The Health Literacy
of Parents in the US:
A Nationally Representative Study
Benard P. Dreyer, MD
H. Shonna Yin, MD, MS
Matthew Johnson, PhD
Alan L. Mendelsohn, MD
Mary Ann Abrams, MD, MPH
Lee M. Sanders, MD
AcademyHealth Conference
June 27, 2009
1
Disclosure
The authors have no relevant financial
relationships to disclose or conflicts of
interest to resolve
2
2003 NAAL & Health Literacy
• NAAL = National Assessment
of Adult Literacy
• Assessment of English literacy
skills of US adults (>16y)
– Periodically performed by NCES
– Prior to 2003, last survey in 1992
• 2003 NAAL
– First large scale national
assessment of adult health
literacy
– Ability to read, understand, and
apply health-related information
3
NAAL Health Literacy Assessment
• Health literacy
assessment
– 28 health literacy
tasks
– “Functional” skills
assessed
• Everyday print
materials given in
original form or
reproduced in
assessment booklets
4
Health Literacy Assessment
• Tasks classified into three types
– Prose (12 items)
• Search, comprehend, and use continuous texts
– Document (12 items)
• Search, comprehend, and use non-continuous texts in
various formats
– Quantitative (4 items)
• Identify and perform computations, either alone or
sequentially, using numbers embedded in printed materials
• Performance levels for health literacy
–
–
–
–
Below Basic
Basic
Intermediate
Proficient
5
Health Literacy Assessment
(cont’d)
Refer to the appointment slip given:
Circle the date of a medical appointment on a
hospital appointment slip.
– Document
– Below Basic HL
6
Health Literacy
Assessment (cont’d)
Refer to the article to
answer the following
question:
According to the
brochure, why is it
difficult for people to
know if they have high
blood pressure?
– Prose task
– Basic HL
7
Health Literacy
Assessment
(cont’d)
Underline
three
substances
that may
increase the
drowsiness
associated
with taking
Allerdryl
– Document
task
– Intermediate
HL
8
Health Literacy
Assessment
(cont’d)
How many polio
vaccinations
should children
receive by the time
they are 7 years
old?
– Document task
– Intermediate HL
9
Health Literacy
Assessment (cont’d)
The rate of death from the
effects of high blood
pressure for white people
is 94.5 per 100,000.
Calculate the rate of
death from the effects of
high blood pressure for
Black people.
• Quantitative task
• Proficient HL
10
NAAL Household Sample Design
• 4 Stage Stratified Probability Sample Design
– Counties / Groups of
counties within states
– Area segments (census
blocks)
– Households / Dwelling
Units
– Individuals
• Blacks and Hispanics oversampled
11
Structure of the NAAL Interview
Background
Questionnaire
1:1 Administration in Homes
Mar ’03 - Jan ‘04
Average time = 90 minutes
Core Screening
Assessment
Main NAAL
Literacy
Assessment
97%
Subjects could take as long as
they wanted
Alternate
Assessment
3%
12
Selected
Sample
97% completed
Core Screening
Questions
97%
Main
Assessment
Subject
Enrollment
2%
not ENG/SPAN speaking
* Did not participate *
3%
ALSA
14
BIB Spiraling Design
• Balanced Incomplete Block (BIB) Spiraling
Design
– Each subject only completes a subset (~1/4 to 1/3)
of the assessment questions
– Everyone completes a
Core Assessment PLUS
3 blocks (out of 13)
– Each block contains
questions on prose,
document and
quantitative areas
• Random assignment to
study subjects
• 26 unique test booklets
15
Study Background
• Increasing interest in how
parent health literacy levels
may impact on child health
• No prior study has
assessed the health literacy
level of parents at a national
level
– Prior national literacy
assessments have not
