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Health Educ Res. 2016 Aug;31(4):492-508. doi: 10.1093/her/cyw024. Epub 2016 May 11.

The impact of health literacy on rural adults' satisfaction with a multi-component intervention to reduce sugar-sweetened beverage intake.

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Department of Health and Exercise Science, Rowan University, Glassboro, NJ 08028, USA
Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA 24061, USA.
Department of Health Promotion, Social & Behavioral Health, University of Nebraska Medical Center, Omaha, NE 68198, USA.
School of Journalism, University of Kansas, Lawrence, KS 66045, USA.
Department of Human Nutrition, Foods and Exercise, Virginia Tech, 1981 Kraft Drive (0913), ILSB 23, Rm 1031, Blacksburg, VA 24061, USA.


SIPsmartER is a 6-month behavioral intervention designed using a health literacy universal precautions approach that has been found effective at reducing sugary beverage intake in rural, low socioeconomic adults. The purpose of this mixed-methods study is to determine if health literacy status influenced participants' satisfaction and perceptions of each intervention component: small group classes, interactive-voice response (IVR) calls, personal action plans and self-monitoring logs. Of the 155 participants enrolled in SIPsmartER, 105 (68%) completed an interview-administered summative evaluation including 68 high and 37 low health literate participants. The quantitative findings show participant satisfaction with each intervention component was high (i.e. classes = 9.6, IVR calls = 8.1, action plans = 8.9-9.1, logs = 8.7 on a 10-point scale) and similar across both health literacy groups. The majority of qualitative responses were positive (81.8%) and code counts were comparable between literacy groups with a few exceptions. As compared with high health literacy respondents, low health literacy respondents more frequently mentioned liking the content and length of IVR calls, liking the motivational aspects of the personal action plans, and identified numeracy issues with the self-monitoring logs. Overall, applying a health literacy universal precautions approach is an effective and acceptable strategy for both high and low health literacy groups.

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