Provider Perceptions of Parent Health Literacy and Effect on Asthma Treatment Recommendations and Instructions

Abstract

Little is known about how pediatric providers assess parental health literacy, how concordant they are with validated measures of health literacy, and how these perceptions may influence treatment recommendations, how instructions are given or how reliable they perceive parents to be in carrying out instructions. Two hundred and eighty-one parents of 6-12-year-old asthma patients attending a pediatric clinic visit were recruited to a cross-sectional study of health literacy and asthma outcomes. Fourteen pediatric healthcare providers participated. Parents completed surveys that included 2 measures of health literacy: the Test of Function Health Literacy in Adults (TOFHLA) and the Rapid Estimate of Adult Literacy in Medicine (REALM). Immediately postvisit, pediatric providers completed a brief survey asking their assessment of the parent's health literacy and how it impacted treatment instructions and recommendations. Kappa statistics tested concordance; chi square and logistic regression tested associations among provider ratings, rating concordance, and demographic factors. Six providers were interviewed regarding the bases for their ratings. Providers' perceptions influenced asthma treatment recommendations ( p = 0.001) and how treatment instructions were given ( p = 0.001). Providers indicated that their perceptions were shaped by parent's verbal communication skills and patterns of past behavior related to children's asthma management. Data from 277 parents indicated that most had adequate health literacy with a lower percentage scored as adequate by the REALM versus the TOFHLA. Pediatric provider estimates of parental health literacy had low concordance with the validated measures. Providers were more likely to designate whites as adequately health literate. Pediatric asthma providers' perceptions of parents' health literacy can influence treatment recommendations and instructional practices.

Enabling and hindering factors influencing adherence to asthma treatment among adolescents: A systematic literature review

“…Health literacy is defined as an "individual's capacity to access, understand, communicate, evaluate, utilize, and make decisions based on health information" [24]. Health literacy is a key factor for good asthma management in children and adults.…”

“…The literature review revealed that low parental health literacy is associated with increased emergency visits, missed school days and inappropriate medication use amongst children with asthma [24]. On the contrary, increasing caregivers' asthma knowledge via educational programs has been proven to be effective in asthma management [42].…”

Healthcare providers' perspectives on parental health literacy and child health outcomes among Southeast Asian American immigrants and refugees

“…Harrington, Haven, Bailey, and Gerald (2013) found that healthcare providers' perception of the parents' health literacy influenced their asthma treatment recommendations and instruction provided to the patients. Specifically, patients' verbal responses and their past behavior regarding asthma management were taken into consideration by healthcare providers.…”

The impact of limited English proficiency on asthma action plan use

“…Hispanic children are less likely to receive an asthma action plan at time of hospital discharge [27]. Provider perceptions of parental health literacy have been shown to have low concordance with actual health literacy while influencing treatment instructions [28]. For Spanish-speaking Latino populations, the impact that language and caregiver LEP have on action plan utilization, medication recognition and emergency department utilization are not well studied.…”