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Background: Low health literacy affects one-third of adults in the United States and can have a negative effect on health behavior and outcomes., Objective: The goal of this study was to examine attitudes and knowledge of health literacy among pediatric residents and faculty in pediatric resident continuity clinics across the country., Methods: An online mixed-methods survey was distributed to pediatric faculty and residents through the Academic Pediatric Association's Continuity Research Network. The 20-question survey included questions about the participants' health literacy knowledge and health literacy practices in continuity clinics, such as use of universal health literacy precautions. Categorical answer choices were dichotomized into positive and negative groupings and resident and faculty responses were compared using the Chi-squared test (significance p < .05). Qualitative data were analyzed using emergent coding and grounded theory to determine themes., Key Results: Responses were received from 402 individuals at 24 pediatric residency programs. Most participants agreed or strongly agreed that they could correctly identify participants with low health literacy (76% residents vs. 53% faculty). Only 19% of residents and 26% of faculty were familiar with universal health literacy precautions. Many residents and faculty had received no training in health literacy (37% residents vs. 38% faculty). Barriers and challenges around health literacy included time, language, limited training or resources, low literacy, disease mismanagement, and fixed misconceptions., Conclusion: Despite ample evidence in the literature to the contrary, most respondents believed they could correctly identify individuals with low health literacy. Additionally, most participants had not heard of universal health literacy precautions and were unaware of their usage in their practice setting. This is not consistent with current expert recommendations. These findings are troubling as they are from academic residency programs, indicating an educational deficit. These findings point toward a next step in health literacy education for pediatric residents. [ HLRP: Health Literacy Research and Practice . 2022;6(1):e51-e60. ] Plain Language Summary: Pediatric residents and faculty in continuity clinics were surveyed about their opinions, health literacy knowledge, ability, and practices in continuity clinics. Despite evidence to the contrary, most respondents believed they could correctly identify individuals with low health literacy and had not heard of universal health literacy precautions. These findings highlight the need for more health literacy education for pediatric residents.

Background and Objectives: Despite recommendations supporting human papillomavirus (HPV) vaccination, pediatric vaccination rates remain suboptimal in the United States; lack of tools to support provider counseling is one barrier. We sought to evaluate HPV-related counseling materials for readability, suitability, and content, and assess parent perceptions of materials, using a health literacy perspective., Methods: A systematic search was conducted for written materials developed for HPV vaccination counseling by examining state Department of Health Web sites and associated links to local and national organizations. Materials were assessed for the following: 1) readability (Flesch Reading Ease, Flesch-Kincaid, Gunning Fog, Simple Measure of Gobbledygook, Fry), 2) suitability (understandability and actionability) (Suitability Assessment of Materials; Patient Education Materials Assessment Tool for Printable Materials), and 3) coverage of 8 key content areas (recommended by Centers for Disease Control and Prevention). Semistructured interviews were conducted with English-speaking parents or caregivers of children 9 to 17 years of age from 3 pediatric clinics (New York, Ohio, Illinois) serving predominantly low-income families to assess perceptions and usefulness of 4 handouts selected for review., Results: Thirty-eight documents were assessed. Mean ± standard deviation (SD) reading grade level was 9.4 ± 2; 10.5% (n = 4) had a reading level of 6th grade or below; 68.4% (n = 26) were considered not suitable. Mean understandability was 41.7% and mean actionability was 20.7%. Only 5.3% (n = 2) addressed all 8 content areas mean ± SD (number of areas = 6.7 ± 1.2). Brochure comprehensiveness and inclusion of a personal story were cited as factors that would be helpful in influencing parents to vaccinate against HPV., Conclusions: Few written materials for HPV vaccination counseling were optimal from a health literacy best practices perspective. Content comprehensiveness was important for informed decision making., (Copyright © 2017 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)