assessed health literacy
– NAAL Reports issued have
not looked at parents as a
group
16
Study Objectives
• To assess overall parent health literacy level
– Compare parents to non-parents
– Examine sociodemographic correlates
• To assess parent ability to perform health literacy
tasks likely related to child health
• To assess the relationship between parent health
literacy and self-report of issues likely to relate to
child health
– Child health insurance status
– Difficulty understanding OTC medication labels
– Use of food labels
17
Study Design
• Cross-sectional analysis
• 2003 NAAL
– Household sample
– >18,000 subjects
representing >200 million
US adults
• ~6,100 parents with
children (<18y) in the
household
• ~12,000 non-parents
18
Assessments:
Determination of Parent Status
• Parent status
– Child living in the
household under 18
– Relationship to child
is parent, guardian,
or step-parent
19
Assessments: Health Literacy
• Overall health literacy category
• Parent ability to perform individual health
literacy tasks likely to relate to child health
20
Assessments: Health Literacy
• Overall health literacy category
– Complex process
• Each subject completed a subset of the health literacy tasks
– Probabilistic approach used to designate likely health
literacy categories for each subject
•
•
•
•
Parameters of measurement model were provided by NCES
Marginal maximum likelihood regression of HL
Inclusion of variables considered to be potential confounders
10 plausible HL scores for each subject
– Conservative approach to decrease error due to random differences
among the plausible values
• Plausible values transformed such that % in each HL category
matched overall percentages reported by NCES
• AM software (version 0.06.00)
21
Assessments: Health Literacy
• Parent ability to perform individual health
literacy tasks likely to relate to child health
– 152 total literacy assessment tasks
– 28 of total tasks part of health literacy assessment
– 13 of the 28 individual health literacy assessment
tasks selected
• 2 specifically related to children
• 11 relate to skills that could affect the care provided by
parents to their children
• Subjects categorized as
Excluded
–
–
–
–
–
Correct
Partially correct
Incorrect
Omitted
Not reached
22
Assessments:
Report of Issues
Likely to Relate to
Child Health
• Parent report of issues
likely to relate to child
health
– Child health insurance
– Over-the-counter
medication labels
– Food label use
23
Assessments: Report of Issues
Likely to Relate to Child Health (cont’d)
• Parent report of issues likely to relate to child
health
– Child health insurance
• “Do the children living in this
household have any type of
medical insurance or health
care coverage?”
– Yes
– No
– At least one child (but not
all children) has medical
insurance
24
Assessments: Report of Issues
Likely to Relate to Child Health (cont’d)
• Parent report of issues likely to relate to child
health
– Over-the-counter medication labels
• “How difficult is it for you to understand the dosage
information on over-the-counter medications?”
– Great deal of difficulty
– Moderate difficulty
– Some difficulty
– No difficulty
Excluded
– Never tried
Question only asked of parents who learned a language other than
English before starting school and stated that they do not read
25
English “very well”
Assessments: Report of Issues
Likely to Relate to Child Health (cont’d)
• Parent report of issues likely to relate to child
health
– Food label use
• “How often do you read the nutritional information on
food labels written in English?”
