title: Use of a low-literacy written action plan to improve parent understanding of pediatric asthma management: A randomized controlled study.
abstract: OBJECTIVE
  The objective of the study was to determine whether parents who use a low-literacy, pictogram- and photograph-based written asthma action plan (WAAP) have a better understanding of child asthma management compared to parents using a standard plan.
  
  
  METHODS
  A randomized controlled study was carried out in 2 urban pediatric outpatient clinics. Inclusion criteria were English- and Spanish-speaking parents of 2- to 12-year-old asthmatic children. Parents were randomized to receive a low-literacy or standard asthma action plan (American Academy of Allergy, Asthma and Immunology) for a hypothetical patient on controller and rescue medications. A structured questionnaire was used to assess whether there was an error in knowledge of (1) medications to give everyday and when sick, (2) need for spacer use, and (3) appropriate emergency response to give albuterol and seek medical help. Multiple logistic regression analyses were performed, adjusting for parent age, health literacy (Newest Vital Sign); child asthma severity, medications; and site.
  
  
  RESULTS
  217 parents were randomized (109 intervention and 108 control). Parents who received the low-literacy plan were (1) less likely to make an error in knowledge of medications to take everyday and when sick compared to parents who received the standard plan (63.0 vs. 77.3%, p = 0.03; adjusted odds ratio [AOR] = 0.5[95% confidence interval: 0.2-0.9]) and (2) less likely to make an error regarding spacer use (14.0 vs. 51.1%, p < 0.001; AOR = 0.1 [0.06-0.3]). No difference in error in appropriate emergency response was seen (43.1 vs. 48.1%, p = 0.5).
  
  
  CONCLUSIONS
  Use of a low-literacy WAAP was associated with better parent understanding of asthma management. Further study is needed to assess whether the use of this action plan improves child asthma outcomes.
authors.affiliation: a Department of Pediatrics , New York University School of Medicine/Bellevue Hospital Center , New York , NY , USA.|c Department of Population Health , NYU School of Medicine , New York , NY , USA.
authors.forename: Hsiang Shonna
authors.initials: HS
authors.lastname: Yin
authors.affiliation: b Department of Pediatrics , Northwestern University School of Medicine , Chicago , IL , USA.
authors.forename: Ruchi S
authors.initials: RS
authors.lastname: Gupta
authors.affiliation: a Department of Pediatrics , New York University School of Medicine/Bellevue Hospital Center , New York , NY , USA.|c Department of Population Health , NYU School of Medicine , New York , NY , USA.
authors.forename: Alan L
authors.initials: AL
authors.lastname: Mendelsohn
authors.affiliation: a Department of Pediatrics , New York University School of Medicine/Bellevue Hospital Center , New York , NY , USA.
authors.forename: Benard
authors.initials: B
authors.lastname: Dreyer
authors.affiliation: a Department of Pediatrics , New York University School of Medicine/Bellevue Hospital Center , New York , NY , USA.
authors.forename: Linda
authors.initials: L
authors.lastname: van Schaick
authors.affiliation: a Department of Pediatrics , New York University School of Medicine/Bellevue Hospital Center , New York , NY , USA.
authors.forename: Christina R
authors.initials: CR
authors.lastname: Brown
authors.affiliation: a Department of Pediatrics , New York University School of Medicine/Bellevue Hospital Center , New York , NY , USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Encalada
authors.affiliation: a Department of Pediatrics , New York University School of Medicine/Bellevue Hospital Center , New York , NY , USA.
authors.forename: Dayana C
authors.initials: DC
authors.lastname: Sanchez
authors.affiliation: b Department of Pediatrics , Northwestern University School of Medicine , Chicago , IL , USA.
authors.forename: Christopher M
authors.identifier: http://orcid.org/0000-0002-8924-3329
authors.initials: CM
authors.lastname: Warren
authors.affiliation: a Department of Pediatrics , New York University School of Medicine/Bellevue Hospital Center , New York , NY , USA.
authors.forename: Suzy
authors.initials: S
authors.lastname: Tomopoulos
mesh_terms: D000328:Adult; D001249:Asthma / Q000628:therapy*; D002648:Child; D005260:Female; D057220:Health Literacy; D006801:Humans; D008297:Male; D010290:Parents / Q000193:education*
keywords: Asthma action plan; health literacy; patient education; pictogram