Health Literacy, Numeracy, and Health Promotion: A Secondary Analysis of the Choosewell 365 Workplace Trial

Overview

Journal Am J Prev Med

Specialty Public Health

Date 2022 Mar 14

PMID 35282955

Authors

Jenny Jia

Douglas E Levy

Jessica L McCurley

Emma Anderson

Emily D Gelsomin

Bianca Porneala

Anne N Thorndike

Affiliations

Soon will be listed here.

Abstract

Introduction: Health literacy and numeracy are linked to obesity and dietary behaviors. This study investigates whether the effect of a workplace behavioral intervention to prevent weight gain and improve diet differed by employee health literacy and numeracy.

Methods: ChooseWell 365 was an RCT of hospital employees testing a 12-month intervention using nudges and feedback to promote healthier choices, building on existing cafeteria traffic light labels (e.g., green=healthy, red=unhealthy). Health literacy and numeracy were measured with the Newest Vital Sign (range=0-6) and General Numeracy Scale (range=0-3). Mixed-effects linear models examined if intervention effects on cafeteria purchases, diet quality (Healthy Eating Index 2015, range=0-100), and weight change over 24 months differed by higher versus lower health literacy or numeracy. Data were collected in 2016-2020 and analyzed in 2020-2021.

Results: In 12 months, 510 participants completed the Newest Vital Sign and General Numerancy Scale; 36.7% had Newest Vital Sign<6 (lower health literacy) and 31.6% had General Numerancy Scale<2 (lower numeracy). Intervention participants increased healthy purchases over 24 months compared with controls in both higher and lower health literacy and numeracy groups. At 12 months, Healthy Eating Index 2015 scores increased in intervention versus control participants with lower health literacy (5.5 points, 95% CI=1.51, 9.54) but not in those with higher health literacy (p-interaction=0.040). BMI did not differ by health literacy or numeracy.

Conclusions: A behavioral intervention improved cafeteria food choices of hospital employees of varying health literacy and numeracy levels and improved diet quality among employees with lower health literacy, suggesting this group also improved food choices outside of work.

Citing Articles

Relationship between Stress and Neuroimmunological Responses and Health Literacy in Newly Diagnosed HIV-Infected Patients: An Exploratory Study.

Arnetz B, Arnetz J, Kaminski N, Tomlin R, Cole A, Bartlett P AIDS Res Treat. 2024; 2024:3432569.

PMID: 39345356 PMC: 11436276. DOI: 10.1155/2024/3432569.

Impacts of educational interventions of librarian instruction on health information seeking attitudes and behaviors in an employee wellness program.

Foy C J Med Libr Assoc. 2024; 112(2):107-116.

PMID: 39119171 PMC: 11305465. DOI: 10.5195/jmla.2024.1775.

Employees' Baseline Food Choices and the Effect of a Workplace Intervention to Promote Healthy Eating: Secondary Analysis of the ChooseWell 365 Randomized Controlled Trial.

Salinger M, Levy D, McCurley J, Gelsomin E, Rimm E, Thorndike A J Acad Nutr Diet. 2023; 123(11):1586-1595.e4.

PMID: 37257691 PMC: 10592532. DOI: 10.1016/j.jand.2023.05.024.

References

Franckle R, Levy D, Macias-Navarro L, Rimm E, Thorndike A . Traffic-light labels and financial incentives to reduce sugar-sweetened beverage purchases by low-income Latino families: a randomized controlled trial. Public Health Nutr. 2018; 21(8):1426-1434. PMC: 6276364. DOI: 10.1017/S1368980018000319. View

Speirs K, Messina L, Munger A, Grutzmacher S . Health literacy and nutrition behaviors among low-income adults. J Health Care Poor Underserved. 2013; 23(3):1082-91. DOI: 10.1353/hpu.2012.0113. View

Berkman N, Sheridan S, Donahue K, Halpern D, Crotty K . Low health literacy and health outcomes: an updated systematic review. Ann Intern Med. 2011; 155(2):97-107. DOI: 10.7326/0003-4819-155-2-201107190-00005. View

Sacks G, Rayner M, Swinburn B . Impact of front-of-pack 'traffic-light' nutrition labelling on consumer food purchases in the UK. Health Promot Int. 2009; 24(4):344-52. DOI: 10.1093/heapro/dap032. View

Schwartz L, Woloshin S, Black W, Welch H . The role of numeracy in understanding the benefit of screening mammography. Ann Intern Med. 1997; 127(11):966-72. DOI: 10.7326/0003-4819-127-11-199712010-00003. View