Objective: We proposed and tested a theoretical framework for how use of Teach-back could influence communication during the pediatric clinical encounter., Methods: Audio-taped pediatric primary care encounters with 44 children with asthma were coded using the Roter Interaction Analysis System to measure patient-centered communication and affective engagement of the parent. A newly created Teach-back Loop Score measured the extent to which Teach-back occurred during the clinical encounter; parental health literacy was measured by Newest Vital Sign. Logistic regression was used to test the relationship between Teach-back and features of communication. Focus groups held separately with clinicians and parents elicited perceptions of Teach-back usefulness., Results: Teach-back was used in 39% of encounters. Visits with Teach-back had more patient centered communication (p=0.01). Adjusting for parent health literacy, parent age, and child age, Teach-back increased the odds of both patient centered communication [proportional AOR (95% CI)=4.97 (4.47-5.53)]and negative affect [AOR (95% CI)=5.39 (1.68-17.31)]. Focus group themes common to clinicians and parents included: Teach-back is effective, could cause discomfort, should be used with children, and nurses should use it., Conclusions: Teach-back was associated with more patient-centered communication and increased affective engagement of parents., Practice Implications: Standardizing Teach-back use may strengthen patient-centered communication., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Context: We evaluated the validity of the Newest Vital Sign (NVS) as a brief screen for health literacy in children., Objectives: To (a) test the hypothesis that child performance on the NVS correlates with performance on a test of child reading comprehension and (b) establish age-based cutoffs for expected performance on the NVS., Design: Children aged 7 to 17 years were administered the NVS followed by the Gray Silent Reading Test (GSRT)., Results: The NVS score correlated strongly with GSRT score (ρ = 0.71, P < .0001) and increased with age. Children aged 7 to 9 years had a median NVS score of 1 (interquartile range = 1-2); children aged 10 to 17 years had a median score of 3 (interquartile range = 2-4), P < .0001., Conclusion: The NVS performs well in this population. Children aged 10 to 17 years with an NVS score lower than 2 may have low health literacy.

Objective: We tested the association between child and parental health literacy (HL) and odds of child and adolescent obesity., Methods: We conducted an anonymous cross-sectional survey of a convenience sample of English-speaking child-parent dyads. Newest Vital Sign (NVS) measured HL. We used multivariable logistic regression to test adjusted association between child and parental NVS and obesity. Analyses were stratified for school-aged children (aged 7-11) vs. adolescents (aged 12-19)., Results: We surveyed 239 child-parent dyads. Median child age was 11 [inter-quartile range 9-13]; 123 (51%) were male; 84% Medicaid recipients; 27% obese. For children, the odds of obesity [adjusted odds ratio (95% confidence interval)] decreased with higher parent NVS [0.75 (0.56,1.00)] and increased with parent obesity [2.53 (1.08,5.94)]. For adolescents, odds of obesity were higher for adolescents with the lowest category of NVS [5.00 (1.26, 19.8)] and older parental age [1.07 (1.01,1.14)] and lower for Medicaid recipients [0.21 (0.06,0.78)] and higher parental education [0.38 (0.22,0.63)]., Conclusion: Obesity in school-aged children is associated with parental factors (obesity, parental HL); obesity in adolescents is strongly associated with the adolescent's HL., Practice Implications: Strategies to prevent and treat obesity should consider limited HL of parents for child obesity and of adolescents for adolescent obesity., (Copyright © 2013. Published by Elsevier Ireland Ltd.)

Objective: To test the relationship between child health literacy and body mass index (BMI) Z-score in overweight children., Methods: Cross-sectional survey of overweight children and parents. Parent and child health literacy was measured by the Short Test of Functional Health Literacy (STOFHLA). Linear regression tested for predictors of childhood BMI Z-score, adjusting for confounders., Results: Of 171 total children, 107 (62%) participated, of whom 78 (73%) had complete data for analysis. Mean child BMI Z-score (SD) was 2.3 (0.40); median child age (interquartile range) was 11.5 (10-16); 53% were female; 80% were Medicaid recipients. Mean child STOFHLA was 22.9 (9.0); mean parental STOFHLA was 29.1 (8.6). Child STOFHLA correlated negatively with BMI Z-score (r=-0.37, p=0.0009) and positively with child eating self-efficacy (r=0.40, p<0.0001). After adjusting for confounders, child STOFHLA was independently associated with child BMI Z-score (standardized B=-0.43, p<0.0001). Overall adjusted r-squared for the regression model was 38%. Child STOFHLA contributed 13% to the overall model., Conclusions: Child health literacy was negatively correlated with BMI Z-scores in overweight children, suggesting the need to consider health literacy in the intersection between self-efficacy and behavior change when planning interventions that aim to improve child BMI., (2009 Elsevier Ireland Ltd. All rights reserved.)

