The Association between Maternal Health Literacy and Assessment for Developmental Delay in Low-Income Latino Children

Tuesday, 10 November 2015: 8:30 AM

Eileen K. Fry-Bowers, PhD, JD, RN, CPNP
Hahn School of Nursing and Health Science, University of San Diego, San Diego, CA, USA


The purpose of this study is to explore the relationship between the level of maternal health literacy and perceptions of assessment and referral for developmental concerns for low-income Latino children aged 3 to 48 months when seeking pediatric primary care services.


Early identification of developmental disorders is paramount for ensuring optimal wellness for young children.  Appropriate assessment is an integral function in providing primary care for children and the responsibility of all pediatric health care providers (PHCP). Specifically, the American Academy of Pediatrics and the Bright Futures Guidelines for well-child care recommend that pediatric development be incorporated at every well-child preventive care visit routinely assessed in order to identify developmental risk factors, provide parents with appropriate anticipatory guidance, and secure adequate intervention to support optimal development.  Moreover, this surveillance should include asking about parents’ concerns, obtaining a developmental history, making observations of the child, identifying risk and protective factors, and documenting the findings. Concerns should be addressed promptly with developmental screening tests.

National data however suggest that PHCPs do not adequately address parental concerns regarding pediatric development, behavior and mental health, and many children with developmental and behavioral problems remain undetected or do not receive referral to an early intervention program until problems escalate.  This is particularly true for children from low-income families or children of color.  In fact, Latino children are diagnosed with autism spectrum disorders 2.5 years later than white children and exhibit more severe symptoms at time of diagnosis.  Similar delays are noted for other developmental, behavioral or mental health conditions for this population.  Importantly, evidence indicates that children with developmental disabilities who are identified early and begin receiving appropriate and coordinated intervention services demonstrate gains and advantages not shown by their peers who do not participate in these programs.  Moreover, these interventions can positively impact outcomes across several developmental domains.

During the pediatric well child visit, parents are expected to provide information, and respond to questions, which should inform the PHCP’s assessment and plan of care.  Research indicates that individuals with low health literacy (HL) experience challenges in communicating with providers, demonstrate poor comprehension of provider instructions, ask few questions within a clinical encounter, and report poor satisfaction with patient-provider communication.  Recent evidence also links low parental HL to suboptimal pediatric health outcomes. However, whether parental HL plays a role in the reciprocal transmission of information needed for developmental assessment and action remains poorly understood.


Low-income English- and Spanish-speaking Latina mothers of children aged three months to four years were recruited from WIC sites in Southern California (n= 124) to participate in this cross-sectional, correlational study.  Maternal HL was assessed using the Newest Vital Sign.  Perception of pediatric developmental screening and receipt of information or referral was measured with the Promoting Health Development Survey. Demographic data included maternal acculturation status and preferred language, child health insurance status, and whether the child received care from a regular place and regular provider. Data analysis was completed using SPSS version 22.0.


Overall, 61 mothers identified their child to be at high risk for a developmental concern, but only 32 reported being asked by their PHCP if they had such concerns, while 34 reported being provided with information to address these concerns.  Fifty-three mothers were identified as having a high likelihood of limited HL, 43 with the possibility of limited HL, and 28 with adequate HL. Chi-square analysis revealed a significant association with moderate effect size between the level of maternal HL and maternal concern that their child was at risk developmentally χ2 (6) = 15.185, p = .019, ϕ = .238.  


Low maternal HL may be a risk factor for incomplete pediatric developmental assessment and referral among low-income Latino families.  Children who receive timely and appropriate assessments are more likely to receive other needed developmental services.  Culturally appropriate screening and dissemination of culturally relevant anticipatory guidance materials to Latino families may be a key tool for improving timely assessment and referral for high quality early intervention services, which can improve a child’s developmental trajectory, and reduce racial and ethnic differences in pediatric health care.