The Health Literacy of Parents in the United States: A Nationally Representative Study

OBJECTIVE: To assess the health literacy of US parents and explore the role of health literacy in mediating child health disparities. METHODS: A cross-sectional study was performed for a nationally representative sample of US parents from the 2003 National Assessment of Adult Literacy. Parent performance on 13 child health-related tasks was assessed by simple weighted analyses. Logistic regression analyses were performed to describe factors associated with low parent health literacy and to explore the relationship between health literacy and self-reported child health insurance status, difficulty understanding over-the-counter medication labeling, and use of food labels. RESULTS: More than 6100 parents made up the sample (representing 72600098 US parents); 28.7% of the parents had below-basic/basic health literacy, 68.4% were unable to enter names and birth dates correctly on a health insurance form, 65.9% were unable to calculate the annual cost of a health insurance policy on the basis of family size, and 46.4% were unable to perform at least 1 of 2 medication-related tasks. Parents with below-basic health literacy were more likely to have a child without health insurance in their household (adjusted odds ratio: 2.4 [95% confidence interval: 1.1–4.9]) compared with parents with proficient health literacy. Parents with below-basic health literacy had 3.4 times the odds (95% confidence interval: 1.6–7.4) of reporting difficulty understanding over-the-counter medication labels. Parent health literacy was associated with nutrition label use in unadjusted analyses but did not retain significance in multivariate analyses. Health literacy accounted for some of the effect of education, racial/ethnic, immigrant-status, linguistic, and income-related disparities. CONCLUSIONS: A large proportion of US parents have limited health-literacy skills. Decreasing literacy demands on parents, including simplification of health insurance and other medical forms, as well as medication and food labels, is needed to decrease health care access barriers for children and allow for informed parent decision-making. Addressing low parent health literacy may ameliorate existing child health disparities.

[1]  Sara J. Rosenbaum,et al.  Low Health Literacy: Implications for National Health Policy , 2007 .

[2]  Shalini G. Forbis,et al.  Health literacy and pediatric health. , 2007, Current problems in pediatric and adolescent health care.

[3]  P. Bach.  Cost sharing for health care--whose skin? Which game? , 2008, The New England journal of medicine.

[4]  M. Wolf,et al.  To err is human: patient misinterpretations of prescription drug label instructions. , 2007, Patient education and counseling.

[5]  Kristine Yaffe,et al.  Limited Literacy in Older People and Disparities in Health and Healthcare Access , 2006, Journal of the American Geriatrics Society.

[6]  William H Shrank,et al.  The variability and quality of medication container labels. , 2007, Archives of internal medicine.

[7]  J. Feinglass,et al.  Health Literacy and Mortality Among Elderly Persons , 2007 .

[8]  David A. Kindig,et al.  Health literacy : a prescription to end confusion , 2004 .

[9]  R. Steinbrook.  Imposing personal responsibility for health. , 2006, The New England journal of medicine.

[10]  M. Rao,et al.  What did the doctor say? , 2007, Pennsylvania medicine.

[11]  A. Wald.  Tests of statistical hypotheses concerning several parameters when the number of observations is large , 1943 .

[12]  Eugene G. Johnson,et al.  Scaling Procedures in NAEP , 1992 .

[13]  William H Shrank,et al.  A critical review of FDA-approved Medication Guides. , 2006, Patient education and counseling.

[14]  J. Gazmararian,et al.  Understanding health literacy : implications for medicine and public health , 2005 .

[15]  William H Shrank,et al.  Educating patients about their medications: the potential and limitations of written drug information. , 2007, Health affairs.

[16]  E. Muraki.  A GENERALIZED PARTIAL CREDIT MODEL: APPLICATION OF AN EM ALGORITHM , 1992 .

[17]  Elizabeth Greenberg,et al.  A First Look at the Literacy of America's Adults in the 21st Century. NCES 2006-470. , 2006 .

[18]  Thomas Lumley,et al.  Analysis of Complex Survey Samples , 2004 .

[19]  L. Hay,et al.  Health literacy: An overlooked factor in understanding HIV health disparities , 2008, Perspectives in public health.

[20]  M. Wolf,et al.  Low literacy impairs comprehension of prescription drug warning labels , 2006, Journal of General Internal Medicine.

[21]  A. Scott,et al.  The Analysis of Categorical Data from Complex Sample Surveys: Chi-Squared Tests for Goodness of Fit and Independence in Two-Way Tables , 1981 .

[22]  M. Wolf,et al.  Misunderstanding of prescription drug warning labels among patients with low literacy. , 2006, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.

[23]  Sheida White,et al.  Relationship of preventive health practices and health literacy: a national study. , 2008, American journal of health behavior.

[24]  Mark A. Kutner,et al.  The Health Literacy of America's Adults: Results from the 2003 National Assessment of Adult Literacy. NCES 2006-483. , 2006 .

[25]  J. Gazmararian,et al.  Impact of health literacy on socioeconomic and racial differences in health in an elderly population , 2006, Journal of General Internal Medicine.

[26]  Kathleen N. Lohr,et al.  A Systematic Review of the Literature: Analysis of APRN Roles Including Effectiveness of Clinical Nurse Specialist Role , 2010, Clinical nurse specialist CNS.

[27]  Mark A. Kutner,et al.  The Health Literacy of American Adults:Results from the 2003 National Assessment of Adult Literacy. , 2006 .

[28]  T. Sentell,et al.  Importance of adult literacy in understanding health disparities , 2006, Journal of General Internal Medicine.