O2056: Assessing the Health Literacy of Caregivers in the Pediatric Intensive Care Unit: A Mixed-methods Study

Background: Limited health literacy is associated with increased hospitalizations, emergency department visits, health care cost, and mortality. Health literacy of caregivers of critically ill children is unknown. This mixed-methods study aims to quantitatively assess the health literacy of caregivers of children admitted to the pediatric intensive care unit (PICU) and qualitatively describe facilitators and barriers to implementing health literacy screening from the provider perspective.

Methods: This was a mixed-methods, prospective single-center study. Caregivers of patients admitted to our quaternary PICU (between August 12, 2022 and March 31, 2023) were screened using the Newest Vital Sign (NVS), which assesses health literacy in both English & Spanish. The primary outcome was health literacy level, which we dichotomized into “Limited Health Literacy” (score of 0-3) and “Adequate Health Literacy” (score of 4-6). Fisher’s exact test was used to determine the association between health literacy level and demographic characteristics. Data analysis was completed using Stata 17 (College Station, TX: StataCorp LLC).
Qualitatively, we conducted three focus groups of PICU providers to characterize facilitators and barriers to screening. The focus group script was based on the Consolidated Framework for Implementation Research (CFIR). Each focus group was conducted virtually and recorded; sessions were later transcribed and de-identified prior to analysis. Thematic analysis of the transcripts was completed by the PI to develop the initial codebook, which was then used independently by a second reviewer. Inter-rater reliability was reported using a kappa statistic. Final themes were discussed among reviewers and organized by CFIR domains. Analysis was completed using NVivo 12 (QSR, Melbourne, Australia).

Results: Among 48 surveyed caregivers, 79% demonstrated adequate health literacy. The majority of caregivers spoke English (96%), were mothers (85%) and identified as White (75%). 83% of caregivers were able to attend rounds at least once and 98% believed it was helpful, regardless of health literacy level. Within the PICU provider focus groups, there were 11 participants (3 attendings, 3 fellows, 2 advanced practice providers, 1 hospitalist, 2 research assistants). Facilitators and barriers were mapped to CFIR domains. Inter-rater reliability between the two coders was good, with a mean kappa statistic of 0.53. Timing of screening and person administering screening were identified as modifiable factors to improve future implementation.

Conclusion: Health literacy of PICU caregivers is similar to prior assessments of pediatric parental health literacy. Participation in morning rounds promoted caregiver understanding, regardless of health literacy status. Qualitative feedback from providers identified barriers across all CFIR domains, with timing of screening and person administering screening as modifiable factors to improve future implementation.