title: Parental Health Literacy and Outcomes of Childhood Nephrotic Syndrome.
abstract: OBJECTIVE
  Determine the association of parental health literacy with treatment response among children with nephrotic syndrome.
  
  
  METHODS
  This was a cohort study of children aged 1-18 with nephrotic syndrome and their parent. Health literacy was measured using the validated Short Test of Functional Health Literacy in Adults assessing reading comprehension and numeracy. Outcomes included initial relapse-free period, frequently relapsing disease, relapse rate, second-line medication use, and complete remission after therapy.
  
  
  RESULTS
  Of 190 parents, 80% had adequate health literacy (score >67 of 100), and higher scores were not correlated with higher education. Almost all achieved perfect numeracy scores (>86%); numeracy was not associated with outcomes. After adjusting for immigration, education, and income, higher reading comprehension scores (tertile 3) compared with lower scores (tertile 1) were significantly associated with lower risk of first relapse (hazard ratio 0.67, 95% confidence interval [CI] 0.48-0.94,Ptrend = .02), lower odds of frequently relapsing disease (odds ratio [OR] 0.38, 95% CI 0.21-0.70,Ptrend = .002), lower relapse rate (rate ratio 0.77, 95% CI 0.73-0.80,Ptrend < .001), and higher odds of complete remission after both initial steroids and cyclophosphamide (OR 2.07, 95% CI 1.36-3.16,Ptrend = .003; OR 5.97, 95% CI 2.42-14.7,Ptrend < .001).
  
  
  CONCLUSIONS
  Lower parental health literacy, specifically reading comprehension, is associated with higher relapse rates among children with nephrotic syndrome and fewer achieving complete remission. This underscores the importance of assessing and targeting health literacy for chronic management of childhood-onset diseases.
authors.affiliation: Child Health Evaluative Sciences, Research Institute.
authors.forename: Karlota
authors.initials: K
authors.lastname: Borges
authors.affiliation: Department of Medicine, University of Toronto, Toronto, Canada.
authors.forename: Cathryn
authors.initials: C
authors.lastname: Sibbald
authors.affiliation: Child Health Evaluative Sciences, Research Institute.
authors.forename: Neesha
authors.initials: N
authors.lastname: Hussain-Shamsy
authors.affiliation: Child Health Evaluative Sciences, Research Institute.
authors.forename: Jovanka
authors.initials: J
authors.lastname: Vasilevska-Ristovska
authors.affiliation: Child Health Evaluative Sciences, Research Institute.
authors.forename: Tonny
authors.initials: T
authors.lastname: Banh
authors.affiliation: Child Health Evaluative Sciences, Research Institute.
authors.forename: Viral
authors.initials: V
authors.lastname: Patel
authors.affiliation: Division of Nephrology, and.
authors.forename: Josefina
authors.initials: J
authors.lastname: Brooke
authors.affiliation: Division of Nephrology, and.
authors.forename: Monica
authors.initials: M
authors.lastname: Piekut
authors.affiliation: Division of Nephrology, and.
authors.forename: Michele
authors.initials: M
authors.lastname: Reddon
authors.affiliation: Division of Nephrology, and.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Aitken-Menezes
authors.affiliation: Division of Nephrology, and.
authors.forename: Ashley
authors.initials: A
authors.lastname: McNaughton
authors.affiliation: Child Health Evaluative Sciences, Research Institute.|Division of Nephrology, and.|Brampton Civic Hospital, William Osler Health System, Brampton, Canada.
authors.forename: Rachel J
authors.initials: RJ
authors.lastname: Pearl
authors.affiliation: Child Health Evaluative Sciences, Research Institute.|Division of Nephrology, and.
authors.forename: Valerie
authors.initials: V
authors.lastname: Langlois
authors.affiliation: Division of Nephrology, and.
authors.forename: Seetha
authors.initials: S
authors.lastname: Radhakrishnan
authors.affiliation: Child Health Evaluative Sciences, Research Institute.|Division of Nephrology, and.|Program in Cell Biology, Research Institute, Hospital for Sick Children, Toronto, Canada.
authors.forename: Christoph P B
authors.initials: CPB
authors.lastname: Licht
authors.affiliation: Child Health Evaluative Sciences, Research Institute.|Division of Nephrology, and.
authors.forename: Tino D
authors.initials: TD
authors.lastname: Piscione
authors.affiliation: Department of Medicine, University of Toronto, Toronto, Canada.
authors.forename: Leo
authors.initials: L
authors.lastname: Levin
authors.affiliation: Child Health Evaluative Sciences, Research Institute.|Division of Nephrology, and.
authors.forename: Damien
authors.initials: D
authors.lastname: Noone
authors.affiliation: Child Health Evaluative Sciences, Research Institute.|Division of Nephrology, and.
authors.forename: Diane
authors.initials: D
authors.lastname: Hebert
authors.affiliation: Child Health Evaluative Sciences, Research Institute, rulan.parekh@sickkids.ca.|Department of Medicine, University of Toronto, Toronto, Canada.|Division of Nephrology, and.|University Health Network, Toronto, Canada; and.|Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
authors.forename: Rulan S
authors.initials: RS
authors.lastname: Parekh
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D032882:Comprehension; D003520:Cyclophosphamide / Q000627:therapeutic use; D019468:Disease Management; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D057220:Health Literacy; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D008297:Male; D009404:Nephrotic Syndrome / Q000188:drug therapy*; D010290:Parents; D012008:Recurrence; D012074:Remission Induction
chemical_list: D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide