Caregiver low health literacy and nonurgent use of the pediatric emergency department for febrile illness

Abstract

Objective: To examine the association between caregiver health literacy and the likelihood of a nonurgent emergency department (ED) visit in children presenting for fever.

Methods: This cross-sectional study used the Newest Vital Sign to assess the health literacy of caregivers accompanying children with fever to the ED. Visit urgency was determined by resources utilized during the ED visit. Findings were stratified by race and child age. Chi-square and logistic regression analysis controlling for race were conducted to determine the association between low health literacy and ED visit urgency.

Results: A total of 299 caregivers completed study materials. Thirty-nine percent of ED visits for fever were nonurgent, and 63% of caregivers had low health literacy. Low health literacy was associated with a higher proportion of nonurgent ED visits for fever (44% vs 31%, odds ratio 1.8, 95% confidence interval [CI] 1.1, 2.9). Low health literacy was associated with higher odds of a nonurgent visit in white and Hispanic caregivers but not in black caregivers. In regression analysis, children ≥ 2 years old had higher odds of a nonurgent visit if caregivers had low health literacy (adjusted odds ratio 2.0; 95% CI 1.1, 4.1); this relationship did not hold for children <2 years old (adjusted odds ratio 0.8; 95% CI 0.4, 1.8).

Conclusions: Nearly two-thirds of caregivers with their child in the ED for fever have low health literacy. Caregiver low health literacy is associated with nonurgent ED utilization for fever in children over 2 years of age. Future interventions could target health literacy skills regarding fever in caregivers of children ≥ 2 years.

Keywords: child; emergency service; health literacy; health services accessibility; hospital; infant; nonurgent emergency care use; preschool; utilization.

Conflict of interest statement

Conflicts of Interest: No author has conflicts of interest and there are no corporate sponsors of this research.

Copyright © 2014 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1

Patient flow through study a. Patients were unable to be recruited due to concurrent enrollment of other caregivers. The missed eligible patients were younger (p=0.01) and triaged as a lower acuity (p=0.02). b. The caregivers that refused participation did not differ from study participants in age (p=0.9) or triage level (p=0.1).

Figure 2

Health Literacy and Proportion of Non-Urgent ED Visits for Fever Stratified by (a) Child Age and (b) Caregiver Race/Ethnicity