Despite advances in asthma management, childhood asthma remains one of the highest ranked causes of pediatric hospitalizations and school absences. Health literacy studies show that because of low health literacy, the parent/guardian often does not understand the need for asthma prophylactic therapy, does not demonstrate the proper use of the asthma metered-dose inhaler, and lacks comprehension of written material. Health care providers do not routinely assess the parent/guardian for the ability to read and comprehend written material.
This study examined the relationships between the parent’s/guardian's level of functional health literacy (FHL) and their capacity to manage their child’s asthma. The following questions were raised:
- Research Question 1: Does the level of functional health literacy predict asthma knowledge among parent’s/caregiver’s of children with asthma?
- Research Question 2: Does the level of functional health literacy predict asthma knowledge among parent’s/caregiver’s of children with asthma?
- Research Question 3: Is there a relationship between the level of functional health literacy and parent/caregiver demographic variables (age, income, education completed, race/ethnicity, previous asthma education) of children who have been diagnosed with asthma?
Methods: Orem’s Self-Care Deficit Nursing Theory propositions maintains that self-care is a deliberate action performed with the intent of doing well for a dependent, but the action preformed may be inadequate due to lack of knowledge and skills. Self-care/dependent care agency can be described in terms of development, operability, and adequacy. IRB approval was obtained. Parents were first contacted using a flyer and gaining verbal consent to study. Signed consent was obtained after explaining the data collection process. The asthma clinic and health department in two states were the primary locations. Private space to conduct the surveys was provided at the locations and took place during the child's visit. A descriptive correlational design was chosen to describe the variables under study and to determine the relationship between the parent’s level of functional health literacy and their asthma knowledge. Instruments used were demographic and health status questions, Asthma Knowledge-Parent (AKP), and Test of Functional Health Literacy-Adult (TOFHLA). The statistical techniques used to analyze the data included calculation of descriptive statistics, frequency tables, t-tests, correlational analysis, and regression model. The design provided sufficient data for analysis of relationships among the variables under study. The primary predictive variable for this study was the level of functional health literacy of the parent/guardian. Fifty-eight (58) parents/guardians who self-identified as having a child with asthma who was 0-9 years of age completed the surveys. This age group of children was chosen as it is the expectation that the parent/guardian would be responsible for the child's health maintenance.
Results:
Since the Functional Health Literacy (FHL) scores were of primary importance in this research, t-test was conducted to determine if FHL scores were significantly different between the groups. A significant difference was not shown between the mean Health Literacy scores of those adults smokers versus nonsmokers; adults who had completed an asthma education program versus those who had not; adults whose child had been hospitalized for asthma during the last year, versus adults whose child had not been hospitalized; and, adults whose child had been taken for an unscheduled office visit for asthma in the last year, versus adults who had not taken their child for an unscheduled office visit for asthma. All participants (n=58) scored within the adequate level of functional health literacy.
A stepwise regression approach was also used to develop the most parsimonious model of the predictors of FHL scores (age, education, AKP, and health status outcomes). The F to enter was set at p<.15 and the F to remove was set at p<.25. In the analysis, an entry criterion of 0.15 was used so if the p-value for the variable of interest was less than 0.05, then it was added to the model. There was a slight association of parents/guardians with a higher FHL score were able to prevent their child from having to be hospitalized for asthma related symptoms, whereas those parents/guardian who had a lower FHL score was unable to prevent this from happening. Almost one-fourth of the sample incorrectly answered 5 or more of the Asthma Knowledge questions, and 4 (7%) said they did not know the correct answer to 10 or more of the questions.
Conclusion:
Preliminary evidence that the level of FHL does predict asthma knowledge among persons who provide care for children with asthma. While not definitive in all aspects, supports the premise that the FHL scores do in part explain health outcome measures. Additionally, higher income of the participants entered the regression model as a significant variable in predicting their score on the FHL. The most troubling methodological limitation of this study was the unexpected failure in being able to recruit participants who scored in the inadequate range of the TOFHLA.
However, lower-literacy parents with low literacy skills may not have been able to read and interpret the information on the recruitment flyer, or they may have been self-conscious or fearful that their participation in the study might lead to the discovery that they did not know how to read.
These findings are a clear indication that asthma education is not reaching the public as it should and confirms the urgent need for more extensively available programs of education to help parents know what to do to address the onset of an asthma exacerbation before it becomes a crisis that requires immediate medical attention. Health literacy problems have increased as the health system has grown more complex. Health literacy implies the accomplishment of certain health information knowledge, skills and competence to provide for and improve self-care and dependent care.
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