P2D320: Evaluating Health Literacy in Families of Injured Children

Background: Optimal recovery after pediatric injury frequently requires primary caregiver participation in complicated rehabilitative and medical aftercare. Health literacy can impact this care, as caregivers are responsible for medication dosing, navigating follow-up appointments, adhering to activity and weight-bearing restrictions, and ensuring participation in therapy. Low health literacy (LHL) has been associated with poor health outcomes in the general pediatric population. Little is known, however, about the health literacy of guardians of injured children. We aimed to quantify health literacy among caregivers of injured children, identify factors associated with LHL of guardians, and assess the impact of LHL on post-injury complications.

Methods: A prospective observational cohort study was conducted to evaluate the health literacy of guardians of children (0-18 years) admitted to a Level 1 Trauma Center after an injury. The primary outcome was caregiver health literacy measured by the Newest Vital Sign health literacy assessment at the time of hospital discharge. Self-reported social demographics were obtained from guardians via survey at the time of discharge. Post-injury complications were assessed by guardian phone interview three months after discharge, or, if the guardian could not be reached, by record review. Patient and caregiver characteristics were compared across levels of health literacy using univariate statistics. Multivariable logistic regression was conducted to identify factors independently-associated with LHL.

Results: A sample of 95 guardian-child dyads were enrolled in the study. The median age of the injured child enrolled was 9 (IQR 3-13), and children were most commonly male (n=67, 71%) and injured by fall (n=25, 26%) or motor vehicle collision (n=18, 19%). The majority of guardians were found to have low health literacy (n=52, 55%), followed by moderate health literacy (n= 36, 38%) and finally high health literacy (n= 7, 7%). Almost half of enrolled families received some type of public benefit (n= 47, 49%) and 12 guardians (13%) had both housing and employment insecurity (Table 1). Those with low health literacy were significantly more likely to have insecure housing and have completed some or all of high school (Table 2). The follow-up rate was 47%. All guardian- children dyads with complications (n=4) or failure to attend follow-up appointment (n=2) had low health literacy.

Conclusion: The majority of children receiving care at an urban pediatric trauma center had a primary guardian with LHL. Families with guardians of LHL are also significantly more likely to struggle with financial and housing security. Pediatric trauma centers should consider screening for LHL. Funding and support for bilingual patient and guardian education after injury is crucial to the recovery of an injured child. Existing resources such as patient navigators, trauma survivorship program and peer support groups are integral to ensuring that families with LHL are supported and can access care.