– Never
– Sometimes
– Most of the time
– Every time when I buy a
food I never bought
before
26
Assessments: Sociodemographics
•
•
•
•
•
•
•
Age
Gender
Educational attainment
Race/ethnicity
Country of birth (immigrant status)
English proficiency
Income
27
Statistical Analysis
• Parent performance on individual health literacy
assessment tasks
– Simple weighted analysis
– AM software
• Associations between health literacy categories
and variables of interest
– 2 way contingency table analyses w/ HL categories
as one of the margins
• Rao and Scott’s corrected chi-square statistics for
complex samples
28
Statistical Analysis (cont’d)
• Associations between health literacy categories
and variables of interest (cont’d)
– Logistic regression analyses
• Describe factors associated with Below Basic /
Basic HL
• Use HL category as an explanatory variable for
self-report of issues likely to affect child health
• Wald’s chi-square test
• R software
29
Results: Descriptive Data
Parent
Non-Parent
p
37.9 (9.0)
47.8 (20.3)
<0.001
Education
In School
<HS
HS / equivalent
>HS
1%
14%
30%
56%
5%
16%
31%
48%
<0.001
Race / Ethnicity
White, non-Hispanic
Black, non-Hispanic
Hispanic
Other
66%
12%
16%
6%
73%
11%
10%
6%
<0.001
Income
Below poverty threshold
100-175% of poverty threshold
>175% of poverty threshold
Missing
18%
16%
58%
8%
14%
16%
57%
12%
<0.001
Age, years (mean (SD))
30
Results: Parent-related Data
# of children living in home
1
2
3
4 or more
Child age, years (mean (SD))
40%
39%
16%
5%
8.5 (5.0)
31
Study Objectives
• To assess overall parent health literacy level
– Compare parents to non-parents
– Examine sociodemographic correlates
• To assess parent ability to perform health literacy
tasks likely related to child health
• To assess the relationship between parent health
literacy and self-report of issues likely to relate to
child health
– Child health insurance status
– Difficulty understanding OTC medication labels
– Use of food labels
32
% Subjects
Results: Overall Health Literacy Level
100
90
80
70
60
50
40
30
20
10
0
11%
15%
Below Basic
24%
Basic
18%
Intermediate
56%
51%
15%
10%
Parent
Non-Parent
mean score =
253.8 (SD 51.1)
mean score =
240.6 (SD 56.3)
Proficient
Health Literacy
33
Results: Parent Status and
Low Health Literacy
- Multivariate Analysis • Below Basic / Basic Health literacy among
Parent and Non-Parents
AOR†
95% CI
p‡
Non-Parent
1.5*
1.3-1.7
<0.001
Parent
1.0
----
†
Adjusting for caregiver age, gender, # of children in the home, education,
race/ethnicity, country of birth, English proficiency, income, region, MSA
‡
p value for test of significance of whether at least one category within the
factor is different
34
Results: Predictors of Parent
Below Basic/ Basic Health Literacy
- Multivariate Analysis Education
Race /
Ethnicity
Country of
Birth
English
Proficiency
Income
AOR†
p‡
In school
<HS
HS/equivalent
>HS
White, non-Hispanic
Black, non-Hispanic
Hispanic
Other
US
Outside of US
Understands very well
Understands well
Understands not well/ not at all
3.2
8.5*
2.8*
1.0
1.0
3.9*
2.3*
1.1
1.0
1.9*
1.0
2.7*
18.4*
<0.001
Below poverty threshold
100-175% of poverty threshold
>175% of poverty threshold
Missing
2.6*
1.8*
1.0
1.6
<0.001
<0.001
<0.001
<0.001
† Adjusting for caregiver age, gender, education, race/ethnicity, country of birth, English proficiency,
‡
income, region, MSA
p value for test of significance of whether at least one category within the factor is different
35
Study Objectives
• To assess overall parent health literacy level
– Compare parents to non-parents
– Examine sociodemographic correlates
• To assess parent ability to perform health literacy
tasks likely related to child health
• To assess the relationship between parent health
literacy and self-report of issues likely to relate to
child health
– Child health insurance status
– Difficulty understanding OTC medication labels
– Use of food labels
36
Results: Parent Performance on
HL Assessment Tasks
% Subjects
Correct
100
90
80
70
60
50
40
30
20
10
0
Incorrect
11%
38%
35%
66%
68%
89%
62%
65%
34%
