Essay on Health Care and Literacy

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Health Literacy and Child Health Outcomes: A Systematic Review of the
Darren A. DeWalt and Ashley Hink
Pediatrics 2009;124;S265
DOI: 10.1542/peds.2009-1162B

The online version of this article, along with updated information and services, is located on the World Wide Web at: PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly publication, it has been published continuously since 1948. PEDIATRICS is owned, published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point
Boulevard, Elk Grove Village, Illinois, 60007. Copyright © 2009 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275.

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Health Literacy and Child Health Outcomes: A
Systematic Review of the Literature
AUTHORS: Darren A. DeWalt, MD, MPH and Ashley Hink,


Program on Health Literacy, Cecil G. Sheps Center for Health
Services Research, University of North Carolina, Chapel Hill,
North Carolina

OBJECTIVES: To review the relationship between parent and child literacy and child health outcomes and interventions designed to improve child health outcomes for children or parents with low literacy skills. KEY WORDS health literacy, literacy, health disparities, child health outcomes ABBREVIATIONS
REALM—Rapid Estimate of Adult Literacy in Medicine
TOFHLA—Test of Functional Health Literacy in Adults
CINAHL—Cumulative Index to Nursing and Allied Health
The views presented in this article are those of the authors, not the organizations with which they are affiliated. doi:10.1542/peds.2009-1162B
Accepted for publication Jul 20, 2009
Address correspondence to Darren A. DeWalt, MD, MPH, Cecil G.
Sheps Center for Health Services Research, Program on Health
Literacy, 5039 Old Clinic Building, CB 7110, Chapel Hill, NC 27599.
PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).
Copyright © 2009 by the American Academy of Pediatrics
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.

METHODS: We searched Medline and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) for articles published from 1980 through 2008 and included studies that reported original data, measured literacy and Ն1 health outcome, and assessed the relationship between literacy and health outcomes. Health outcomes included health knowledge, health behaviors, use of health care resources, intermediate markers of disease status, and measures of morbidity. Two abstractors reviewed each study for inclusion. Included studies were abstracted into evidence tables and were assessed by using an 11-item quality scale.
RESULTS: We reviewed 4182 new titles and abstracts published since
2003. Fifty-eight articles were retained for full review, and 13 met the inclusion criteria. Eleven articles from the systematic review from 1980 to 2003 met the inclusion criteria, giving us a total of 24 articles. Children with low literacy generally had worse health behaviors. Parents with low literacy had less health knowledge and had behaviors that were less advantageous for their children’s health compared with parents with higher literacy. Children whose parents had low literacy often had worse health outcomes, but we found mixed results for the relationship of literacy to the use of health care services. Interventions found that improving written materials can increase health knowledge, and combining good written materials with brief counseling can improve behaviors including adherence. The average quality of the studies was fair to good.