Low caregiver health literacy is associated with non-urgent pediatric emergency department use

Katharine V Jensen; Andrea Morrison; Keon Ma; Waleed Alqurashi; Tannis Erickson; Janet Curran; Ran D Goldman; Serge Gouin; April Kam; Naveen Poonai; Tania Principi; Shannon Scott; Antonia Stang; Patricia Candelaria; Kurt Schreiner; Maryna Yaskina; Samina Ali; Pediatric Emergency Research Canada Family Needs Study Group

doi:10.1007/s43678-024-00771-8

Low caregiver health literacy is associated with non-urgent pediatric emergency department use

CJEM. 2024 Sep 27. doi: 10.1007/s43678-024-00771-8. Online ahead of print.

Authors

Katharine V Jensen^{1

2}, Andrea Morrison³, Keon Ma⁴, Waleed Alqurashi⁵, Tannis Erickson⁶, Janet Curran⁷, Ran D Goldman⁸, Serge Gouin⁹, April Kam¹⁰, Naveen Poonai¹¹, Tania Principi¹², Shannon Scott¹³, Antonia Stang⁴, Patricia Candelaria¹, Kurt Schreiner¹⁴, Maryna Yaskina², Samina Ali^{15

16}; Pediatric Emergency Research Canada Family Needs Study Group

Collaborators

Pediatric Emergency Research Canada Family Needs Study Group:
Ashley Jones, Paul Clerc, Darcy Beer, Rachel Keijzer, Sylvia Froese, Kamary Coriolano, Amy Plint, Candice McGahern, Tyrus Crawford, Laura Weingarten, Wenli Xie, Bethany Lerman, Marie-Christine Auclair, Katie Gardner, Helen Wong, Yvonne Suranyi, Christine Westerlund, Lisa Hartling, Manasi Rajagopal, Elise Kammerer, Julie Leung

Affiliations

¹ Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada.
² Women & Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada.
³ CommunicateMD, Grafton, WI, USA.
⁴ Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
⁵ Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada.
⁶ Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB, Canada.
⁷ School of Nursing, Faculty of Health Professions, Dalhousie University, Halifax, NS, Canada.
⁸ The Pediatric Research in Emergency Therapeutics (PRETx) Program, Division of Emergency Medicine, Department of Pediatrics, University of British Columbia and BC Children's Hospital Research Institute, Vancouver, BC, Canada.
⁹ CHU Ste Justine, Montreal, QC, Canada.
¹⁰ Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
¹¹ Departments of Paediatrics, Internal Medicine, Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.
¹² Department of Pediatrics, Hospital for SickKids, Toronto, ON, Canada.
¹³ Faculty of Nursing, University of Alberta, Edmonton, AB, Canada.
¹⁴ PEAK Research Team, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.
¹⁵ Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada. sali@ualberta.ca.
¹⁶ Women & Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada. sali@ualberta.ca.

PMID: 39331337
DOI: 10.1007/s43678-024-00771-8

Abstract
in English, French

Objective: Caregivers with low health literacy are more likely to overestimate illness severity and have poor adherence with health-promoting behaviors. Our primary objective was to relate caregiver health literacy to the urgency of emergency department (ED) utilization. The secondary objective was to explore the relationship between social and demographic characteristics, health literacy, and urgency of ED use.

Methods: This sub-study was a descriptive cross-sectional survey with health record review. Data were collected from ten Canadian pediatric EDs. Study variables included demographics, visit details, and the Newest Vital Sign measurement of health literacy. ED visits were classified as urgent or non-urgent based on the resource utilization method.

Results: The response rate was 97.6% (n = 2005). Mean (SD) caregiver age was 37.0 (7.7) years, 74.3% (n = 1950) were mothers, 72.6% (n = 1953) spoke English as a primary language, 51.0% (n = 1946) had a university degree, and 45.1% (n = 1699) had a household income greater than $100,000. The mean (SD) age of the children was 5.9 (5.0) years and 48.1% (n = 1956) were female. 43.7% (n = 1957) of caregivers had low health literacy. Being a caregiver with a child < 2 years old [aOR 1.83 (1.35, 2.48)] and low health literacy [aOR 1.56 (1.18, 2.05)] were associated with greater non-urgent pediatric ED use. Interprovincial variation was evident: Quebec caregivers were less likely to use the pediatric ED for non-urgent presentations compared to Alberta, while those in Nova Scotia, Manitoba, British Columbia, and Ontario were more likely compared to Alberta.

Conclusion: Almost half of caregivers presenting to Canadian pediatric EDs have low health literacy, which may limit their ability to make appropriate healthcare decisions for their children. Low caregiver health literacy is a modifiable factor associated with increased non-urgent ED utilization. Efforts to address this may positively influence ED utilization.

RéSUMé: OBJECTIF: Les soignants ayant une faible littératie en santé sont plus susceptibles de surestimer la gravité de la maladie et d’avoir un manque d’adhésion aux comportements favorisant la santé. Notre objectif principal était de faire le lien entre la littératie en santé des soignants et l’urgence d’utiliser les services d’urgence (SU). L’objectif secondaire était d’explorer la relation entre les caractéristiques sociales et démographiques, la littératie en santé et l’urgence de l’utilisation du traitement. MéTHODES: Cette sous-étude était une enquête transversale descriptive avec examen du dossier de santé. Les données ont été recueillies auprès de dix ED pédiatriques canadiens. Les variables étudiées comprenaient la démographie, les détails des visites et la mesure du dernier signe vital de la littératie en santé. Les visites de DS ont été classées en urgence ou non selon la méthode d’utilisation des ressources. RéSULTATS: Le taux de réponse était de 97,6 % (n=2005). L’âge moyen des aidants naturels était de 37,0 (7,7) ans, 74,3 % (n=1950) étaient des mères, 72,6 % (n=1953) parlaient l’anglais comme langue principale, 51,0 % (n=1946) avaient un diplôme universitaire et 45,1 % (n=1699) avaient un revenu familial supérieur à 100 000 $. L’âge moyen (SD) des enfants était de 5,9 (5,0) ans et 48,1 % (n=1956) étaient des femmes. 43,7 % (n=1957) des aidants avaient une faible littératie en santé. Le fait d’être un aidant naturel avec un enfant de moins de 2 ans [aOR 1,83 (1,35, 2,48)] et une faible littératie en santé [aOR 1,56 (1,18, 2,05)] étaient associés à une utilisation plus importante de l’ES pédiatrique non urgente. La variation interprovinciale était évidente : les aidants naturels du Québec étaient moins susceptibles d’utiliser le DE pédiatrique pour des présentations non urgentes comparativement à l’Alberta, tandis que ceux de la Nouvelle-Écosse, du Manitoba, de la Colombie-Britannique et de l’Ontario étaient plus susceptibles d’utiliser le DE pédiatrique pour des présentations non urgentes. CONCLUSION: Près de la moitié des aidants naturels qui se présentent aux ÉE pédiatriques au Canada ont une faible littératie en santé, ce qui peut limiter leur capacité à prendre les décisions appropriées en matière de soins de santé pour leurs enfants. Le faible niveau de connaissances en santé des aidants est un facteur modifiable associé à une utilisation accrue de l’ES non urgente. Les efforts déployés pour remédier à cette situation peuvent influencer positivement l’utilisation de la DE.

Keywords: Caregiver; Health education; Health literacy; Urgency.

Grants and funding

Clinical/Community Research Integration Support Program/Women and Children's Health Research Institute

Abstract in English, French

Grants and funding

Abstract
in English, French