Garad R, McPhee C, Chai T, Moran L, OReilly S, Lim S . The Role of Health Literacy in Postpartum Weight, Diet, and Physical Activity. J Clin Med. 2020; 9(8). PMC: 7465022. DOI: 10.3390/jcm9082463. View

Levy D, Riis J, Sonnenberg L, Barraclough S, Thorndike A . Food choices of minority and low-income employees: a cafeteria intervention. Am J Prev Med. 2012; 43(3):240-8. PMC: 3422505. DOI: 10.1016/j.amepre.2012.05.004. View

Thorndike A, McCurley J, Gelsomin E, Anderson E, Chang Y, Porneala B . Automated Behavioral Workplace Intervention to Prevent Weight Gain and Improve Diet: The ChooseWell 365 Randomized Clinical Trial. JAMA Netw Open. 2021; 4(6):e2112528. PMC: 8185595. DOI: 10.1001/jamanetworkopen.2021.12528. View

Thorndike A, Riis J, Sonnenberg L, Levy D . Traffic-light labels and choice architecture: promoting healthy food choices. Am J Prev Med. 2014; 46(2):143-9. PMC: 3911887. DOI: 10.1016/j.amepre.2013.10.002. View

10.

Gazmararian J, Yang B, Elon L, Graham M, Parker R . Successful enrollment in Text4Baby more likely with higher health literacy. J Health Commun. 2012; 17 Suppl 3:303-11. DOI: 10.1080/10810730.2012.712618. View

11.

Subar A, Kirkpatrick S, Mittl B, Zimmerman T, Thompson F, Bingley C . The Automated Self-Administered 24-hour dietary recall (ASA24): a resource for researchers, clinicians, and educators from the National Cancer Institute. J Acad Nutr Diet. 2012; 112(8):1134-7. PMC: 3721511. DOI: 10.1016/j.jand.2012.04.016. View

12.

Rothman R, Montori V, Cherrington A, Pignone M . Perspective: the role of numeracy in health care. J Health Commun. 2008; 13(6):583-95. PMC: 2767457. DOI: 10.1080/10810730802281791. View

13.

Rothman R, Housam R, Weiss H, Davis D, Gregory R, Gebretsadik T . Patient understanding of food labels: the role of literacy and numeracy. Am J Prev Med. 2006; 31(5):391-8. DOI: 10.1016/j.amepre.2006.07.025. View

14.

Morris N, MacLean C, Littenberg B . Change in health literacy over 2 years in older adults with diabetes. Diabetes Educ. 2013; 39(5):638-46. DOI: 10.1177/0145721713496871. View

15.

Ni Mhurchu C, Volkova E, Jiang Y, Eyles H, Michie J, Neal B . Effects of interpretive nutrition labels on consumer food purchases: the Starlight randomized controlled trial. Am J Clin Nutr. 2017; 105(3):695-704. DOI: 10.3945/ajcn.116.144956. View

16.

Visschers V, Siegrist M . When reduced fat increases preference. How fat reduction in nutrition tables and numeracy skills affect food choices. Appetite. 2010; 55(3):730-3. DOI: 10.1016/j.appet.2010.09.001. View

17.

Thorndike A, Bright O, Dimond M, Fishman R, Levy D . Choice architecture to promote fruit and vegetable purchases by families participating in the Special Supplemental Program for Women, Infants, and Children (WIC): randomized corner store pilot study. Public Health Nutr. 2016; 20(7):1297-1305. PMC: 5407909. DOI: 10.1017/S1368980016003074. View

18.

Kanellopoulou A, Notara V, Antonogeorgos G, Chrissini M, Rojas-Gil A, Kornilaki E . Inverse Association Between Health Literacy and Obesity Among Children in Greece: A School-Based, Cross-Sectional Epidemiological Study. Health Educ Behav. 2021; 49(1):54-65. DOI: 10.1177/1090198120982944. View

19.

Wing R, Espeland M, Tate D, Perdue L, Bahnson J, Polzien K . Weight Gain Over 6 Years in Young Adults: The Study of Novel Approaches to Weight Gain Prevention Randomized Trial. Obesity (Silver Spring). 2019; 28(1):80-88. PMC: 6927481. DOI: 10.1002/oby.22661. View

20.

Olstad D, Vermeer J, McCargar L, Prowse R, Raine K . Using traffic light labels to improve food selection in recreation and sport facility eating environments. Appetite. 2015; 91:329-35. DOI: 10.1016/j.appet.2015.04.057. View