title: Parents with low literacy report higher quality of parent-provider relationships in a residency clinic.
abstract: OBJECTIVE
  Quality of care in pediatrics is suboptimal for many children from families of low socioeconomic status. Literacy is one aspect of socioeconomic status. We hypothesized that low parental literacy would be associated with low-quality well-child care.
  
  
  METHODS
  We performed a cross-sectional study of caregivers of 1- to 4- year-old children in a pediatric resident clinic. To assess parental literacy, we used the Rapid Estimate of Adult Literacy in Medicine. To assess the quality of well-child care, we used 5 subscales from the Promoting Healthy Development Survey relevant to either provider-parent relationships or content of discussions in the well-child visit.
  
  
  RESULTS
  We enrolled 157 caregivers. The mean age of the respondents was 30 years, 55% were African American, 69% received Medicaid, and 85% had graduated high school. A total of 34% of the respondents scored below a ninth-grade reading level (low literacy). Parents with low literacy were more likely than those with higher literacy to report Family-centered care (79% vs 61%, P = .03), and Helpfulness and Confidence building (79% vs 57%, P = .01). There was no difference, by literacy level, in the percentage of parents who reported reaching established threshold levels for discussion of Psychosocial issues, Safety issues, or Anticipatory guidance topics.
  
  
  CONCLUSIONS
  The lower-literacy respondents reported higher-quality parent-provider relationships; there was no difference in quality of content of discussions by literacy level. Parents with low literacy may have lower expectations regarding relationships with their health care provider or may be less likely to be critical. Alternatively, pediatric residents may be more effective at relationship building with low-literacy families.
authors.affiliation: Robert Wood Johnson Clinical Scholars Program and Division of General Pediatrics, Yale University School of Medicine, New Haven, CT 06520, USA. marjorie.rosenthal@yale.edu
authors.forename: Marjorie S
authors.initials: MS
authors.lastname: Rosenthal
authors.forename: Rebecca R
authors.initials: RR
authors.lastname: Socolar
authors.forename: Darren A
authors.initials: DA
authors.lastname: DeWalt
authors.forename: Michael
authors.initials: M
authors.lastname: Pignone
authors.forename: Joanne
authors.initials: J
authors.lastname: Garrett
authors.forename: Peter A
authors.initials: PA
authors.lastname: Margolis
mesh_terms: D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities; D002662:Child Health Services; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004522:Educational Status; D006801:Humans; D007223:Infant; D007396:Internship and Residency; D008875:Middle Aged; D010290:Parents; D011368:Professional-Family Relations; D011787:Quality of Health Care