|
DeWalt et al., 2007 [15]
|
Retrospec-tive cohort
|
Asthma
|
REALM
|
ED visits
|
Children from parents with low health literacy had greater incidence of ED visits (IRR 1.4; 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 socio-demographic factors
|
IIIA
|
|
N = 150
|
24 % of parents had low HL
|
Hospitalizations
|
|
Children (age 3–12 years) and parents from University pediatric clinic, USA
|
Days missed from school
|
|
Farber et al., 1998 [16]
|
Cross-sectional survey
|
Asthma
|
REALM
|
Asthma care practices, knowledge asthma medications, management plans, prior hospitalizations and previous ED visits for asthma
|
All descriptive findings on frequency of asthma exacerbations and practices; not correlated with HL levels so HL interpretation limited. Not one participant had a written self-management plan.
|
IIIC
|
|
N = 46
|
49 % of adults had HL 8th grade level or below; 20 % of adults had lower than 6th grade HL (low HL)
|
|
Children (age 2–6 years) and adults accompanying them in an inner-city emergency department (mother in 91 % of cases), all adults were African-American, USA
|
|
Freedman et al., 2008 [17]
|
Prospec-tive observa-tional
|
Glaucoma
|
REALM
|
Adherence to eye drops, dosing errors, proportion of doses taken on schedule
|
Decreased parental health literacy associated with decreased medication adherence in multivariable regression model (p = 0.01)
|
IIIB
|
|
N = 46
|
Overall HL assessments not provided
|
|
Children (age 5–17 years) and parents (majority mothers, percent not specified) from an academic pediatric ophthalmology clinic, USA
|
|
Gandhi et al., 2013 [18]
|
Cross-sectional survey
|
Asthma
|
S-TOFHLA
|
Asthma control, asthma-specific HRQoL
|
HL-related path analysis (from HL to perceived self-efficacy with patient-physician interaction to asthma control and asthma-specific HRQoL) not statistically significant. Parents with higher HL and greater self-efficacy with patient-physician interaction had higher satisfaction with shared decision making (β = 0.38, p < 0.05)
|
IIIB
|
|
N = 160
|
6.26 % of parents had inadequate or marginal HL
|
|
Children (age 8–17 years) and their parents (91 % female parent/guardian) from academic pediatric clinic, USA
|
|
Harrington et al., 2013 [19]
|
Cross-sectional survey
|
Asthma
|
REALM and TOFHLA
|
Provider estimates of parental HL; perceptions influence on treatment recommendations
|
Providers perceptions of HL influenced asthma treatment recommendations (p = 0.001) and how treatment instructions were given (p = 0.001). Pediatric providers had low concordance between perceptions and actual parental assessment of HL.
|
IIIA
|
|
N = 281; 14
|
|
Children (age 6–12 years) and their parents; 14 providers from pediatric clinic, USA
|
35 % of parents had either marginal or inadequate HL
|
|
Hassan et al., 2010 [20]
|
Cross-sectional survey
|
Type 1 Diabetes
|
NVS
|
Glycemic control via mean hemoglobin A1c (HbA1c)
|
After controlling for race, language, income, education there was a significant relationship between HL and glycemic control (p, 0.004; R2 0.23)
|
IIIA
|
|
N = 200
|
17 % of parents had limited or possibly limited HL
|
|
Children (diagnosed at least 1 year prior) and their caregivers from academic pediatric clinic, USA
|
|
Janisse et al., 2010 [21]
|
Cross-sectional survey
|
Type 1 Diabetes
|
S-TOFHLA
|
Glycemic control via mean hemoglobin A1c (HbA1c); Diabetes Management Scale (DMS)
|
HL not significantly related to DMS or HbA1c for total sample. For adolescents on intensive insulin regimen (n = 65), parental HL correlated with DMS adherence (p < 0.01).
|
IIIC
|
|
N = 93
|
All caregivers screened as adequate HL
|
|
Adolescents (age 10–17 years) in poor metabolic control and their primary caregivers (89 % female) from a pediatric clinic, USA
|
|
Macy et al., 2011 [22]
|
RCT
|
Asthma
|
REALM
|
Asthma knowledge
|
Randomized to either video (intervention) or written materials (control). Among low HL parents, improvement in knowledge regardless of education type (p < 0.001)
|
IB
|
|
N = 129
|
31 % of parents had low HL
|
|
Children (age 2–14 years) with parents who presented to the ED, USA
|
|
Porter et al., 2012 [23]
|
RCT
|
ADHD
|
TOFHLA
|
Report of sufficient and accurate clinical data
|
Randomized to either paper-based or computer-based data collection. Parents with adequate HL had increased odds of reporting sufficient and accurate data (sufficiency for ADHD screening: OR 8.0; 2.0-32.1; accuracy of medication report OR: 4.4; 0.5-37.4)
|
IB
|
|
N = 182
|
5.6 % of parents had inadequate or marginal HL
|
|
Children (age 5–12 years) with parents (86 % female) from advertisement in a city, USA
|
|
English and Spanish-speaking participants
|
|
Pulgaron et al., 2014 [24]
|
Cross-sectional survey
|
Type 1 Diabetes
|
S-TOFHLA
|
Glycemic control via mean hemoglobin A1c (HbA1c)
|
Parental numeracy and HL positively correlated (r = 0.37, p = 0.02). Parent numeracy (r = −0.52, p <0.01,), but not HL (r = −0.25, p = NS) were inversely correlated to their child’s HbA1c.
|
IIIB
|
|
N = 70
|
PDNT (numeracy)
|
|
Children (age 3–9 years) with caregivers (84 % mothers) from diabetes clinics, USA
|
Overall HL assessments not provided
|
|
English and Spanish
|
|
Shone et al., 2009 [25]
|
Cross-sectional survey
|
Asthma
|
REALM
|
Number of symptom free days over 2 weeks; use of urgent care in the past year; parent experiences with filling out medical forms; parent perception of asthma control; HRQoL using PACQLQ
|
Low parental HL was independently associated with perceiving child’s health as fair/poor (OR 3.96; 2.4-6.4), greater parent worry (OR 1.85; 1.2-2.8), needing help to read forms (OR 2.03; 1.3-3.1) and lower HRQoL (β = −0.097; p = 0.047). Measures of health care use were not associated with parent HL.
|
IIIA
|
|
N = 499
|
33 % of parents had low HL
|
|
Children age (3–10 years) with persistent asthma and parents from an urban school district, USA
|
|
Wittich et al., 2007 [26]
|
Cross-sectional survey
|
Asthma
|
TOFHLA
|
Provider perception of parental HL
|
Moderate agreement between provider perception of caregiver HL (kappa = 0.5095). Inadequately assessed HL for 16 % of caregivers.
|
IIIC
|
|
N = 51
|
14 % of caregivers had inadequate or marginal HL
|
|
Adult caregivers (96 % female; 86 % mothers) of pediatric patients from a university-asthma clinic, USA
|
|
Wood et al., 2010 [27]
|
Cross-sectional survey
|
Asthma
|
NVS
|
Perceived self-efficacy to manage their child’s asthma; frequency of physician visits, visits to ED, number of times admitted to hospital for asthma; asthma control
|
Significant relationship between HL and perceived self-efficacy to manage asthma symptoms (r = 0.155, r2 = 0.02). There were no significant differences in HL by utilization variables or asthma control.
|
IIIB
|
|
N = 196
|
44.4 % possibility of limited HL; 20.8 % high likelihood of limited HL
|
|
African-American children (age 5–12 years) with caregivers (84 % mothers) in urban pulmonology clinics, USA
|
