Low Parental Health Literacy: A Pediatric Nursing Concern

Monday, 9 November 2015

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

Purpose:  The purpose of this presentation is to provide the pediatric nurse with information regarding low parental health literacy (HL) and its impact on pediatric health outcomes.  Clinical assessment of HL versus adoption of a “universal precautions” approach to health care communication will be discussed.  Evidence-based interventions for clear communication to parents at risk for low HL will be presented.

Background:  Health literacy (HL), which comprises numerous skills beyond those of reading and writing, including speaking, listening, and numeracy, allows individuals to obtain, process, and understand basic health information and services needed for making appropriate health decisions. Nearly half of all adult Americans possess low levels of HL.  Limited HL appears to profoundly affect a myriad of health indicators.

Given the reciprocal nature of health communication, patient-nurse interactions play an important role in care, particularly among patients with low literacy.  Nursing knowledge regarding the prevalence of and patient characteristics associated with low HL may influence these interactions.  Lack of knowledge among nurses regarding issues related to parental HL can alter communication and hinder benefits expected from medical care. 

Despite expanding research on HL and health outcomes in adult populations, few studies have assessed the relationship between parental, caregiver or child literacy and pediatric health outcomes, or the association between patient/parent-provider communication and health outcomes, among patients/parents with limited HL. Given nursing's role in direct patient care and its responsibility in the delivery and management of health services, nurses must gain an improved understanding of this phenomenon and those interventions which mitigate the negative impact of low HL, particularly among parents and caregivers.

All patients/parents, not only those with limited HL, will benefit from interventions which improve health care communication, offer clear and unambiguous instructions, and simplify use of services —all of which play a substantial role in improving the safety and quality of health care.

Practice Implications:  Nurses caring for pediatric patients and their families must enhance those skill sets that are most useful for communicating appropriately with parents of low education or socio-economic status, those at risk for low HL, and those for whom English is not their first language.  Evidence-based techniques that improve interactive communication skills include using plain language, sitting down to achieve eye-level with a parent, breaking information into sentences, using visual models and pictures when possible, and promoting a safe environment where parents can ask questions are simple steps that will foster self-efficacy, improve communication, and support cultural expectations. In addition, a Health Literacy Universal Precautions Toolkit (United States Department for Health and Human Services, Agency for Healthcare Research and Quality, 2013) can be used by pediatric primary care practices and health systems to design and implement strategies to minimize the impacts of low HL and support the delivery of culturally and linguistically sensitive pediatric health care.