Low Parental Literacy Is Associated With Worse Asthma Care Measures in Children

DeWalt, Darren A.; Dilling, Marylee H.; Rosenthal, Marjorie S.; Pignone, Michael P.

doi:10.1016/j.ambp.2006.10.001

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Volume 7, Issue 1 , Pages 25-31, January 2007

Low Parental Literacy Is Associated With Worse Asthma Care Measures in Children

Darren A. DeWalt, MD, MPH
- Division of General Internal Medicine and the Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC
- Address correspondence to Darren A. DeWalt, MD, MPH, Department of Medicine, Division of General Internal Medicine, 5039 Old Clinic Building, CB#7110, Chapel Hill, NC 27599-7110.
Marylee H. Dilling, BS
- Division of General Internal Medicine and the Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC
Marjorie S. Rosenthal, MD, MPH
- Division of General Pediatrics, Yale University School of Medicine, New Haven, Conn.
Michael P. Pignone, MD, MPH
- Division of General Internal Medicine and the Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC

Received 11 February 2006; accepted 1 October 2006.

Objective

To determine whether parental literacy is related to emergency department visits, hospitalizations, and days of school missed for children with asthma.

Methods

We performed a retrospective cohort study at a university pediatric clinic. We enrolled children between 3 and 12 years old with a diagnosis of asthma and a regular source of care at the site of the study and their parent or guardian. Primary asthma care measures included self-reported rates of emergency department visits, hospitalizations, and days of school missed. Secondary asthma care measures included rescue and controller medication use, classification of asthma severity, and parental asthma-related knowledge.

Results

We enrolled 150 children and their parents. Twenty-four percent of the parents had low literacy. Children of parents with low literacy had greater incidence of emergency department visits (adjusted incidence rate ratio [IRR] 1.4; 95% confidence interval 0.97, 2.0), hospitalizations (IRR 4.6; 1.8, 12), and days missed from school (IRR 2.8; 2.3, 3.4) even after adjusting for asthma-related knowledge, disease severity, medication use, and other sociodemographic factors. Parents with low literacy had less asthma-related knowledge, and their children were more likely to have moderate or severe persistent asthma and had greater use of rescue medications.