title: Health literacy and task environment influence parents' burden for data entry on child-specific health information: randomized controlled trial.
abstract: BACKGROUND
  Health care systems increasingly rely on patients' data entry efforts to organize and assist in care delivery through health information exchange.
  
  
  OBJECTIVE
  We sought to determine (1) the variation in burden imposed on parents by data entry efforts across paper-based and computer-based environments, and (2) the impact, if any, of parents' health literacy on the task burden.
  
  
  METHODS
  We completed a randomized controlled trial of parent-completed data entry tasks. Parents of children with attention deficit hyperactivity disorder (ADHD) were randomized based on the Test of Functional Health Literacy in Adults (TOFHLA) to either a paper-based or computer-based environment for entry of health information on their children. The primary outcome was the National Aeronautics and Space Administration Task Load Index (TLX) total weighted score.
  
  
  RESULTS
  We screened 271 parents: 194 (71.6%) were eligible, and 180 of these (92.8%) constituted the study cohort. We analyzed 90 participants from each arm. Parents who completed information tasks on paper reported a higher task burden than those who worked in the computer environment: mean (SD) TLX scores were 22.8 (20.6) for paper and 16.3 (16.1) for computer. Assignment to the paper environment conferred a significant risk of higher task burden (F(1,178) = 4.05, P = .046). Adequate literacy was associated with lower task burden (decrease in burden score of 1.15 SD, P = .003). After adjusting for relevant child and parent factors, parents' TOFHLA score (beta = -.02, P = .02) and task environment (beta = .31, P = .03) remained significantly associated with task burden.
  
  
  CONCLUSIONS
  A tailored computer-based environment provided an improved task experience for data entry compared to the same tasks completed on paper. Health literacy was inversely related to task burden.
authors.affiliation: Division of Paediatric Emergency Medicine, The Hospital for Sick Children, Toronto, ON, Canada. stephen.porter@sickkids.ca
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Porter
authors.forename: Chao-Yu
authors.initials: CY
authors.lastname: Guo
authors.forename: Janine
authors.initials: J
authors.lastname: Bacic
authors.forename: Eugenia
authors.initials: E
authors.lastname: Chan
mesh_terms: D000328:Adult; D001289:Attention Deficit Disorder with Hyperactivity / Q000523:psychology*; D002648:Child; D015331:Cohort Studies; D003201:Computers; D054626:Consumer Health Information; D005260:Female; D057220:Health Literacy; D006801:Humans; D008297:Male; D010290:Parents; D013647:Task Performance and Analysis