How midwives tailor health information used in antenatal care M. Wilmore, PhD (Associate Professor) a , D. Rodger, PhD (Senior Research Fellow) b,n , S. Humphreys, PhD (Senior Lecturer) a , V.L. Clifton, PhD (Associate Professor and NHMRC Senior Research Fellow) c , J. Dalton, GDip, BN, RN, RM (Research Midwife) c , M. Flabouris, GDip (Masters Student) a , A. Skuse, PhD (Associate Professor) b a Faculty of Humanities and Social Sciences, School of Humanities, Discipline of Media, The University of Adelaide, Adelaide, SA 5005, Australia b Faculty of Humanities and Social Sciences, School of Social Sciences, Discipline of Anthropology and Development Studies, The University of Adelaide, Adelaide, SA 5005, Australia c Faculty of Health Sciences, School of Paediatrics and Reproductive Health, Discipline of Obstetrics and Gynaecology, The University of Adelaide, Adelaide, SA 5005, Australia article info Article history: Received 15 February 2014 Received in revised form 3 June 2014 Accepted 16 June 2014 Keywords: Health literacy Health promotion Health communication Antenatal care Tailored health information Pregnancy abstract Objective: to examine the informal approaches taken by midwives and other antenatal staff to adapt health communication to the needs of their patients, as well as their perception of the barriers faced when trying to provide tailored health promotion. Design: qualitative research methods (participant observation, individual and group interviews) were utilised to gain an understanding of how media and communication resources were used in practice within the study hospital. Setting: a major metropolitan teaching hospital located in the Northern suburbs of Adelaide, South Australia. Participants: individual semi-structured interviews with antenatal staff (n ¼8) were combined with group interviews (n ¼2; total number of staff ¼13), and observational research. Findings: midwives and other antenatal staff use a range of strategies to meet the perceived health literacy level of their patients. However, their attempts to tailor health information to individual needs are frequently based on incomplete information about patients' health literacy, may be inconsistent in delivery and content and are seldom assessed to determine whether communication has been under- stood or led to patient behaviour change. Key conclusions: midwives fully recognise the need to adapt standard printed materials to meet the diverse health literacy needs of patients but lack the resources required to evaluate whether these adaptations have positive effect. Implications for practice: midwives' commitment to improving health communication provides a latent resource that institutions can build on to improve health outcomes for patients with low health literacy. This requires improvements in health communication training, willingness to use a range of validated instruments for measuring health literacy, and commitment to use of innovative approaches to health promotion where these have been shown to have a positive impact on health behaviours. & 2014 Elsevier Ltd. All rights reserved. Introduction The benefit of tailoring health information delivery to meet the specific needs of patients has become an accepted principle for effective health promotion and acute care (NCI, 2005). This need is particularly important in relation to the information needs of patients with low levels of health literacy, with specific communication needs due to minority cultural and linguistic background, or whose low socio-economic status makes it difficult to access health care resources that others may take for granted (Barber et al., 2009). Nevertheless, putting this principle into practice presents significant challenges to health care professionals given the resource constraints they often face in delivery of care, including inadequate knowledge regarding these principles. Evi- dence suggests that health care professionals may be unable or unwilling to implement systematic evaluations of patient health literacy as part of standard care (Macabasco-O'Connell and Fry- Bowers, 2011), but informal estimates of health literacy are Contents lists available at ScienceDirect journal homepage: www.elsevier.com/midw Midwifery http://dx.doi.org/10.1016/j.midw.2014.06.004 0266-6138/& 2014 Elsevier Ltd. All rights reserved. n Corresponding author. E-mail address: dianne.rodger@adelaide.edu.au (D. Rodger). Midwifery 31 (2015) 74–79