title: 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.
authors.affiliation: Department of Pediatrics, Section of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wis. Electronic address: akmorris@mcw.edu.
authors.forename: Andrea K
authors.initials: AK
authors.lastname: Morrison
authors.affiliation: Medical College of Wisconsin, Milwaukee, Wis.
authors.forename: Ruben
authors.initials: R
authors.lastname: Chanmugathas
authors.affiliation: Department of Medicine, University of Pennsylvania, Philadelphia, Pa.
authors.forename: Marilyn M
authors.initials: MM
authors.lastname: Schapira
authors.affiliation: Children's Hospital of Wisconsin, Milwaukee, Wis.
authors.forename: Marc H
authors.initials: MH
authors.lastname: Gorelick
authors.affiliation: Quantitative Health Sciences/Biostatistics, Milwaukee, Wis.
authors.forename: Raymond G
authors.initials: RG
authors.lastname: Hoffmann
authors.affiliation: Department of Pediatrics, Section of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wis.
authors.forename: David C
authors.initials: DC
authors.lastname: Brousseau
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000367:Age Factors; D000368:Aged; D017028:Caregivers / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004522:Educational Status; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005334:Fever; D057220:Health Literacy / Q000706:statistics & numerical data*; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010290:Parents; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult
keywords: child; emergency service; health literacy; health services accessibility; hospital; infant; nonurgent emergency care use; preschool; utilization