32%
Enter names and
birth dates in a
health insurance
form
Check correct Check correct box
box to indicate
to indicate sex,
which person is
marital status, if
applying for
person is a student,
health insurance
and person’s
relationship to you
Enter SS #
into a health
insurance
application
Calculate price per
year of an insurance
policy using a table
that shows how
monthly cost varies
based on income and
family size
Health Insurance-related Tasks
37
Results: Parent Performance on
HL Assessment Tasks
% Subjects
Correct
100
90
80
70
60
50
40
30
20
10
0
Incorrect
11%
38%
35%
66%
68%
89%
62%
65%
34%
32%
Enter names and
birth dates in a
health insurance
form
Check correct Check correct box
box to indicate
to indicate sex,
which person is
marital status, if
applying for
person is a student,
health insurance
and person’s
relationship to you
Enter SS #
into a health
insurance
application
Calculate price per
year of an insurance
policy using a table
that shows how
monthly cost varies
based on income and
family size
Health Insurance-related Tasks
38
% Subjects
Results: Parent Performance on
HL Assessment Tasks (cont’d)
100
90
80
70
60
50
40
30
20
10
0
23%
36%
Incorrect
Correct
77%
64%
Underline 3 substances that
may interact with an OTC
drug to cause a side effect,
using a OTC drug label
Determine what time a person
can take a prescription
medication, based on
information on the Rx drug label
that relates the timing of the
medication to eating
Medication-related Tasks
39
% Subjects
Results: Parent Performance on
HL Assessment Tasks (cont’d)
100
90
80
70
60
50
40
30
20
10
0
8%
13%
54%
92%
87%
Incorrect
Correct
46%
List 3 health risks
associated with
being overweight
or obese
Determine a healthy
weight range for a
person who is 5’ 5”,
based on a graph that
relates height and
weight to BMI
Determine how a
person who is 5’ 8”
and weighs 175 lbs
is categorized
Nutrition / Obesity-related Tasks
40
% Subjects
Results: Parent Performance on
HL Assessment Tasks (cont’d)
100
90
80
70
60
50
40
30
20
10
0
27%
40%
73%
Incorrect
Correct
60%
Determine when children should
receive their 3rd hepatitis B
vaccine, using a chart that
shows all childhood vaccines
and the ages children should
receive them
Determine how many polio
vaccinations a child should
have by a certain age
Immunization-related Tasks
41
% Subjects
Results: Parent Performance on
HL Assessment Tasks (cont’d)
100
90
80
70
60
50
40
30
20
10
0
5%
95%
Incorrect
Correct
Circle the date of an
appointment on a hospital
appointment slip
Navigation-related Task
42
Study Objectives
• To assess overall parent health literacy level
– Compare parents to non-parents
– Examine sociodemographic correlates
• To assess parent ability to perform health literacy
tasks likely related to child health
• To assess the relationship between parent health
literacy and self-report of issues likely to relate to
child health
– Child health insurance status
– Difficulty understanding OTC medication labels
– Use of food labels
43
Results:
Child Health Insurance and Parent HL
• 8.1% of households with at least 1 child without health
insurance
% Subjects
All Children with Health Insurance
100
90
80
70
60
50
40
30
20
10
0
3%
p <0.001
At Least One Child with No Health Insurance
5%
11%
24%
97%
95%
89%
76%
Proficient
Health Literacy
Intermediate
Health Literacy
Basic
Health Literacy
Below Basic
Health Literacy 44
Results: Predictors of Presence of Child in
Household without Health Insurance
- Multivariate Analysis • Parent with at least one child in the household
without health insurance
AOR†
95% CI
p‡
Below Basic HL
2.4*
1.1-4.9
0.04
Basic HL
1.7
0.5-5.7
Intermediate HL
1.4
0.4-4.2
Proficient HL
1.0
---
†
Adjusting for caregiver age, gender, # of children in the home, education,
race/ethnicity, country of birth, English proficiency, income, region, MSA
‡ p value for test of significance of whether at least one category within the
factor is different
45
Results: Predictors of Presence of Child in
Household without Health Insurance
Education
Race /
Ethnicity
English
Prof.
