Is Health Literacy Associated With Parental Comprehension of Discharge Medications for Children With Medical Complexity?

Health literacy is the ability to find, understand, and use information and services to inform health-related decisions and actions. Inadequate health literacy is associated with health disparities, poor health outcomes, and increased emergency department (ED) visits and hospitalizations. Children with medical complexity (CMC) have high rates of acute health care utilization. We examined the association of parental health literacy with acute care utilization and costs in CMC. This cross-sectional study included parents of CMC receiving primary care at a free-standing children's hospital. We measured parental health literacy using the Single Item Literacy Screener, which measures the assistance needed to read health care materials. Our main predictor was parental health literacy, categorized as adequate versus inadequate. In a sensitivity analysis, we categorized health literacy as never needing assistance versus needing any assistance. Main outcomes were annual ED visits, hospitalizations, and associated costs. Of the 236 parents of CMC, 5.5% had inadequate health literacy. Health literacy was not associated with acute care utilization or associated costs. In our sensitivity analysis, CMC whose parents need any assistance to read health care materials had 188% higher ED costs (adjusted rate ratio 2.88 [95% confidence interval: 1.63-5.07]) and 126% higher hospitalization costs (adjusted rate ratio 2.26 [95% confidence interval: 1.49-3.44]), compared with CMC whose parents never need assistance. Inadequate parental health literacy was not associated with acute care utilization. However, CMC of parents needing any assistance to read health materials had higher ED and hospitalization costs. Further multicenter studies are needed.

Parent Health Literacy and “Obesogenic” Feeding and Physical Activity-Related Infant Care Behaviors

Parents’ functional health literacy is associated with children’s health outcomes: Implications for health practice, policy, and research

To test associations between health literacy and clinical outcomes in patients undergoing hematopoietic stem-cell transplantation (HSCT). English- and Spanish-speaking patients age ≥ 18 years were recruited while admitted for first allogeneic HSCT. Associations between low health literacy (Newest Vital Sign ≤ 3 or Short Test of Functional Health Literacy in Adults ≤ 22) and HSCT outcomes were evaluated. Twenty-eight percent of 177 participants had low health literacy by Newest Vital Sign. None had low health literacy by Short Test of Functional Health Literacy in Adults. There was no statistically significant difference between patients with low and adequate health literacy in hospital readmissions (60% v 54%, P = .4), 2-year overall survival (58% v 66%, P = .19), 2-year cumulative incidence of nonrelapse death (16% v 10%, P = .35), and acute graft-versus-host disease (53% v 44%, P = .3). In multivariable analyses, there were no significant associations between health literacy and clinical outcomes. In this cohort of patients undergoing HSCT, we did not identify a relationship between health literacy and clinical outcomes. Although we did not find statistically significant associations between health literacy and HSCT outcomes, interventions to address health literacy should be considered, given complex outpatient care and evidence for adverse outcomes associated with health literacy in similar diseases.

Population-wide research on the impact of parent health literacy to children's health outcomes is limited. We assessed the relationship of low parent health literacy to a range of pediatric health risks within a large cohort of primary care patients. Data were from 17 845 English- and Spanish-speaking parents of children aged ≤7 years presenting for well-child care. We used a 3-item screener to measure health literacy. Outcomes included secondhand smoke exposure, asthma treatment nonadherence, parent depression, child-rearing practices, injury prevention, and parent first-aid knowledge. We summarized study variables with descriptive statistics and then performed multivariable logistic regression to identify associations between low parent literacy and our dependent measures. Mean child age was 4.8 years (SD 3.7); 36.5% of parent respondents had low health literacy. In models adjusted for child gender, race/ethnicity, insurance, age, and parent language preference, low parent health literacy was related to a range of pediatric health risks, including parent depression (adjusted odds ratio [AOR] 1.32; 95% confidence interval 1.18-1.48), firearm access (AOR 1.68; 1.49-1.89), not having a working smoke detector (AOR 3.54; 2.74-4.58), and lack of first-aid knowledge about choking (AOR 1.67; 1.44-1.93) and burns (AOR 1.45; 1.29-1.63). Children of parents with low health literacy were also more likely to watch >2 hours of television per day (AOR 1.27; 1.17-1.36). Low parent health literacy is independently and significantly related to parent depression, child television viewing, and at-risk family behaviors associated with child injury. Use of low-literacy approaches to health-behavior interventions may be essential to address common child morbidities.

