Elsevier

Academic Pediatrics

Volume 10, Issue 5, September–October 2010, Pages 309-316
Academic Pediatrics

Children and Adolescents Who Are at Risk
Parental Understanding of Infant Health Information: Health Literacy, Numeracy, and the Parental Health Literacy Activities Test (PHLAT)

https://doi.org/10.1016/j.acap.2010.06.007Get rights and content

Abstract

Objective

To assess parental health literacy and numeracy skills in understanding instructions for caring for young children, and to develop and validate a new parental health literacy scale, the Parental Health Literacy Activities Test (PHLAT).

Methods

Caregivers of infants (age <13 months) were recruited in a cross-sectional study at pediatric clinics at 3 academic medical centers. Literacy and numeracy skills were assessed with previously validated instruments. Parental health literacy was assessed with the new 20-item PHLAT. Psychometric analyses were performed to assess item characteristics and to generate a shortened, 10-item version (PHLAT-10).

Results

A total of 182 caregivers were recruited. Although 99% had adequate literacy skills, only 17% had better than ninth-grade numeracy skills. Mean score on the PHLAT was 68% (standard deviation 18); for example, only 47% of caregivers could correctly describe how to mix infant formula from concentrate, and only 69% could interpret a digital thermometer to determine whether an infant had a fever. Higher performance on the PHLAT was significantly correlated (P < .001) with education, literacy skill, and numeracy level (r = 0.29, 0.38, and 0.55 respectively). Caregivers with higher PHLAT scores were also more likely to interpret age recommendations for cold medications correctly (odds ratio 1.6, 95% confidence interval 1.02, 2.6). Internal reliability on the PHLAT was good (Kuder-Richardson coefficient of reliability = 0.76). The PHLAT-10 also demonstrated good validity and reliability.

Conclusions

Many parents do not understand common health information required to care for their infants. The PHLAT and PHLAT-10 have good reliability and validity and may be useful tools for identifying parents who need better communication of health-related instructions.

Section snippets

Methods

A cross-sectional study was performed at pediatric clinics at 3 academic institutions to examine caregiver literacy and numeracy skills related to the understanding of common health tasks in caring for infants, and to validate the PHLAT. The institutional review boards for all 3 institutions approved the study. All participants provided informed consent and were given a nominal reimbursement for their time.

Results

From September 2006 through October 2007, a total of 413 eligible caregivers were referred, of which 261 consented (63%) and 182 participated (70% of those consenting and 44% of those initially referred). The primary reason for nonparticipation was lack of time because recruitment occurred in a busy clinical setting. Baseline characteristics are presented in Table 1. Participants had similar characteristics to the families that seek care in our clinics, except that we excluded Spanish-speaking

Discussion

It is concerning that this study found that many caregivers had difficulty understanding basic health information for the care of infants. For example, 1 in 4 could not properly prepare doses of prescription medication or read a digital thermometer, half could not properly prepare doses of OTC medication or understand a growth chart, and more than 3 in 4 could not understand a commonly used breastfeeding brochure. The PHLAT demonstrated excellent reliability and construct validity, suggesting

Acknowledgments

We thank Matthew Oettinger and Steven Pattishall for their help with recruitment. We thank Graham Gipson for graphic design assistance with Table 2. Dr Rothman is currently supported by an NIDDK Career Development Award (NIDDK 5K23 DK065294). Dr Perrin is currently supported by an NICHD career development award (NICHD K23 HD051817). Dr Sanders's work on this study was supported in part by the Robert Wood Johnson Generalist Physician Scholars Program. This research was also supported with

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