Julie Ayre|Erin Cvejic|Carissa Bonner|Robin Turner|Stephen D. Walter|Kirsten McCaffery
Effects of health literacy, screening, and participant choice on action plans for reducing unhealthy snacking in Australia: A randomised controlled trial
University of Sydney|University of Sydney|University of Sydney|University of Otago|McMaster University|Impact|University of Sydney
background low health literacy associated poorer health outcomes key strategy address health literacy universal precautions approach recommends using healthliterate design health interventions targeting people low health literacy approach advantages health literacy assessment tailoring required however action plans may effective tailored health literacy study evaluated impact health literacy action plan type unhealthy snacking people high bmi type 2 diabetes aim 1 effective method action plan allocation aim 2 methods findings performed 2stage randomised controlled trial australia 14 february 6 june 2019 total 1769 participants mean age 498 years sd 117 561 female n 992 mean bmi 329 kgm2 sd 87 296 selfreported type 2 diabetes n 523 randomised 1 3 allocation methods random health literacy screening participant selection 1 2 action plans reduce unhealthy snacking standard versus literacysensitive regression analysis evaluated impact health literacy newest vital sign nvs allocation method action plan reduction selfreported serves unhealthy snacks primary outcome 4week followup secondary outcomes perceived extent unhealthy snacking difficulty using plans habit strength action control analyses controlled age level education language spoken home diabetes status baseline habit strength baseline selfreported serves unhealthy snacks average nvs score 36 6 sd 20 participants reported consuming 250 serves snacks average per week baseline sd 280 regarding aim 1 398 participants random allocation arm completed followup 677 average people scoring 1 sd mean health literacy consumed 100 fewer serves per week using literacysensitive action plan compared standard action plan 95 ci 005 195 p 0039 whereas scoring 1 sd mean consumed 30 fewer serves using standard action plan compared literacysensitive action plan 95 ci 63 122 p 0529 although difference reach statistical significance addition observed nonsignificant action plan health literacy nvs interaction b 325 95 ci 655 005 p 0054 regarding aim 2 1177 participants across 3 allocation method arms completed followup 665 effect allocation method reduction unhealthy snacking including effect health literacy screening compared participant selection b 179 95 ci 016 373 p 0067 key limitations include lowmoderate retention use singleoccasion selfreported primary outcome reporting number extreme yet plausible snacking scores rendered interpretation challenging adverse events assessed conclusions study observed nominal improvements effectiveness action plans tailored health literacy however improvements reach statistical significance costs associated strategies compared universal precautions need investigation study highlights importance considering differential effects health literacy intervention effectiveness trial registration australia new zealand clinical trial registry actrn12618001409268