CORE Posters Fall 2025

Health Literacy and Nutrition Knowledge Attitude and Practice in Mothers Enrolled in the Childhood Health Improvement Program (CHIP) of Southwest Virginia

BucciK 1 ., Gough H 1 ., Jacques TZ. 1 *, Lane N. 1 , Ofori C 1 ., Soares L 1 *., Villegas B. 1 , Shelby K. 2 , Nicholson CJ 3 ., Kadio B 3 .

1. Edward Via College of Osteopathic Medicine, Virginia Campus 2. Children Health Improvement Program, Blacksburg Virginia 3. Department of Preventive Medicine and Public Health Edward Via College of Osteopathic Medicine, Virginia Campus

* Corresponding authors: Soares, Laura: lsoares@vt.vcom.edu; Jacques, Tayce Z. tjacques@vt.vcom.edu

Group I

** This project was undertaken as part of the Community Outreach and Research (CORE) Program at the Edward Via College of Osteopathic Medicine (VCOM), which engages DO students in applied research addressing community health needs.

Abstract

Results

Conclusions

● CHIP participation is linked with improved maternal and childhood nutrition knowledge in southwest Virginia, with the strongest gains in childhood outcomes. ● Self-efficacy scores showed modest improvement over time, though pregnancy literacy remained consistently lower, highlighting a persistent gap. ● These findings suggest that CHIP can extend its impact beyond direct services, but additional targeted strategies are needed to strengthen pregnancy-specific health education and reduce disparities in rural maternal health literacy. ● Addressing structural barriers such as food insecurity, transportation challenges, and healthcare access is also essential to ensuring that the benefits of CHIP are fully acknowledged. Strengthening these areas can help reduce disparities, close knowledge gaps, and improve long-term health outcomes for both mothers and children in rural communities.

In 1964, President Lyndon Johnson’s Economic Opportunity Act created Community Action Agencies (CAAs) to reduce disparities in housing, health, education, and nutrition. The Children’s Health Improvement Program (CHIP) is one such initiative in Virginia, providing in-home maternal and child health services tailored to family needs. Yet despite these programs, gaps in maternal health literacy and nutrition knowledge remain, particularly in rural areas where access to care is limited. Data suggest that rural women are significantly less likely to demonstrate adequate maternal health literacy compared to urban women, underscoring the need for targeted, community-based interventions [1,4]. This study evaluated differences in health literacy and nutrition knowledge among women enrolled in CHIP in Southwest Virginia. Surveys were conducted across Montgomery, Floyd, Giles, Radford, and Pulaski counties to assess maternal nutrition knowledge related to children under six years of age. Mean pregnancy nutrition scores increased from 2.13 (early-term) to 3.13 (long-term), while young child nutrition scores increased from 2.75 to 3.20, demonstrating steady gains with longer enrollment. Self efficacy scores showed a modest positive correlation with knowledge (R² = 0.054 for pregnancy, R² = 0.106 for young child). Findings provide empirical evidence to support targeted interventions, guide CHIP program expansion and policy development, and strengthen outreach strategies to address maternal health education gaps in underserved communities. ● Children’s Health Improvement Partnership (CHIP) is a New River Valley, Southwest Virginia community organization that improves the health of young children and pregnant women to promote self-sufficiency. ● CHIP uses a family-based, in-home care model that pairs families with integrated teams of registered nurses and parent educators. The team helps families keep and maintain appointments, follow physician recommendations, and access medical, dental, and mental health services. ● Urban women are twelve times more likely than rural women to have adequate maternal health literacy [4]. This disparity highlights the urgent need for targeted maternal health literacy programs for low-income households to improve health outcomes [3]. ● Addressing barriers such as access to care, food security, and mental health services ensures that families receive comprehensive support. Introduction We conducted a cross-sectional study in mothers enrolled in CHIP to assess maternal health literacy and nutrition knowledge, attitudes, and practices (KAP) . Study population and Recruitment: 48 mothers currently enrolled in CHIP were surveyed between May-August 2025 during home visits by CHIP representatives and nurses. All responses were anonymous and coded with non-identifying numbers. Exclusion criteria: Non-CHIP participants, declined participation, or surveys with incomplete responses Data Collection: Survey question were adapted from the following validated questionnaires: ● Maternal Health Literacy Inventory in Pregnancy (MHELIP) ● General Knowledge Questionnaire (GNKQ-R) ● USDA Infant and Toddler Feeding Practices Study (ITFP-2) Exposure Variables: Duration in CHIP was assessed via survey and categorized as: Early (0-12 months); Medium-term (13-24 months); Long-term (24+ months) Data Analysis : Descriptive statistics were computed for all variables. To assess the relationships between the exposure variables (self-efficacy/KAP scores) and the outcome variables (nutrition knowledge scores), Pearson’s correlation coefficient was utilized, with statistical significance established at p < 0.05. Linear trendlines were added to scatter plots to illustrate the strength and direction of these relationships, and R² values were reported to indicate the proportion of variance explained. Methods

