particularly in areas of high deprivation. This thesis aimed to explore effective ways to measure and profile the health literacy strengths and challenges of parents of children aged 0–4 years in areas of high deprivation, with the ultimate aim of co-producing relevant and acceptable health literacy solutions and intervention ideas.

Methods

Guided by the Optimising Health Literacy and Access (Ophelia) process, five empirical studies were conducted. A systematic review assessed the effectiveness of community-based health literacy interventions for parents (Chapter 3). The Health Literacy Questionnaire–Parent (HLQ–Parent), a new adaptation of the HLQ, was tested for validity through cognitive interviews, and exploratory and confirmatory factor analysis (Chapters 4 and 5). Health literacy profiles of parents living in areas of high deprivation were developed using cluster analysis of survey data, supplemented by qualitative data to produce vignettes (Chapter 6). These vignettes were used in stakeholder engagement workshops with parents and practitioners to co-develop health literacy interventions and solution ideas (Chapter 7). Patient and Public Involvement and Engagement (PPIE) contributed to shaping accessible study materials, supporting recruitment, and addressing power dynamics.

Results

The systematic review identified 11 community-based interventions, showing some potential to improve parental health literacy; however, study quality was mixed. Despite the HLQ–Parent demonstrating partial construct validity, further refinement and testing are required. Health literacy profiling revealed diverse strengths and challenges among parents, with variations linked to demographic and contextual factors. The vignettes were recognised as realistic and valuable tools. Stakeholders co-produced a set of intervention ideas, which were synthesised into 26 proposed solutions across six overarching strategies. These solutions spanned individual, service, commissioner, and policy levels. Further work is needed to prioritise these solutions and support the development, implementation, and evaluation of future interventions. Recommendations have been made for practice and future research.

Conclusions

This thesis contributes to the evidence base on the health literacy of parents with children aged 0–4 years by generating localised health literacy profiles, and applying an inclusive, co-designed approach to the initial stages of intervention development.

Date of Award	4 Jul 2025
Original language	English
Awarding Institution	University of Winchester
Supervisor	James Faulkner (Supervisor), Margaret Husted (Supervisor) & Rachel Locke (Supervisor)