Use of Active Ingredient Information for Low Socioeconomic Status Parents' Decision-Making Regarding Cough and Cold Medications: Role of Health Literacy

Abstract

OBJECTIVE Parent administration of multiple medications with overlapping active ingredients places children at risk for overdose. We sought to examine how parents use active ingredient information as part of the process of selecting a cough/cold medication for their child, and how health literacy plays a role. METHODS Experimental study of parents of children presenting for care in an urban public hospital pediatric clinic. Parents were asked to determine which of 3 cough/cold medications could be given to relieve a child’s cold symptoms, as part of a scenario in which they had already given a dose of acetaminophen; only 1 did not contain acetaminophen. Primary dependent variable: correct selection of cough/cold medication, using active ingredient as the rationale for choice. Primary independent variable: parent health literacy (Newest Vital Sign (NVS)). RESULTS Of 297 parents, 79.2% had low health literacy (NVS score 0–3). 35.4% correctly chose the cough/cold medication which did not contain acetaminophen. The proportion of those who made the correct choice was no different than expected from chance alone (Goodness of fit test; χ2=2.1, p=0.3). Only 7.7% chose the correct medication and used active ingredient as the rationale. Those with adequate literacy skills were more likely to have selected the correct medication and rationale (25.8% vs. 3.0% (p=0.001); AOR=11.1 [95%CI: 3.6–33.7], adjusting for sociodemographics, including English proficiency and education). CONCLUSIONS Many parents, especially those with low health literacy, do not use active ingredient information as part of decision-making related to administering multiple medications.

Caregiver Low Health Literacy and Nonurgent Use of the Pediatric Emergency Department for Febrile Illness

“…Having a child with fever requires caregivers to assess a numeric value and recognize and adequately treat symptoms. Adults with low health literacy have poor understanding of illness 8,19,20 and are known to dose antipyretic medications incorrectly, 9,10 leading to poor treatment of fever at home. Lack of health system navigational skills and hesitance to seek information about illness, could lead to higher ED use.…”

Pharmacotherapy literacy questionnaire for parents of pre-school children in Serbia: Construction and psychometric characteristics

“…It was found that the parents with low health literacy harder understand the importance of vaccination and are not completely able to realize the risks of malnutrition and overweight. They can hardly recognize hazards in the home, which leads to frequent injuries of children 4,[5][6][7][8] .…”

“…Furthermore, low health literacy among the parents cause difficulties to dose the medicine which is purchased without a prescription (OTC) for a child. Errors in dosing the OTC medicines to children can cause the risk of adverse effects and therapeutic failure 6,7 .…”

Measuring Health Literacy in Caregivers of Children

“…The NVS has shown predictive ability in a study of emergency department utilization whereas the S-TOFHLA did not. Others have found the NVS to distinguish health outcomes in patients, including diabetes, 15 obesity, 16 health system navigation, 17 medication dosing and understanding, 18,19 and use of mHealth, 20 Additionally, the NVS has been used to assess health literacy in adolescents. 15,21,22 As in our study, another study found that the NVS performed superiorly in detecting a relationship between limited health literacy and a health outcome (knowledge of appropriate antibiotic use) whereas the S-TOFHLA did not.…”