The purpose was to collect assessment data with three separate health literacy tools and compare the efficiency of identifying individuals that are at risk for low health literacy levels.Health Literacy is defined as the capacity to obtain, communicate, process, and understand basic health information and services to make appropriate health decisions. Adults with basic or below basic health literacy skills (35% in the U.S.) have problems reading a chart and understanding simple medical instructions. Literature supports the association between low health literacy levels and poor health outcomes.Approval for the project was obtained from the Human Subjects Committee. A partnership was formed with a local physician office to assess a total of 50 patients. Students worked in pairs and collected the following data: highest level of education, a single question assessment, the Newest Vital Sign (NVS) assessment, and the Rapid Estimate of Adult Literacy in Medicine- Short Form (REALM-SF) assessment.Using linear correlation, the three tools are not well related. Of all participants, 96% reported that they never or rarely ask for help, yet on the NVS, 43% scored a limited or possibly limited health literacy result. Correlating education level: of those participants with a high school, technical, and associate degree, the average scores put them at a limited or possibly limited health literacy level. However, with those participants with a bachelor degree or higher, the average score was at a level of adequate health literacy.

Serving Culturally and Linguistically Diverse Patients in Audiology-Part 2: Promoting Health Literacy

Kidney Health for All: Bridging the Gap in Kidney Health Education and Literacy

ObjectiveHealth literacy is a significant public health concern, particularly given the increased complexity of chronic disease health management and health system navigation, and documented associations between low health literacy and poor health outcomes. This study therefore aimed to identify the proportion and characteristics of outpatients visiting a specialist cancer hospital who report low health literacy and/or low cancer health literacy.MethodThis study used a cross-sectional survey administered verbally with patients attending a specialist cancer hospital located in Melbourne, Australia over a two-week period. Process data on conducting health literacy screening within a clinical setting was collected.ResultsThose identified with inadequate general health literacy were different to those identified with low cancer-specific health literacy, although overall both proportions were low. Cross-sectional screening of patients was difficult, despite utilising verbal surveying methods designed to increase capacity for participation.ConclusionHealth literacy screening using the tools selected was not useful for identifying or describing patients with low health literacy in this setting, given the disparity in those categorised by each measure.Practice ImplicationsUntil the theoretical construct of health literacy is better defined, measurement of health literacy may not be clinically useful.

BackgroundProcessing Web-based health information can be difficult, especially for people with low health literacy. Presentinghealth information in an audiovisual format, such as animation, is expected to improve understanding among low health literateaudiences.ObjectiveThe aim of this paper is to investigate what features of spoken health animations improve information recall and attitudes and whether there are differences between health literacy groups.MethodsWe conducted an online experiment among 231 participants aged 55 years or older with either low or high health literacy. A 2 (spoken vs written text) x 2 (illustration vs animation) design was used. Participants were randomly exposed to one of the four experimental messages, all providing the same information on colorectal cancer screening.ResultsThe results showed that, among people with low health literacy, spoken messages about colorectal cancer screening improved recall (P=.03) and attitudes (P=.02) compared to written messages. Animations alone did not improve recall, but when combined with spoken text, they significantly improved recall in this group (P=.02). When exposed to spoken animations, people with low health literacy recalled the same amount of information as their high health literate counterparts (P=.12), whereas in all other conditions people with high health literacy recalled more information compared to low health literate individuals. For people with low health literacy, positive attitudes mediated the relationship between spoken text and the intention to have a colorectal cancer screening (b=.12; 95% CI 0.02-0.25).ConclusionsWe conclude that spoken animation is the best way to communicate complex health information to people with low health literacy. This format can even bridge the information processing gap between audiences with low and high health literacy as the recall differences between the two groups are eliminated. As animations do not negatively influence high health literate audiences, it is concluded that information adapted to audiences with low health literacy suits people with high health literacy as well.

Health literacy is an important public health goal and of particular relevance when people are starting a family. Health literacy is thought to be crucial for the management of the manifold demands relating to child health which are imposed on parents. The aim of this study was to investigate health literacy in a large sample of mothers of newborn children in Germany. Sociodemographic factors and health literacy (as assessed by the HLS-EU health care scale) were analyzed using data from 2403 mothers of newborns who take part in an ongoing birth cohort study (KUNO-Kids health study). Almost 40% of mothers had a limited health literacy level. Being primiparous was significantly associated with lower health literacy, while having a high level of education compared with a medium level of education was significantly associated with higher health literacy.Conclusion: The finding of a substantial amount of mothers experiencing problems in dealing with and navigating through the healthcare system is important for the design of pediatric health services.What is Known:• New parents are confronted with many recommendations about child health.• Health literacy of parents is considered crucial for child health outcomes.What is New:• Many mothers of newborns have a limited health literacy level.• First-time mothers and mothers with lower education are particularly at risk for low health literacy.

