title: Parent Preferences and Perceptions of Milliliters and Teaspoons: Role of Health Literacy and Experience.
abstract: A recent American Academy of Pediatrics policy statement recommends milliliter-exclusive dosing for pediatric liquid medications. Little is known about parent preferences regarding units, perceptions about moving to milliliters only, and the role of health literacy and prior milliliter-dosing experience.
  
  
  
  Cross-sectional analysis of data collected as part of a randomized controlled study in 3 urban pediatric clinics (SAFE Rx for Kids study). English- and Spanish-speaking parents (n = 493) of children aged ≤8 years were randomized to 1 of 4 study arms and given labels and dosing tools which varied in label instruction format (text plus pictogram, text only) and units (milliliter only ["mL"], milliliter/teaspoon ["mL"/"tsp"]). Outcomes included teaspoon preference in dosing instructions and perceived difficulty with milliliter-only dosing. The predictor variable was health literacy (Newest Vital Sign; low [0-1], marginal [2-3], adequate [4-6]). The mediating variable was prior milliliter-dosing experience.
  
  
  
  Over two-thirds of parents had low or marginal health literacy. The majority (>70%) preferred to use milliliters, perceived milliliter-only dosing to be easy, and had prior milliliter-dosing experience; 11.5% had a teaspoon preference, 18.1% perceived milliliter-only dosing will be difficult, and 17.7% had no prior milliliter-dosing experience. Parents with lower health literacy had a higher odds of having a teaspoon preference (low vs adequate: adjusted odds ratio [AOR] = 2.9 [95% confidence interval [CI] 1.3-6.2]), and greater odds of perceiving difficulty with milliliter-only dosing (low vs adequate: AOR = 13.9 [95% CI 4.8-40.6], marginal vs adequate: AOR = 7.1 [95% CI 2.5-20.4]). Lack of experience with milliliter dosing partially mediated the impact of health literacy.
  
  
  
  Most parents were comfortable with milliliter-only dosing. Parents with low health literacy were more likely to perceive milliliter-only dosing to be difficult; educational efforts will need to target this group to ensure safe medication use.
authors.affiliation: Department of Pediatrics, NYU School of Medicine, Bellevue Hospital, New York, NY.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Torres
authors.affiliation: Department of Medicine, Emory University School of Medicine, Atlanta, Ga.
authors.forename: Ruth M
authors.initials: RM
authors.lastname: Parker
authors.affiliation: Department of Pediatrics, Stanford University School of Medicine, Stanford, Calif.
authors.forename: Lee M
authors.initials: LM
authors.lastname: Sanders
authors.affiliation: Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Ill.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Wolf
authors.affiliation: Department of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, Chapel Hill, NC.
authors.forename: Stacy Cooper
authors.initials: SC
authors.lastname: Bailey
authors.affiliation: Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Ill.
authors.forename: Deesha A
authors.initials: DA
authors.lastname: Patel
authors.affiliation: Department of Pediatrics, NYU School of Medicine, Bellevue Hospital, New York, NY.
authors.forename: Jessica J
authors.initials: JJ
authors.lastname: Jimenez
authors.affiliation: Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill.
authors.forename: Kwang-Youn A
authors.initials: KA
authors.lastname: Kim
authors.affiliation: Department of Pediatrics, NYU School of Medicine, Bellevue Hospital, New York, NY.
authors.forename: Benard P
authors.initials: BP
authors.lastname: Dreyer
authors.affiliation: Department of Pediatrics, NYU School of Medicine, Bellevue Hospital, New York, NY.
authors.forename: Alan L
authors.initials: AL
authors.lastname: Mendelsohn
authors.affiliation: Department of Pediatrics, NYU School of Medicine, Bellevue Hospital, New York, NY; Department of Population Health, NYU School of Medicine, New York, NY. Electronic address: yinh02@med.nyu.edu.
authors.forename: H Shonna
authors.initials: HS
authors.lastname: Yin
mesh_terms: D000328:Adult; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D054796:Drug Dosage Calculations; D005260:Female; D057220:Health Literacy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D010290:Parents; D057240:Patient Preference; D004364:Pharmaceutical Preparations / Q000008:administration & dosage*; D055815:Young Adult
chemical_list: D004364:Pharmaceutical Preparations
keywords: ambulatory care; dosing errors; dosing units; health communication; health literacy; medication errors