The study sample comprised 48 women residing in Montgomery, Floyd, Giles, Radford, and Pulaski counties, with ages ranging from 17 to 63 years. Education among participants spanned from a high school diploma to a master’s degree. Duration of involvement with CHIP ranged from 3 to 60 months. Both pregnancy and young child nutrition knowledge increased with longer CHIP enrollment (Figure 1), with pregnancy knowledge showing the strongest linear improvement (R² = 0.936). This figure shows that as duration enrolled in CHIP increased, so did pregnancy and child nutrition knowledge scores. Self-efficacy, defined as participants’ confidence in making nutrition-related choices, was modestly but positively correlated with knowledge. This relationship was slightly stronger for young child nutrition (Figure 3, R² = 0.106) compared to pregnancy (Figure 2, R² = 0.054), suggesting that while efficacy supports knowledge gains in both areas, pregnancy-specific knowledge may need additional reinforcement. Within our sample, 39 gave quantifiable data concerning their nutrition and exercise habits. Our sample consumed an average of 4.8 servings of fruits and vegetables per week, while the recommendation is 5 servings per day [5]. Additionally, participants exercise on average 2 times per week for at least 20 minutes each time. Participants were asked what they prioritize when buying food, with responses rated on a scale from most unhealthy (1) to most healthy (5). Twenty-five participants provided quantifiable answers, with an average healthy eating score of 3.5.

Figure 2: Pregnancy Nutrition Self Efficacy vs Nutrition Knowledge.

Scatter plot showing individual participants’ pregnancy self efficacy (KAP scores) versus their nutrition knowledge scores. A linear trendline is included, with R² = 0.054, indicating a very weak positive relationship.

Figure 3: Young Children Nutrition Self-Efficacy and Nutrition Knowledge Scatter plot showing individual participants’ child self-efficacy (KAP scores) versus their nutrition knowledge scores. A linear trendline is included, with R² = 0.106, indicating a weak positive relationship.

Figure 1: Mean Pregnancy and Child Nutrition Knowledge Scores by Program Duration Bars represent the mean scores, and error bars indicate standard error of the mean. Linear trendlines are overlaid for each group, with R² = 0.936 for pregnancy nutrition scores and R² = 0.519 for child nutrition scores, indicating a strong positive relationship for pregnancy and a moderate positive relationship for child nutrition.

Table 1: KAP self-efficacy scores and nutrition knowledge scores for pregnancy and young children among CHIP participants, grouped by program duration. Early-term = 0 – 12 months, Medium-term = 13 – 24 months, Long-term = 24+ months. Values represent mean scores for each group.

Discussion

Recommendations for improving maternal health literacy include expanding community-based maternal health education, increasing access to pregnancy care in rural areas, and enhancing health communication strategies. Integrating health literacy programs for mothers, such as CHIP, could improve maternal and child health outcomes while also addressing the disparities faced by this population [1]. Our research has shown that CHIP’s efforts towards educating mothers on pregnancy and child nutrition knowledge has been effective. Although CHIP’s primary focus is targeted towards improving health outcomes and not specifically health literacy, our findings demonstrate encouraging trends. Our results show promising improvements in nutrition knowledge with modest but meaningful gains in health literacy as time enrolled CHIP progresses. These findings suggest that CHIP has the potential to extend its impact beyond direct services and help reduce gaps in maternal health literacy.

References

1. Angley M, Thorsten VR, Drews-Botsch C, et al. Association of participation in a supplemental nutrition program with stillbirth by race, ethnicity, and maternal characteristics. BMC Pregnancy Childbirth. 2018;18(1):306. Published 2018 Jul 24. doi:10.1186/s12884-018-1920-0 2. Department of Medical Assistance Services. 2022 – 23 Child Welfare Focus Study Report. Commonwealth of Virginia; 2023. Accessed March 27, 2025. https://www.dmas.virginia.gov/media/vuievjjb/2022-2023-child-welfare-focus-study. 3. Ferguson B. Health literacy and health disparities: the role they play in maternal and child health. Nurs Women’s Health . 2008;12(4):286 – 298. doi: 10.1111/j.1751-486X.2008.00343.x 4. Jiregna B, Amare M, Dinku M, Nigatu D, Desalegn D. Women Health Literacy and Associated Factors on Women and Child Health Care in Ilu Ababor Public Health Facilities, Ethiopia. Int J Womens Health . 2024;16:143-152 1. U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2020 – 2025. 9th ed., Dec. 2020, www.dietaryguidelines.gov/sites/default/files/2020 12/Dietary_Guidelines_for_Americans_2020-2025.pdf We thank the participants and staff of the Childhood Health Improvement Program (CHIP) of New River Valley for their collaboration. This study was determined to be exempt by the Edward Via College of Osteopathic Medicine Institutional Review Board (IRB Record #2025-060; Approval Date: August 27, 2025, Exemption Category 2). Acknowledgements