198 - Low Caregiver Health Literacy is Associated with Low Satisfaction with Provider Communication at Well Child Checkups

Poster Number: 198
Publication Number: 198.319

Ellen McMahon, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, United States; aihua bian, Vanderbilt Medican Center, nashville, TN, United States; Jonathan Schildcrout, Vanderbilt University Medical Center, Nashville, TN, United States; Shonna Yin, NYU Grossman School of Medicine, New York City, NY, United States; Kori Flower, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States; Eliana M. Perrin, Johns Hopkins School of Medicine, Baltimore, MD, United States; Russell Rothman, Vanderbilt University Medical Center, Nashville, TN, United States; Lee Sanders, Stanford University, Stanford, CA, United States; Alan M. Delamater, University of Miami Leonard M. Miller School of Medicine, Miami, FL, United States; William Heerman, Vanderbilt University Medical Center, Nashville, TN, United States

Background: Low health literacy (HL) and dissatisfaction with provider communication are associated with poor adherence to provider recommendations and worse health outcomes, yet little is known about how they are associated with each other. Understanding this association would be important for designing effective interventions to improve communication quality and adherence to provider recommendations.

Objective: To describe the association between caregiver HL and satisfaction with provider communication at pediatric well child checkups (WCCs) using a longitudinal dataset.

Design/Methods: We performed a retrospective cohort analysis using data from the Greenlight Intervention Study, a cluster randomized trial at 4 pediatric resident clinics. Caregiver-infant dyads were enrolled at the child’s 2 month WCC and followed for 24 months. Caregiver HL was assessed by The Newest Vital Sign (NVS) at the 9 month WCC. NVS scores range from 0-6 with < 4 indicating limited HL. Perception of communication was measured by the Communication Assessment Tool (CAT) at each WCC, with a possible averaged score range of 0-4, with higher scores reflecting greater communication satisfaction. To assess the association between HL and CAT, we conducted a longitudinal proportional odds regression that accounted for repeated individual measures of CAT scores from 9 to 24 months. We adjusted for caregiver age, WIC status, race/ethnicity, language, income, education, insurance type, postpartum depression, and clinic site.

Results: Among 865 caregivers, median age was 27 years (IQR 20, 36) and 85% of dyads were enrolled in WIC. Self-reported race/ethnicity were 50% Hispanic, 18% white, 28% black, and 4% other. Preferred language was English in 65% and Spanish in 35%. Median NVS was 3.0 (IQR 1.0, 6.0), and median CAT was 4.0 (IQR 2.9, 4.0). Adjusted models revealed a nonlinear relationship between NVS and CAT (Figure 1). Lower NVS was associated with lower CAT for NVS scores < 3 (NVS score 1 vs 3: aOR 0.91, 95% CI 0.68, 0.97). Of note, maternal depression was found to be an an important predictor of CAT score (p=0.0002), with higher depression scores associated with lower CAT scores.Conclusion(s): Longitudinal analysis of a large and diverse population indicated that as HL increased, so did caregiver satisfaction with communication up to a NVS score of 3 where the relationship plateaued. These data identify an opportunity for pediatric healthcare providers to improve communication, especially among families with low HL.
Ellen McMahon CVMcMahon CV.pdf