BACKGROUND: Low health literacy has been linked to increased morbidity in chronic diseases such as asthma. Objectives: 1) To determine whether low parent health literacy is associated with reduced caregiver quality of life, a measure of family impairment for children with asthma. 2) To determine whether asthma-related knowledge and locus of control mediate this relationship.
DESIGN/METHODS: Convenience sample, parents of children presenting to the Bellevue Hospital Asthma clinic. Inclusion criteria: parent of child 2-12 years of age, child with persistent asthma, primary language English/Spanish. Independent variable: Health literacy (HL) [Newest Vital Sign (NVS)]. Dependent variable: caregiver asthma quality of life (QoL) [Pediatric Asthma QoL Questionnaire (C-PAQLQ)]. Potential mediating variables: asthma knowledge [Asthma Knowledge Questionnaire (AKQ)], asthma-related locus of control (LOC) / perceived ability to impact health [adapted from Parent Health Beliefs Scale]. Potential confounders: Asthma severity classification, child age.
RESULTS: 50 parents enrolled to date, ongoing study. 84% Latino, 76% non-US born, 82% low SES (Hollingshead 4 or 5), 82% low HL (NVS score 0-3). Mean (SD) child age 8.5 (5.0) y. 53% mild persistent asthma, remainder moderate-severe. Mean (SD) AKQ score was 70.4 (11.1) %. In multiple linear regression analysis adjusting for potential confounders, low parent health literacy was associated with reduced caregiver asthma-related quality of life QoL (b=.34, p=.02; almost 1 SD difference in QoL score between parents with low and high HL (Cohen’s d=.9)). As shown in path analysis (FIGURE 1), this relationship was mediated by the association between parent health literacy and asthma knowledge (b=.34, p=.02). Although health literacy was also associated with parent locus of control (b=.40, p=.008), this association did not mediate the relationship between health literacy and quality of life.
CONCLUSIONS: Parent health literacy is associated with reduced caregiver quality of life. This association is mediated by asthma knowledge but not by asthma-related locus of control. Interventions to improve the asthma-related outcomes of children whose parents have low health literacy should focus on improving parent asthma knowledge.