To mitigate the negative impact of resource needs on child health, practices serving low-income immigrant families have implemented screening programs to connect families to community resources. Little is known about how duration of US residence relates to patterns of resource needs and indicators of acculturation such as community resource knowledge/experience or self-efficacy. We conducted a cross-sectional analysis of a convenience sample of immigrant families with young children at an urban primary care clinic. These families were seen 5/2018–1/2020 for well child care, screening positive for ≥1 social need using a tool derived from Health Leads. Analysis of 114 families found that newly arrived families with a shorter duration of US residence (≤5 years) were more likely to report immediate material hardships like food insecurity and need for essential child supplies. Newly arrived families were also less likely to have access to technology resources such as a computer or smartphone. Long-term families with a longer duration of US residence (≥15 years) were more likely to report chronic needs like poor housing conditions, but also reported increased community resource knowledge/experience and increased self-efficacy. Primary care pediatric practices should assess immigration contextual factors to identify subgroups such as newly arrived families with young children to target resources (e.g., increase screening frequency) or enhance services (e.g., patient navigators) to relieve resource needs. Highlights: This was a study of immigrant families with young children at a federally qualified health center with a social resource screening program. Newly arrived immigrant families were more likely to report material hardships like food insecurity, essential child supplies, and technology needs (e.g., computer, smart phone). Given society's increased reliance on virtual services, screening tools should incorporate technology resources (e.g., computers, high speed internet). Intervention strategies should identify subgroups such as newly arrived families with young children to target resources (e.g., increase screening frequency) or enhance services (e.g., patient navigators) to relieve resource needs. [ABSTRACT FROM AUTHOR]

Despite endorsement by the American Academy of Pediatrics, there are no national data on literacy promotion (LP) training and behaviors. To describe LP training experiences and behaviors of pediatric and internal medicine/pediatrics residents and faculty nationally, and the association between LP training and behaviors. The Academic Pediatric Association's Continuity Research Network and Reach Out and Read National Center sent an online survey to faculty and residents at participating Continuity Research Network clinics. Respondents were asked about LP training experiences and behaviors. Data were analyzed using descriptive statistics, chi-square tests, and logistic regression modeling. 473 faculty and 1216 residents at 42 institutions participated. More faculty than residents reported completing online Reach Out and Read training (63% vs 45%, P <.0001). More residents reported learning in clinic from others (92% vs 89%, P =.04). Training experiences did not differ otherwise. More faculty reported providing anticipatory guidance (87% vs 77%, P <.0001); modeling shared reading (69% vs 45%, P <.0001); and using books for developmental assessment (80% vs 62%, P <.0001). Both groups (97%) reported distributing books. The training modality most often endorsed as "very/extremely influential" was learning in clinic from others. Some LP behaviors were associated more strongly with online training while others were associated more strongly with in-person training. Online training and in-person training are both associated with high quality delivery of LP. Faculty members are more likely to have completed online training and to report engaging in the full range of recommended LP behaviors. These data have implications for LP training. [ABSTRACT FROM AUTHOR]

Background—Health literacy measures the degree to which individuals understand health information, it has not been studied among parents with limited English proficiency (LEP). Objective.—We aimed to determine how well Spanish-speaking Latino parents with LEP understood the written instructions accompanying a routinely prescribed medication. Design and Methods.—We conducted a cross-sectional survey of parents of young children, We showed subjects a medicine bottle with an English prescription label and a Spanish drug information sheet (DIS). Subjects demonstrated how much medicine they would give and stated how often they would give it (Medication Dosing). Then they answered 5 questions regarding information from the DES (DIS comprehension). We coded responses dichotomously as correct or incorrect. We compared Medication Dosing and DIS comprehension by age, comfort with speaking English, birthplace, number of years in the United States, and education. Regression analyses were performed to adjust for these potential confounders. Results—Of 100 participants, 22% correctly dosed the medication; 29% correctly answered all questions regarding the Spanish DES. Of subjects comfortable speaking English, 50% correctly demonstrated the amount of medicine to give. Overall, higher education and comfort speaking English were associated with better Medication Dosing. Higher education and birth in South America were associated with better DES comprehension. Conclusions—Few parents with LEP were able to understand routinely dispensed written medication instructions. Pediatricians should not assume that Spanish-speaking Latino parents who are comfortable speaking English will understand a prescription label written in English, or that Latino parents who speak Spanish will understand drug information written in Spanish. [ABSTRACT FROM AUTHOR]