Exploring the Association Between Low Maternal Health Literacy and Pediatric Health Care Utilization: Are Limited Reading Skills a Barrier of Concern?

Background: Women with low health literacy (HL) underutilize preventive healthcare. However, there is little research on healthcare utilization for their children. In this mixed method study we examined the relationship between maternal HL and healthcare use in young children (0-24mo). Methods: We assessed HL of mothers using the Rapid Assessment of Adult Literacy in Medicine, in a nested random sample from a cohort study (n=1,034) of low-income, minority women (n=234). We were able to link the Medicaid Claims data of 165 children (0-24 months) to unique women in our sample. Additionally we conducted 14 semi-structured interviews with mothers with varied HL. Guided by Andersen's Behavioral Health Model we analyzed and coded verbatim transcripts. Results: In our sample 14.1% of the women had low HL (<6thgrade). The overall rate of children receiving >5 well-child visits between age 0 and 2 was 94.5%. HL was not associated with the number of well-child visits, sick-child visits or emergency room visits. Qualitative analyses of interview transcripts revealed that poor readers and strong readers encountered an overlapping set of challenges when navigating the healthcare system. Communication, power and respect were among the themes that emerged as obstacles to care. Participants reported finding a way to access care despite such obstacles. Conclusions: In this study of low income mothers we found no association between HL and utilization of pediatric health services. This adds to the body of work indicating that mothers with low HL are better advocates for the healthcare of their children than for themselves.