Elsevier

Ambulatory Pediatrics

Volume 7, Issue 1, January 2007, Pages 25-31
Ambulatory Pediatrics

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

https://doi.org/10.1016/j.ambp.2006.10.001Get rights and content

Objective

To determine whether 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] 1.4; 95% confidence interval 0.97, 2.0), hospitalizations (IRR 4.6; 1.8, 12), and days missed from school (IRR 2.8; 2.3, 3.4) even after adjusting for asthma-related knowledge, disease severity, medication use, and other sociodemographic 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.

Section snippets

Study Design

We conducted a retrospective cohort study in 3 outpatient pediatrics clinics (general, asthma and allergy, and pulmonary) at the North Carolina Children’s Hospital, the public children’s hospital of the state. Patients in these clinics receive care from attending faculty and residents from the University of North Carolina at Chapel Hill School of Medicine.

Study Participants

Potential subjects were identified at the beginning of each clinic session. A research assistant screened daily appointment lists for

Results

Between January 2004 and March 2005, 150 children with asthma and their parents were enrolled into the study (Figure). The characteristics of study participants are shown in Table 2, stratified by parental literacy status. Among the 150 participating parents, 36 (24%) were considered to have low literacy, defined as less than a 9th-grade reading level on REALM. Those in the low parental literacy group were more likely to be African American and to have an annual household income below $15 000.

Discussion

We found that children of parents with low literacy reported more severe asthma symptoms and were more likely to report missing school and requiring ED visits or hospitalization than children of parents with higher literacy. Parents with low literacy had lower mean scores on asthma knowledge questions and reported more frequent use of albuterol, but the differences were small. We find it particularly disconcerting that children whose parents have lower literacy are more prone to miss days of

Acknowledgments

This study was funded by the Pfizer Health Literacy Scholar Award and the Robert Wood Johnson Foundation Clinical Scholars Program. Dr DeWalt was also supported by the National Center for Research Resources under grants 5K12RR017667-04 and 5M01RR-000046 and the Translational Scholars Program at the University of North Carolina. Drs DeWalt and Pignone have received grants and honoraria from Pfizer Inc for work related to health literacy. No product of Pfizer is mentioned in this article. Charity

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