# Care Providers’ and Parents’ Experiences with Implementing the Conversational Health Literacy Assessment Tool (CHAT)-Maternity-Care in the Netherlands: A Mixed Methods Study

## TL;DR

This study examines how maternity care providers and parents in the Netherlands experienced using CHAT-maternity-care, a tool to assess health literacy during conversations.

## Contribution

The study introduces insights into the implementation of a conversational health literacy tool in maternity care and identifies facilitators and barriers to its adoption.

## Key findings

- CHAT-maternity-care improved care providers' health literacy awareness and structured estimation of parents' health literacy.
- Parents found CHAT-based conversations beneficial for uncovering unaddressed concerns.
- Key barriers to implementation included time constraints and the tool's novelty.

## Abstract

Background/Objectives: Care providers’ understanding of patients’ health literacy is crucial to tailoring care and reducing health inequalities. This study explores the experiences, facilitators, and barriers encountered by maternity care providers when implementing CHAT-maternity-care: a conversational tool that supports care providers in estimating (expectant) parents’ health literacy. As a secondary objective, the study also examines the experiences of (expectant) parents. Methods: Maternity care providers used CHAT-maternity-care after finalizing an e-learning. Implementation was evaluated among maternity care providers with a questionnaire and in-depth focus group meetings and among (expectant) parents with semi-structured interviews. Results: Providers experienced that using CHAT-maternity-care enhanced their health literacy insight, improved health literacy awareness, and fostered easier, more comprehensive and structured estimation of parents’ health literacy. Key facilitators for implementing CHAT-maternity-care as perceived by providers were the perceived value of health literacy insights; the tool’s relevance, user-friendliness, and familiarity; and social factors. The main barriers were time constraints, the tool’s novelty, and social factors. (Expectant) parents were positive and open to having conversations based on CHAT-maternity-care. Questions based on CHAT-maternity-care were perceived as beneficial by parents in uncovering previously unaddressed concerns. Conclusions: CHAT-maternity-care is mostly well received and assessed as helpful to improving health literacy insights. The findings underscore the importance of education, peer support, and organizational alignment for broader adoption and implementation of CHAT-maternity-care.