Perceived Barriers to Care and Attitudes Towards Shared Decision-making Among Low Socioeconomic Status Parents: Role of Health Literacy

doi:10.1016/j.acap.2012.01.001

Academic Pediatrics

Volume 12, Issue 2, March–April 2012, Pages 117-124

https://doi.org/10.1016/j.acap.2012.01.001 Get rights and content

Abstract

Objective

Although low parent health literacy (HL) has been linked to poor child health outcomes, it is not known whether differences in perceptions related to access to care and provider–parent partnership in care are potential contributing factors. We sought to assess whether parent HL is associated with differences in perceived barriers to care and attitudes regarding participatory decision-making with the provider.

Methods

This was a cross-sectional analysis of data collected from parents presenting with their child to an urban public hospital pediatric clinic in New York City. Dependent variables were caregiver-reported barriers to care (ability to reach provider at night/on weekends, difficult travel to clinic) and attitudes towards participatory decision-making (feeling like a partner, relying on doctor’s knowledge, leaving decisions up to the doctor, being given choices/asked opinion). The primary independent variable was caregiver HL (Short Test of Functional Health Literacy in Adults [S-TOHFLA]).

Results

A total of 823 parents were assessed; 1 in 4 (27.0%) categorized as having low HL. Parents with low HL were more likely to report barriers to care than those with adequate HL: trouble reaching provider nights/weekends, 64.9% vs. 49.6%, (p < 0.001, adjusted odds ratio [AOR] 1.7, 95% confidence interval [95% CI] 1.2–2.4); difficult travel, 15.3% vs. 8.0%, (p = 0.004, AOR 1.8, 95% CI 1.1–3.0). Low HL was also associated with not feeling like a partner (28.8% vs. 17.1%; AOR 2.0; 95% CI 1.4–3.0), preference for relying on the doctor's knowledge (68.9% vs. 52.2%; AOR 1.7; 95% CI 1.2–2.4), and preference for leaving decisions up to the doctor (57.7% vs. 33.3%; AOR 2.2; 95% CI 1.6–3.1).

Conclusions

Addressing issues of parent HL may be helpful in ameliorating barriers to care and promoting provider-parent partnership in care.

Section snippets

Study Sample

This was a cross-sectional analysis of data gathered as part of a large study examining provider–parent communication and medication counseling. Parents and caregivers presenting with their child for an acute care visit to the pediatric clinic at Bellevue Hospital, an urban public hospital in New York City, were enrolled from July 13, 2007, through October 7, 2008. During times when enrollment was taking place, research assistants consecutively assessed families to determine eligibility.

Results

During the enrollment period from July 2007 through October 2008, families presenting with their children to the pediatric clinic for acute care were consecutively assessed during times when research assistants were available. Of 1534 families assessed, 1236 (80.6%) were considered to be eligible (Fig. 1). A total of 298 (19.4%) were considered to be ineligible because of 1 or more of the following: caregiver not parent or legal guardian (n = 53), caregiver not able to communicate in English or

Discussion

Our study is one of the first to investigate health literacy and its relationship to parent perceptions of barriers to care and preferences for clinical decision-making. We found that within a single primary care site, considerable heterogeneity exists in perceived access to care and perceptions of provider–parent partnership in care, and that health literacy was found to be significantly associated with this heterogeneity. Parents with low health literacy were more likely to perceive

Acknowledgments

Preliminary data from this study were presented at the 2009 Pediatric Academic Societies’ annual meeting (E-PAS2009:2350.4); May 2, 2009; Baltimore, MD. Research coordinators Isabel Bazan, BA, Maria Cerra, BA, Hannah Moreira, BA, and Dayana Sanchez, BA, and research assistants Brian Alvelo, BA, Cindy Encalada, BA, Alexandra Goodwin, BA, Brian Ahuja, BA, Bradley Collins, BS, Benjamin L. Kitchens, BA, Matthew Kline, MA, Jill Linnell, MPH, Nimesh Patel, BA, Tina Roa, BA, Mark Sechter, BA,

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Health Care Delivery ResearchPerceived Barriers to Care and Attitudes Towards Shared Decision-making Among Low Socioeconomic Status Parents: Role of Health Literacy

Abstract

Objective

Methods

Results

Conclusions

Section snippets

Study Sample

Results

Discussion

Acknowledgments

Child and Adolescent Psychiatric Clinics of North America

Trends in Cognitive Science

Patient Education and Counseling

Academic Pediatrics

Patient Education & Counseling

Ambulatory Pediatrics

Ambulatory Pediatrics

Ambulatory Pediatrics

Ambulatory Pediatrics

Patient Education and Counseling

The Medical Home-Improving Quality of Primary Care for Children

Pediatric Clinics of North America

The medical home: Health care access and impact for children and youth in the United States

Pediatrics

The Medical Home, Access to Care, and Insurance: A Review of Evidence

Pediatrics

Context and healthcare access: Looking beyond the individual

Medical Care

Improved Asthma Care After Enrollment in the State Children's Health Insurance Program in New York

Pediatrics

Barriers to Care and Primary Care for Vulnerable Children with Asthma

Pediatrics

Parents' Perceptions of Primary Care

Pediatrics

Patient and Visit Characteristics Related to Physicians' Participatory Decision-Making Style

Medical Care

Patient Participation in Medical Care: Effects on blood sugar control and quality of life in diabetes

Journal of General Internal Medicine

Change in Metabolic Control and Functional Status after Hospitalization

Diabetes Care

An Assessment of the Shared-Decision Model in Parents of Children with Acute Otitis Media

Pediatrics

Health Care Delivery Research
Perceived Barriers to Care and Attitudes Towards Shared Decision-making Among Low Socioeconomic Status Parents: Role of Health Literacy