Income
Region
†
In school
<HS
HS/equivalent
>HS
White, non-Hispanic
Black, non-Hispanic
Hispanic
Other
Understands very well
Understands well
Understands not well/ not at all
Below poverty threshold
100-175% of poverty threshold
>175% of poverty threshold
Missing
Northeast
Midwest
South
West
MODEL 1
MODEL 2
(without Health Literacy)
(inclusion of Health Literacy)
AOR†
p‡
AOR†
p‡
2.5
1.4
1.7*
1.0
1.0
1.5
1.9*
1.2
1.0
1.4
2.9*
3.1*
2.6*
1.0
2.1*
1.0
1.7*
2.3*
2.0*
0.01
2.3
1.2
1.5*
1.0
1.0
1.3
1.8*
1.1
1.0
1.3
2.3*
2.9*
2.4*
1.0
2.1*
1.0
1.7*
2.3*
2.0*
0.06
0.03
<0.001
<0.001
<0.001
0.08
0.02
<0.001
<0.001
Adjusting for caregiver age, gender, # of children in the home, education, race/ethnicity,
country of birth, English proficiency, income, region, MSA
46
‡ p value for test of significance of whether at least one category within the factor is different
Results: Predictors of Presence of Child in
Household without Health Insurance
Education
Race /
Ethnicity
English
Prof.
Income
Region
†
In school
<HS
HS/equivalent
>HS
White, non-Hispanic
Black, non-Hispanic
Hispanic
Other
Understands very well
Understands well
Understands not well/ not at all
Below poverty threshold
100-175% of poverty threshold
>175% of poverty threshold
Missing
Northeast
Midwest
South
West
MODEL 1
MODEL 2
(without Health Literacy)
(inclusion of Health Literacy)
AOR†
p‡
2.5
1.4
1.7*
1.0
1.0
1.5
1.9*
1.2
1.0
1.4
2.9*
3.1*
2.6*
1.0
2.1*
1.0
1.7*
2.3*
2.0*
0.01
0.03
<0.001
<0.001
<0.001
AOR†
p‡
0.06
2.3
1.2
1.5*
1.0
0.08
1.0
1.3
1.8*
1.1
0.02
1.0
1.3
Education
and
2.3*
<0.001
2.9*
Race/Ethnicity
2.4*
no
1.0longer
2.1*
significant
<0.001
1.0
1.7*
2.3*
2.0*
Adjusting for caregiver age, gender, # of children in the home, education, race/ethnicity,
country of birth, English proficiency, income, region, MSA
47
‡ p value for test of significance of whether at least one category within the factor is different
Results: Predictors of Presence of Child in
Household without Health Insurance
MODEL 1
MODEL 2
(without Health Literacy)
(inclusion of Health Literacy)
AOR†
Education
Race /
Ethnicity
English
Prof.
Income
Region
†
In school
<HS
HS/equivalent
>HS
White, non-Hispanic
Black, non-Hispanic
Hispanic
Other
Understands very well
Understands well
Understands not well/ not at all
Below poverty threshold
100-175% of poverty threshold
>175% of poverty threshold
Missing
Northeast
Midwest
South
West
2.5
1.4
1.7*
1.0
1.0
1.5
1.9*
1.2
1.0
1.4
2.9*
3.1*
2.6*
1.0
2.1*
1.0
1.7*
2.3*
2.0*
p‡
AOR†
p‡
0.06
2.3
1.2
1.5*
1.0
0.08
0.03
1.0
1.3
1.8*
1.1
0.02
<0.001
1.0
1.3
2.3*
<0.001
<0.001
2.9*
2.4*
1.0
2.1*
Effect
estimate
for<0.001
<0.001
1.0
those 1.7*
with poor
English2.3*
proficiency
2.0*
0.01
diminished 27%
Adjusting for caregiver age, gender, # of children in the home, education, race/ethnicity,
country of birth, English proficiency, income, region, MSA
48
‡ p value for test of significance of whether at least one category within the factor is different
Results: Difficulty Understanding
OTC Medication Labels and Parent HL*
• 59.2% reported difficulty understanding OTC labels
% Subjects
No Difficulty
100
90
80
70
60
50
40
30
20
10
0
38%
Any Difficulty
p <0.001
43%
74%
62%
57%
26%
Proficient /
Intermediate
Health Literacy
Basic Health
Literacy
Below Basic
Health Literacy
* Question only asked of parents who learned a language other than English 49
before starting school and stated that they do not read English “very well”
Results: Predictors of Any Difficulty
Understanding OTC Medication Labels*
