Low Parental Literacy Is Associated With Worse Asthma Care Measures in Children

Abstract

Objective-To determine if parental literacy is related to emergency department visits, hospitalizations, and days of school missed for children with asthma.Methods-We performed a retrospective cohort study at a university pediatric clinic. We enrolled children between 3 and 12 years old with a diagnosis of asthma and a regular source of care at the site of the study and their parent or guardian. Primary asthma care measures included self-reported rates of emergency department visits, hospitalizations, and days of school missed. Secondary asthma care measures included rescue and controller medication use, classification of asthma severity and parental asthma-related knowledge.Results-We enrolled 150 children and their parents. Twenty-four percent of the parents had low literacy. Children of parents with low literacy had greater incidence of emergency department visits (adjusted incidence rate ratio [IRR] 1.5; 95% CI 1.1, 2.1), hospitalizations (IRR 3.2; 1.4, 7.3), and days missed from school (IRR 2.5; 2.1, 3.0) even after adjusting for asthma-related knowledge, disease severity, medication use and other socio-demographic factors. Parents with low literacy had less asthma-related knowledge, and their children were more likely to have moderate or severe persistent asthma and had greater use of rescue medications.Conclusions-Low parental literacy is associated with worse care measures for children with asthma.

Parent Health Literacy and Communication With Diabetes Educators in a Pediatric Diabetes Clinic: A Mixed Methods Approach

“…Although the 18.5% prevalence rate of low health literacy for the parents in this study falls within the rates of 1-29% reported for a variety of parent samples (DeWalt, Dilling, Rosenthal, & Pignone, 2007;Driessnack, Chung, Perkhounkova, & Hein, 2013;Kumar et al, 2010;Otal et al, 2012;Wittich, Mangan, Grad, Wang, & Gerald, 2007;Yin et al, 2009), it is lower than the 28.7% prevalence rate reported for a national sample of parents (Yin et al, 2009). Although no longitudinal data have been reported examining the change in health literacy level after the diagnosis of diabetes, it is plausible that parents, experienced in the health care demands of caring for a child with type 1 diabetes, may have improved health literacy.…”

“…The Rapid Estimate of Adult Literacy in Medicine (REALM) (Murphy, Davis, Long, Jackson, & Decker, 1993) is the most commonly used instrument in health literacy research and has been used to measure parent health literacy (DeWalt, Dilling, Rosenthal, & Pignone, 2007;Yin, Dreyer, Foltin, van Schaick, & Mendelsohn, 2007). The REALM focuses on basic reading and writing skills, measuring functional health literacy.…”

“…REALM score was the total number of correctly pronounced words. The Cronbach's α was .96 in a diverse sample of adults (Shea et al, 2004) and has been used in parent samples (DeWalt, Dilling, Rosenthal, & Pignone, 2007). REALM has strong criterion validity with the Slosson Oral Reading Test-Revised (.96, p< .0001) and the Wide Range Achievement Test-Revised (.88, p < .001), both standardized tests for literacy.…”

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

“…DeWalt et al found that parent health literacy was associated with ED visits, hospitalizations, and missed school days among inner-city children with asthma. 29 Shone et al found similar findings for healthcare use. 31 In contrast, we did not find these relationships, similar to findings in urban upstate New York 31 and Midwestern urban African American 32 cohorts.…”

“…27,28 Findings for pediatric asthma outcomes are inconsistent. Lower parent health literacy has been associated with more healthcare utilization by children with asthma in some studies, 29,30 but not in others. 31,32 Two studies examining parent health literacy and child asthma control have disparate findings: one reports an indirect relationship between health literacy and asthma control through satisfaction with shared decision making, 33 while the other found no relationship.…”