Asthma Patients' Assessments of Health Care and Medical Decision Making: The Role of Health Literacy

Mancuso, Carol A.; Rincon, Melina

doi:10.1080/02770900500447052

Cited by 77 publications

(62 citation statements)

References 21 publications

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“…Further, we found that overall knowledge of asthma triggers and management was high among caregivers of high healthcare utilizers and did not differ by ethnicity. Our findings differ from prior ASTHMA KNOWLEDGE, APTITUDE, AND PRACTICEstudies that report limited parental asthma knowledge, 18,19 primarily related to parental literacy, 20 among caregivers of children with asthma in both Hispanic and AA households. 7 However, despite having high knowledge levels, the caregivers had high usage of ED and hospitalization for management of their child's asthma.…”

Section: Discussioncontrasting

confidence: 56%

Caregiver Asthma Knowledge, Aptitude, and Practice in High Healthcare Utilizing Children: Effect of an Educational Intervention

Rastogi

Madhok

Kipperman

2013

Pediatric Allergy, Immunology, and Pulmonology

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Factors underlying high healthcare utilization among Hispanic and African American (AA) children with asthma are not well known. We hypothesized that low parental knowledge and suboptimal practices are associated with high healthcare utlization and sought to elucidate these factors and identify ethnicity-specific differences. We also hypothesized that a targeted educational intervention will decrease emergency department (ED) visits and hospitalizations. A 57-item questionnaire investigating asthma knowledge, aptitude, and practice was administered during a hospitalization to 268 caregivers (158 Hispanic and 110 AA) of high healthcare utilizer children. Responses were compared between ethnicities. Participants were randomized into an education group and a control group to investigate the impact of an in-hospital educational intervention on future ED visits and hospitalizations. More than 80% of caregivers knew that asthma is associated with muscle constriction and mucus production. Overall, 66.7%-86.9% of caregivers found preventive steps including allergen avoidance, regular primary care physician (PCP) follow-up, and medication adherence helpful, but only 45.2% reported adherence to controller medications. Similarly, caregivers found management steps, including albuterol use, avoidance of ineffective medications, and need to contact PCP helpful but 33% Hispanic caregivers contacted their child's PCP at the time of the exacerbation leading the current hospitalization, compared with 17% AA caregivers (P = 0.006). Moreover, 40% and 30% Hispanic and 27% and 18% AA caregivers felt stressed and helpless, respectively, about their child's asthma. Despite high baseline levels of knowledge, there were fewer ED visits in the education group (1.56 -1.94) compared with the control group (2.05 -2.32) (P = 0.02) 2 years after the intervention. Although Hispanic and AA caregivers of children with high healthcare utilization were knowledgeable of asthma pathophysiology, and preventive and management steps, they reported being stressed and helpless and were unable to implement the steps at the time of an exacerbation, seeking care at the ED rather than contacting their PCP. The high health utilizers who underwent a targeted educational intervention had fewer ED visits 2 years following the intervention.

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Section: Discussioncontrasting

confidence: 56%

Caregiver Asthma Knowledge, Aptitude, and Practice in High Healthcare Utilizing Children: Effect of an Educational Intervention

Rastogi

Madhok

Kipperman

2013

Pediatric Allergy, Immunology, and Pulmonology

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“…Paradoxically, an appropriate asthma action plan relies upon the parent providing accurate information to the healthcare provider. Low literacy adults with asthma often lack these skills; [14][15][16] low literacy parents likely lack them as well. While health literacy may be difficult to change, how and what skills parents are taught has the potential to improve children's asthma outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Studies among adults with asthma indicate that lower health literacy predicts worse asthma outcomes, 14 medical decision making, knowledge, and selfmanagement skills, such as correctly using a meter-dose inhaler and communicating with their healthcare provider. 15,16 Parents need these same skills, as well as reading and numeracy skills, to manage their children's asthma successfully in order to achieve better asthma health outcomes.…”

Section: Introductionmentioning

confidence: 99%

The Impact of Parent's Health Literacy on Pediatric Asthma Outcomes

Harrington

Zhang

Magruder

et al. 2015

Pediatric Allergy, Immunology, and Pulmonology

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Background: Health literacy has been associated with health disparities in many disease outcomes, including children's asthma. Parents are responsible for most of children's healthcare. Therefore, parents' health literacy may impact children's health outcomes, including asthma control. This study sought to determine the association between parent health literacy and children's asthma control among a cohort of predominately minority urban children aged between 6 and 12 years. Methods: This cross-sectional study assessed children with asthma and their parents at a single outpatient visit. English-speaking parents and their children, aged between 6 and 12 years with physician-diagnosed asthma, were eligible for this study. Healthcare providers assessed asthma control and severity, and parents completed demographic, health literacy, asthma control, and asthma knowledge measures. Children completed a pulmonary function test as part of the Asthma Control Questionnaire (ACQ) scoring. Results: A total of 281 parent-child dyads provided data, with the majority of parents being mothers and African American, with a high school level education or less. Lower parent health literacy was associated with worse asthma control as rated both by the provider ( p = 0.007) and the ACQ ( p = 0.013), despite only moderate concordance between ratings (r = 0.408, p < 0.0001). Lower parent health literacy also was associated with less asthma knowledge, which was associated with worse asthma control. Conclusions: Higher parent health literacy was associated with more parent asthma knowledge and better child asthma control. Pediatric providers should consider tailoring education or treatment plans or utilizing universal precautions for low health literacy.

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“…A total of 13 articles were thus identified, and the main findings of these articles are summarized in Table I. [18][19][20][21][22][23][24][25][26][27][28][29][30] The studies included in these articles differ with regard to the instrument used to assess HL, the thresholds used to define categories of HL, and the variables included in multivariate analyses.…”

Section: Hl and Asthmamentioning

confidence: 99%