- Multivariate Analysis • Parent with any difficulty understanding OTC
medication label†
AOR‡
95% CI
p
Below Basic HL
3.4*
1.6-7.4
<0.001
Basic HL
1.1
0.4-2.5
Intermediate /
Proficient HL
1.0
---
† Adjusting for caregiver age, gender, education, race/ethnicity, country of birth, income,
region, MSA
‡ p value for test of significance of whether at least one category within the factor is different
* Question only asked of parents who learned a language other than English before
starting school and stated that they do not read English “very well”
50
Results: Predictors of Any Difficulty
Understanding OTC Medication Labels*
- Multivariate Analysis -
Education
Country
of Birth
Income
In school
<HS
HS/equivalent
>HS
US
Outside of US
Below poverty threshold
100-175% of poverty threshold
>175% of poverty threshold
Missing
MODEL 1
MODEL 2
(without Health Literacy)
(inclusion of Health Literacy)
AOR†
p‡
AOR†
p‡
3.1*
2.9*
1.7*
1.0
1.0
8.4*
2.0*
1.5
1.0
2.5
<0.001
2.0
1.8*
1.4
1.0
1.0
6.8*
1.7
1.4
1.0
2.5*
0.2
<0.001
0.02
<0.001
0.08
† Adjusting for caregiver age, gender, education, race/ethnicity, country of birth, income,
region, MSA
‡ p value for test of significance of whether at least one category within the factor is different
* Question only asked of parents who learned a language other than English before starting
school and stated that they do not read English “very well”
51
Results: Predictors of Any Difficulty
Understanding OTC Medication Labels*
- Multivariate Analysis -
Education
Country
of Birth
Income
In school
<HS
HS/equivalent
>HS
US
Outside of US
Below poverty threshold
100-175% of poverty threshold
>175% of poverty threshold
Missing
MODEL 1
MODEL 2
(without Health Literacy)
(inclusion of Health Literacy)
AOR†
p‡
3.1*
2.9*
1.7*
1.0
1.0
8.4*
2.0*
1.5
1.0
2.5
<0.001
<0.001
0.02
AOR†
p‡
0.2
2.0
1.8*
1.4
1.0
1.0
<0.001
6.8*
0.08
1.7
1.4
Effect estimate of
1.0
Education
2.5*
(<HS education)
diminished
66%
† Adjusting for caregiver age, gender, education, race/ethnicity, country
of birth, income,
region, MSA
and became
‡ p value for test of significance of whether at least one category within
the factor is different
non-significant
* Question only asked of parents who learned a language other than English before starting
school and stated that they do not read English “very well”
52
Results: Predictors of Any Difficulty
Understanding OTC Medication Labels*
- Multivariate Analysis -
Education
Country
of Birth
Income
In school
<HS
HS/equivalent
>HS
US
Outside of US
Below poverty threshold
100-175% of poverty threshold
>175% of poverty threshold
Missing
MODEL 1
MODEL 2
(without Health Literacy)
(inclusion of Health Literacy)
AOR†
p‡
AOR†
p‡
3.1*
2.9*
1.7*
1.0
1.0
8.4*
2.0*
1.5
1.0
2.5
<0.001
2.0
1.8*
1.4
1.0
1.0
6.8*
1.7
1.4
1.0
2.5*
0.2
<0.001
0.02
<0.001
0.08
Effect estimate of
† Adjusting for caregiver age, gender, education, race/ethnicity, country ofNon-US
birth, income,
Country
of Birth
region, MSA
diminished
23%
‡ p value for test of significance of whether at least one category within
the factor is
different
* Question only asked of parents who learned a language other than English before starting
school and stated that they do not read English “very well”
53
Results: Predictors of Any Difficulty
Understanding OTC Medication Labels**
- Multivariate Analysis -
Education
Country
of Birth
Income
In school
<HS
HS/equivalent
>HS
US
Outside of US
Below poverty threshold
100-175% of poverty threshold
>175% of poverty threshold
Missing
