Refinement of an Instrument to Measure Mental Health Literacy and Examination of Interventions to Enhance Mental Health Literacy

Publication Date: 6/1/2008

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There is a growing consensus about the importance of involving mental health care consumers in making decisions about their health care. This is a challenge, however, for those who cannot effectively understand health information. Research has shown that poor health literacy results in poor health outcomes and higher costs. Mental healthcare consumers and caregivers of children with mental illness and SED (Serious Emotional Disturbances), especially struggle with navigating complex systems and interactions with their and their children's mental health care providers. In this paper, we report on our continued refinement of an instrument to measure mental health literacy among caregivers of children with SED and their providers. We also report on a qualitative study to design message interventions to improve and enhance mental health literacy among caregivers and providers.

Results of the study suggest that three sub-domains, Family Agency, Knowledge and Capability, and Belief in Control may determine mental health literacy. These sub domains show moderate to high internal reliability and evidence of validity when tested on a sample of 175 caregivers. Further analysis suggests a complex relationship between mental health literacy among caregivers and their providers. Both groups consider a belief in the family's agency (the right and ability to control their own destiny) the highest of all sub-domains; and both rated their own communication behaviors and knowledge moderately among all sub-domains. The results associated with "Knowledge and Competency" are consistent with previous research. The results suggest a positive relationship between provider and caregiver mental health literacy. However, mental health literacy appears to be a complex concept, with some aspects of caregiver literacy (Belief in Control), negatively related to provider literacy.

Finally, an investigation of message-interventions to raise literacy among providers and caregivers' communications was conducted through focus groups with caregivers and providers. Results suggest that multiple information sources are needed to enhance caregiver literacy, and that different aspects of literacy may be best delivered using different information channels. Simple messages may be best disseminated through posters or brochures, such as messages regarding caregiver rights and the importance of caregivers' opinions. Other messages may be best disseminated through channels such as DVDs. These messages might include where to obtain services and how to receive testing for a child. Finally, complex messages, such as how to balance the risks and benefits of medication, and how to make placement decisions for a child, may involve teaching caregivers decision-making or other complex skills and should be conveyed through techniques such as one-on-one counseling, training, or coaching.