Author, year | Design | Disease/Sample | Assessment of HL | Outcomes | Notable findings (HL-specific) | Quality assess-ment |
---|---|---|---|---|---|---|
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 |