THE DEVELOPMENT OF A PRENATAL CARE HEALTH LITERACY INSTRUMENT FOR AMERICAN INDIAN MOTHERS

American Indian (AI) women are nearly four times as likely as white women to experienced delayed prenatal care until the third trimester. Additionally, AI are the only racial/ethnic group that has not had a decline in infant mortality between 2005 and 2014. While these inequities are apparent, little is known about health literacy among AI women of childbearing age. Existing health literacy instruments do not take the cultural context surrounding the prenatal period into account. Method: After a comprehensive review of the literature of health literacy tools and questionnaires, a measure of prenatal care health literacy for AI mothers was developed with four domains. Measure development was iterative. Cognitive interviews, a standard technique to assist validation, were used to verify the face validity of the instrument and to check understanding in the population of interest. Results: The initial instrument had 60 questions. Iterative review by experts in population health and AI health disparity research eliminated 30 duplicative questions. Cognitive interviews were conducted with AI researchers and community members, after which 5 more questions were eliminated. These interviews also help establish the validity of the tool, understanding of the questions, and suggestions for formatting of the instruments. The final instrument consists of 25 questions. Discussion: Health literacy is the ability to obtain, process, and understand health information to make knowledgeable health decisions. There is little information on health literacy specific to prenatal care and infant health among AI. This instrument was developed specifically for this marginalized population.