Department of Pediatrics Section of Emergency Medicine, Medical College of Wisconsin, Milwaukee.
Acad Pediatr. 2013 Sep-Oct;13(5):421-9. doi: 10.1016/j.acap.2013.03.001. Epub 2013 Mar 5.
Low health literacy in parents can potentially impact understanding of a child's diagnosis and treatment course. No reviews have addressed parent health literacy in the emergency department (ED), the relationship between parent health literacy and child ED utilization, or the impact of low literacy interventions on child ED utilization.
To systematically evaluate the peer-reviewed literature pertaining to parental health literacy and ED utilization. The following key questions were addressed: question (Q) 1) What is the prevalence of low health literacy, as estimated by validated health literacy measures, of parents in the ED? Q2) Is parent low health literacy related to ED use for children? Q3) Do low literacy interventions targeting parents likely to have low health literacy affect ED use for children?
The authors reviewed 483 unduplicated titles and abstracts published between 1980 and May 2012 using PubMed and CINAHL, with 117 retained for full review and 17 included in the final analytic review.
STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS: All included articles had a valid measure of parent health literacy and a Q1) descriptive measurement of the population, Q2) ED utilization, or Q3) utilized a low literacy educational intervention.
One author extracted data verified by a second author. Studies were rated for quality by both authors.
Q1) A median of 30% (interquartile range 22-36%) of parents in the ED possesses low health literacy. Q2) Studies investigating the relationship between health literacy and ED yielded mixed results. Q3) Seven of 8 low literacy interventions were associated with a reduction in ED use. Random effects pooled odds ratios from 6 studies showed intervention effectiveness (odds ratio 0.35; 95% CI 0.15-0.81).
No intervention studies measured health literacy, limiting the ability to determine whether the low literacy intervention targeted health literacy.
Roughly 1 in 3 parents of children presenting to the ED have low health literacy. Importantly, interventions targeting parents likely to have low health literacy have an impact in reducing ED utilization.
父母的健康素养较低可能会影响他们对孩子诊断和治疗过程的理解。目前尚无文献综述探讨急诊科（ED）中父母的健康素养、父母健康素养与儿童 ED 使用之间的关系，以及针对低文化素养父母的干预措施对儿童 ED 使用的影响。
系统评价有关父母健康素养与 ED 使用的同行评议文献。本研究提出了以下三个关键问题：问题 1）使用经过验证的健康素养测量工具，ED 中父母的健康素养低的流行率是多少？问题 2）父母的低健康素养与儿童 ED 使用相关吗？问题 3）针对可能健康素养较低的父母的低文化素养干预措施是否会影响儿童 ED 使用？
作者检索了 1980 年至 2012 年 5 月期间发表的 483 篇不重复的标题和摘要，使用了 PubMed 和 CINAHL，其中 117 篇全文符合纳入标准并进行了回顾性分析，17 篇最终纳入分析性综述。
研究入选标准、参与者和干预措施：所有纳入的文章都有有效的父母健康素养测量工具，且都回答了问题 1）人群的描述性测量，问题 2）ED 使用，或问题 3）使用了低文化素养教育干预措施。
一位作者提取数据，由另一位作者验证。两位作者均对研究进行质量评估。
问题 1）ED 中约 30%（四分位距 22-36%）的父母健康素养较低。问题 2）研究健康素养与 ED 之间的关系得出了不同的结果。问题 3）8 项低文化素养干预措施中有 7 项与 ED 使用减少相关。来自 6 项研究的随机效应汇总优势比表明干预的有效性（比值比 0.35；95%CI 0.15-0.81）。
没有干预研究测量健康素养，限制了确定低文化素养干预措施是否针对健康素养的能力。
大约每 3 个 ED 就诊儿童的父母中就有 1 个健康素养较低。重要的是，针对可能健康素养较低的父母的干预措施可减少 ED 使用。