Why Parents Seek Care for Acute Illness in the Clinic or the ED: The Role of Health Literacy

This study aimed to evaluate the low health literacy prevalence and its socio-demographic related factors in Xingtai.This study was a community-based, cross-sectional survey performed in Xingtai, with a sample size of 960. Participants’ socio-demographic characteristics were collected, and their health literacy status was evaluated by the questionnaire designed by the 2012 Chinese Resident Health Literacy Survey.There were 904 (94.2%) participants who provided valid questionnaires and they were included in the analyses. The mean health literacy score was 63.0 ± 16.6; for its subscales, the mean scores of health literacy of basic knowledge and concepts, lifestyle, and health-related skills were 31.6 ± 8.7, 17.1 ± 4.7, and 14.3 ± 3.9, respectively. Low total health literacy prevalence was 83.1%; as for its subscales, the prevalence of low health literacy of basic knowledge and concepts, lifestyle, and health-related skills was 72.5%, 87.8%, and 87.4%, respectively. Meanwhile, age, male and rural location were positively correlated, but education level and annual household income were negatively correlated with low health literacy risk. Further multivariate analysis revealed that lower education level was the only independent related factor for low total health literacy, and the most important independent related factor for low total health literacy of basic knowledge and concepts, lifestyle and health-related skills.Low health literacy prevalence is 83.1%, and lower education level is the most critical related factor for low health literacy in Xingtai.

INTRODUCTION: Health literacy encompasses a patient’s literacy; comprehension and participation. 1,2 Low health literacy is associated with $106–$236 billion annually in increased hospitalizations. 3,4 Currently, there is no data on levels of health literacy in plastic surgery patients. A recent survey of ASPS members demonstrated that plastic surgeons overestimate the health literacy of their patients. 5 Our goal is to assess health literacy of patients in academic plastic surgery practice and identify patients at risk for low health literacy. MATERIALS AND METHODS: This study was approved by our Institutional Review Board. Patients who underwent surgical repair of facial trauma, hand trauma, and breast reconstruction were included. Separate questionnaires were created for each group. Questionnaires were collected during patients’ first post-operative visits. The health literacy assessment was graded by comparing patients’ responses with their medical records, and a health literacy score was calculated for each patient. Logistic regression and the Student’s t-Test were used for associations between demographic variables and mean health literacy scores. RESULTS: One hundred and six patients were included. Mean health literacy scores were 1.97 ± 0.94 out of 3 for the facial trauma patients (63.3%), 2.4 ± 1.4 out of 5 for hand trauma patients (48%), and 3.76 ± 0.43 out of 4 for breast reconstruction patients (95%). In the facial trauma and hand trauma groups, patients receiving a college education or higher had significantly higher mean health literacy scores (Table 1). In the hand trauma group, a statistically significant difference was found between the mean scores of patients with Medicaid [1.75 (SD: 1.66)] and patients with private health insurance/Medicare [2.80 (SD: 1.20)] on the health literacy assessment (P=0.0358). In the breast reconstruction group, a statistically significant difference was found between the mean scores of patients with Medicaid [3.33 (SD: 0.52)] and patients with private health insurance/Medicare [3.84 (SD: 0.37)] on the health literacy assessment (P=0.0300) (Table 2).Table 1: Mean Health Literacy Scores by Highest Level of Education Completed.*indicates significance; p-value <0.05.Table 2: Mean Health Literacy Scores by Insurance Type (Private/Medicare versus Medicaid).*indicates significance; p-value <0.05. CONCLUSION: This study demonstrates that in an academic plastic surgery setting, patients with traumatic injuries, low education level, and public insurance may be at risk for low health literacy. Identifying risk factors for low health literacy will enable future efforts to enhance the quality and efficiency of healthcare.

To the Editors: —We commend Kiser et al. for their work addressing the impact of a literacy-sensitive, self-management intervention on improving inhaler technique for patients with chronic obstructive pulmonary disease (COPD).1 Given the high prevalence of inhaler misuse among patients with COPD,2 there is a great need for targeted approaches such as those utilized in this study. We applaud their use of verbal administration for the majority of the study. However, because the commonly used Short Test of Functional Health Literacy in Adults (S-TOFHLA) is a written tool, we wonder what role poor vision might have played in classifying participants’ health literacy. In studies at our institution, we found that among hospitalized patients one-third of participants had poor vision (worse than 20/50 vision in both eyes), 56 % of whom were found to have poor health literacy using a verbal tool.3 This raised concern that poor vision is an additional, unaddressed risk factor for hospitalized patients with COPD. This is salient because research has shown that poor vision can be a separate barrier to self-management, such as the ability to open medication containers,4 and among hospitalized patients, appropriate inhaler technique.2 Given these findings, it is important to understand the role of vision for self-management strategies, with respect to assessing health literacy level and/or whether poor vision compounds health risks associated with low health literacy. Lastly, the average age in Kiser’s study was 63 years old. Because older adults are at increased risk for low health literacy,5 it may be especially important to understand the association between health literacy and vision for older patients. We have found that patients aged 65 years or older are at a dual risk for low health literacy and poor vision, compared to their younger counterparts.3 With the rising numbers of older Americans, it is becoming even more important to differentiate between inhaler misuse due to poor vision and misuse due to low health literacy, as interventions may differ. Future work should attempt to achieve greater clarity between these risk factors.