Health care provider perceptions of parents' health literacy and effect on treatment recommendations for pediatric asthma patients

Purpose: Treatment plan adherence and disease self-management are known to be improved by engaging patients in the decision-making process. We examined provider perceptions of the health literacy of parents of pediatric asthma patients, the accuracy of these perceptions, and how perceptions affected treatment recommendations and the way instructions were given.

Methods: Parents of 6-12 year-old children with asthma attending a clinic visit were recruited to a cross-sectional study of health literacy and asthma outcomes. Parents completed demographics and the TOFHLA, a validated health literacy measure. Providers completed a survey after the visit which included perceived parent health literacy level and if this perception influenced the content and communication of treatment recommendations. In-depth interviews were conducted with the six core providers to ascertain qualitatively what influenced perceptions. Chi square and kappa tested associations.

Results: 281 parents (95% female, 86% Black, 2% Hispanic) and 13 providers provided data. The majority of parents scored as having adequate health literacy (91%). Providers correctly rated 65.2% of parents, under-rating 30.8% and over-rating 4.0% (χ² p=0.003; κ=0.11). Providers reported changing treatment recommendations (p=0.001) and how treatment instructions were given (p=0.001) based on perceived health literacy. Qualitatively, all six providers described their perceptions as influenced by parents' ability to articulate their children's asthma history and/or treatment plan.

Conclusions: Pediatric providers were moderately accurate in assessing parents' health literacy. Accurate provider perceptions and provider awareness of perceptions may result in more appropriate treatment instructions and better health outcomes.