title: Parental understanding of infant health information: health literacy, numeracy, and the Parental Health Literacy Activities Test (PHLAT).
abstract: OBJECTIVE
  To assess parental health literacy and numeracy skills in understanding instructions for caring for young children, and to develop and validate a new parental health literacy scale, the Parental Health Literacy Activities Test (PHLAT).
  
  
  METHODS
  Caregivers of infants (age <13 months) were recruited in a cross-sectional study at pediatric clinics at 3 academic medical centers. Literacy and numeracy skills were assessed with previously validated instruments. Parental health literacy was assessed with the new 20-item PHLAT. Psychometric analyses were performed to assess item characteristics and to generate a shortened, 10-item version (PHLAT-10).
  
  
  RESULTS
  A total of 182 caregivers were recruited. Although 99% had adequate literacy skills, only 17% had better than ninth-grade numeracy skills. Mean score on the PHLAT was 68% (standard deviation 18); for example, only 47% of caregivers could correctly describe how to mix infant formula from concentrate, and only 69% could interpret a digital thermometer to determine whether an infant had a fever. Higher performance on the PHLAT was significantly correlated (P < .001) with education, literacy skill, and numeracy level (r = 0.29, 0.38, and 0.55 respectively). Caregivers with higher PHLAT scores were also more likely to interpret age recommendations for cold medications correctly (odds ratio 1.6, 95% confidence interval 1.02, 2.6). Internal reliability on the PHLAT was good (Kuder-Richardson coefficient of reliability = 0.76). The PHLAT-10 also demonstrated good validity and reliability.
  
  
  CONCLUSIONS
  Many parents do not understand common health information required to care for their infants. The PHLAT and PHLAT-10 have good reliability and validity and may be useful tools for identifying parents who need better communication of health-related instructions.
authors.affiliation: Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee 37232-8300, USA.
authors.forename: Disha
authors.initials: D
authors.lastname: Kumar
authors.forename: Lee
authors.initials: L
authors.lastname: Sanders
authors.forename: Eliana M
authors.initials: EM
authors.lastname: Perrin
authors.forename: Nicole
authors.initials: N
authors.lastname: Lokker
authors.forename: Baron
authors.initials: B
authors.lastname: Patterson
authors.forename: Veronica
authors.initials: V
authors.lastname: Gunn
authors.forename: Joanne
authors.initials: J
authors.lastname: Finkle
authors.forename: Vivian
authors.initials: V
authors.lastname: Franco
authors.forename: Leena
authors.initials: L
authors.lastname: Choi
authors.forename: Russell L
authors.initials: RL
authors.lastname: Rothman
mesh_terms: D000328:Adult; D017028:Caregivers; D054626:Consumer Health Information; D003430:Cross-Sectional Studies; D005260:Female; D057220:Health Literacy; D006801:Humans; D007223:Infant; D007224:Infant Care; D008297:Male; D010290:Parents; D012959:Socioeconomic Factors; D055815:Young Adult