Degree Name

PhD (Doctor of Philosophy)



Date of Award


Committee Chair or Co-Chairs

Florence Weierbach

Committee Members

Patricia Hayes, Deborah Setliff, Octavia Flanagan


Health literacy is recognized as a contributor to health outcomes and maternal health literacy is important to the health and wellbeing of children and families. Of particular interest are mothers seeking immunization services for their children. The complexity of the recommended immunization schedule and the care management of children receiving immunizations have the potential to create negative health outcomes in the low health literate population. Assessment of maternal health literacy and provision of effective patient education adapted to the health literacy level of the individual is important for information transfer. The Teach-Back provides an opportunity to both assess understanding and reinforce teaching.

This study used an experimental design to study two groups of women for a total of 90 participants in a public health department setting. The control group received the usual immunization patient education using Vaccination Information Sheets. The intervention group also received patient education in this manner plus use of the Teach-Back. Immunization knowledge was assessed prior to and after patient education. Immunization currency was assessed as well.

The Newest Vital Sign was used to assess the maternal health literacy for 90 mothers bringing their children for immunizations. A demographic survey addressing both individual characteristics and social determinants of health variables was also administered.

Most of the participants were low health literate (84%) and low health literacy was related to lower immunization knowledge and poor immunization currency. Social determinants of health variables were related to maternal health literacy, immunization knowledge and immunization currency. The results demonstrated an improvement of immunization knowledge scores with the use of the Teach-Back method of patient education.

Additional research is needed in the area of patient education interventions specific to the low health literate population. The development of instruments to measure interactive and critical health literacy are needed and interventions to promote growth in health literacy are also needed. Clinically, improved patient education interventions for low health literate mothers has the potential to improve health outcomes and decrease health care costs of these women, their children and their families.

Document Type

Dissertation - unrestricted


Copyright by the authors.

Included in

Nursing Commons