MODEL 1
MODEL 2
(without Health Literacy)
(inclusion of Health Literacy)
AOR†
p‡
AOR†
p‡
3.1*
2.9*
1.7*
1.0
1.0
8.4*
2.0*
1.5
1.0
2.5
<0.001
2.0
1.8*
1.4
1.0
1.0
6.8*
1.7
1.4
1.0
2.5*
0.2
<0.001
0.02
<0.001
0.08
† Adjusting for caregiver age, gender, education, race/ethnicity, country of
birth, income,
Income
region, MSA
no longer
‡ p value for test of significance of whether at least one category within the factor is different
significant
** Question only asked of parents who learned a language other than English before starting
school and stated that they do not read English “very well”
54
Results: Food Label Use
and Parent HL
• Overall, 15% of parents said they never use food labels
p <0.001
% Subjects
Any Food Label Use
100
90
80
70
60
50
40
30
20
10
0
9%
91%
Proficient
Health Literacy
13%
87%
Intermediate
Health Literacy
Never Use Food Labels
18%
82%
Basic
Health Literacy
28%
72%
Below Basic
Health Literacy 55
Results: Predictors of Food Label Use
- Multivariate Analysis • Parent report of never using a food label
AOR†
95% CI
p‡
Below Basic HL
1.4
0.4-4.4
0.9
Basic HL
1.2
0.5-3.2
Intermediate HL
1.1
0.5-2.6
Proficient HL
1.0
---
†
Adjusting for caregiver age, gender, education, race/ethnicity, country of
birth, English proficiency, income, region, MSA
‡ p value for test of significance of whether at least one category within the
factor is different
56
Discussion
• First study to examine health literacy among a
representative population of parents in the US
– At least 1 in 4 parents, or 21 million US parents,
have limited HL skills
• Low HL is an independent predictor
– Of having an uninsured child in the household
– Of difficulty understanding medication labels
57
Discussion (cont’d)
• Consumer-driven health care
system
– Need for simplification of health
insurance forms & health
insurance plan materials
• Pediatric medication
errors / patient safety
– Improve content, readability, and
design of medication instructions
58
Discussion (cont’d)
• Parent health literacy appears to play a
mediating role in disparities
• Further research needed
– To fully examine how HL mediates health
disparities
– Determine whether addressing HL needs of
parents can help ameliorate existing
disparities
59
Limitations
• Health literacy assessment tasks performed
under testing conditions
• Health literacy assessment tasks used printed
materials written in English
• NAAL measured comprehension of printed /
written health-related materials
– Oral comprehension / communication not assessed
– Actual knowledge of health issues not assessed
60
Limitations (cont’d)
• Reliance on self-report
– Child health insurance status
– Difficulty understanding OTC medications
– Food label use
• BIB sampling may have limited power in some of
the analyses because study subjects completed
only a subset of the literacy assessment
61
Acknowledgements
• Statistical support
– Matthew Johnson, PhD
• Additional support
– IES / NCES – for use of the restricted NAAL dataset
– NYUMC IT Department
• Hai Ngo
• Steven Yuen
– NYUSOM Dept. of Pediatrics IT support
• Igor Sidorkin
• Funding for Research
– Dr. Yin is supported by the Pfizer Fellowship in Health Literacy /
Clear Health Communication and a grant from the United
Hospital Fund
– NYU SOM Department of Pediatrics
62
Questions?
Benard P. Dreyer, MD
H. Shonna Yin, MD, MS
Benard.Dreyer@nyumc.org
YINH02@med.nyu.edu
Department of Pediatrics
NYU School of Medicine / Bellevue Hospital Center
550 First Avenue NBV 8S-4-11
New York, NY 10016
63