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Health Literacy and Pediatric Care- What’s a Doctor to Do? :

June 8, 2016

In a study released this month in Pediatrics, “Parent health literacy, depression, and risk for pediatric injury,” Dr. Erika Cheng  et al. (peds.2016-0025) look at the impact of parental...


In a study released this month in Pediatrics, “Parent health literacy, depression, and risk for pediatric injury,” Dr. Erika Cheng et al. (peds.2016-0025) look at the impact of parental health literacy on multiple measures of child health. The authors used a 3 item screener to assess health literacy among 17,845 families with children age < 7 years attending 5 urban community health centers in Indianapolis IN. Children were largely  publicly insured (91.4%); a majority were African-American (50.5%) with a sizeable minority of Spanish speaking families (28.8%). Health literacy, as a quick reminder, is the ability to obtain and understand health information well enough to make important health decisions.

In this study, parents of 36.5% of children were considered to have low health literacy, which aligns with national data estimating that 30% of US caregivers have low health literacy.  Even without a spoiler alert, I can share with you that parents with low health literacy failed to endorse a significantly greater number of injury prevention practices related to childproofing, fire safety, first aid and gun safety than parents with adequate (higher) health literacy. Other important associations with lower health literacy included parental depression and TV viewing > 2 hours daily.

What can we do with this data? The authors conclude with a pragmatic, useful and common sense discussion of ways to communicate important health information to parents with low health literacy. But couldn’t we take an additional step and begin to link our pediatric care to adult (parental) literacy programs within our practices? Newer models of care that include partners such as Health Leads ( that assist families by providing connections to resources for families with needs related to food insecurity, utility bills and legal issues, could certainly emphasize links to adult literacy resources.  However, at the individual provider level, pediatricians could consider integrating the 3 question health literacy screener of Cheng et al into our own practices, just as many of us have begun to integrate screening for postpartum depression into primary pediatric care. And if we ask, we need to act, with accessible low-cost community resources ready to go at our fingertips. Although any literacy is not health literacy, certainly learning to read is a necessary first step.

Finally, I note that the authors used data from the Child Health Improvement through Computer Automation (CHICA) system to answer their research question.  CHICA is quite amazing – it starts with a tablet-based 20 question prescreening form that parents complete in the waiting room.  Prompts use age-appropriate clinical guidelines and information from the child’s EMR, and responses zip back to providers, so that a personalized 6-item physician worklist is generated for the visit. I wonder if this system would help me make better use of the precious 15 minutes I have with each family for well care?

CORRECTION: An earlier version of this blog post indicated that Health Leads provides legal aid to patients, which is not the case.

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