The relationship between parent health literacy and pediatric emergency department utilization: a systematic review

Abstract

Background: Low health literacy in parents can potentially impact understanding of a child's diagnosis and treatment course. No reviews have addressed parent health literacy in the emergency department (ED), the relationship between parent health literacy and child ED utilization, or the impact of low literacy interventions on child ED utilization.

Objective: To systematically evaluate the peer-reviewed literature pertaining to parental health literacy and ED utilization. The following key questions were addressed: question (Q) 1) What is the prevalence of low health literacy, as estimated by validated health literacy measures, of parents in the ED? Q2) Is parent low health literacy related to ED use for children? Q3) Do low literacy interventions targeting parents likely to have low health literacy affect ED use for children?

Data sources: The authors reviewed 483 unduplicated titles and abstracts published between 1980 and May 2012 using PubMed and CINAHL, with 117 retained for full review and 17 included in the final analytic review.

Study eligibility criteria, participants, and interventions: All included articles had a valid measure of parent health literacy and a Q1) descriptive measurement of the population, Q2) ED utilization, or Q3) utilized a low literacy educational intervention.

Study appraisal and synthesis methods: One author extracted data verified by a second author. Studies were rated for quality by both authors.

Results: Q1) A median of 30% (interquartile range 22-36%) of parents in the ED possesses low health literacy. Q2) Studies investigating the relationship between health literacy and ED yielded mixed results. Q3) Seven of 8 low literacy interventions were associated with a reduction in ED use. Random effects pooled odds ratios from 6 studies showed intervention effectiveness (odds ratio 0.35; 95% CI 0.15-0.81).

Limitations: No intervention studies measured health literacy, limiting the ability to determine whether the low literacy intervention targeted health literacy.

Conclusions and implications of key findings: Roughly 1 in 3 parents of children presenting to the ED have low health literacy. Importantly, interventions targeting parents likely to have low health literacy have an impact in reducing ED utilization.

Keywords: adolescent; child; child, preschool; emergency service; health literacy; hospital; infant; newborn; patient education as topic; utilization.

Figure 1

Literature search results flow diagram.

Figure 2

Forest plot of prevalence estimate of parent low health literacy and 95% CI (Q1). For each study, the estimated prevalence of low health literacy is shown as a diamond. The lateral bars indicate 95% CI. The vertical line indicates the median across all studies (30%), with the IQR in gray (22–36%).

Figure 3

Forest plot of ORs for educational interventions (all interventions and general health interventions) and ED use. For each study, the OR is shown as a diamond with area proportional to the sample size. The lateral bars indicate 95% CI. Treatment is favored by studies with OR and 95% CI left of the vertical line. *Mailed intervention, with no evidence that the intervention was received or read.