TABLE 3

Interventions to Improve Child Health Outcomes by Addressing Child or Low Caregiver Literacy

AuthorStudy DesignLiteracy MeasureLevel of MeasurementType of InterventionInterventionOutcome DescriptionQuality
Campbell et al17 (2004)RCTREALM; Woodcock Johnson Psycho- Educational Battery-Revised, Part 2PModified print, video, and computerConsent information for a high- and low-risk pediatric study was presented via modified print, video, and laptop presentation compared with original print materialsRecall of consent information positively correlated with literacy (P < .001); modified print materials equivalent or superior to original print, video, and computer materials for parents with LLG
Davis et al18 (1996)NRCTREALMPBrochurePolio vaccine information pamphlet written at 6th-grade level, compared to standard pamphlet (10th-grade level)LL intervention pamphlet elicited better comprehension than the standard pamphlet (P < .0001), but not for readers at ≤3rd-grade reading levelG
Davis et al22 (1998)NRCTREALMPBrochureLocally designed polio vaccine pamphlet (intervention) written at <9th-grade reading level, compared with an improved CDC pamphlet, also written at <9th-grade levelReaders of intervention pamphlet had higher comprehension than readers of the CDC pamphlet (P < .01); comprehension improved with intervention pamphlet among those at ≥9th-grade reading level (P < .001) but not those below; the intervention was easier to read overallG
Robinson et al36 (2008)UCTGilmore Oral Reading TestCClasses and campAsthmatic children attended 2-h literacy and asthma education classes on Saturdays for 6 mo and a 5-d campED asthma-related visits dropped from 63% 6 mo before study to 33% 6 mo after study; improved self-efficacy decreased ED visits (OR: 0.27; P < .01) and hospitalizations (OR: 0.33; P < .001); improved reading level not directly associated with hospitalizationsF
Yin et al37 (2008)RCTTOFHLAPPictogram-based instructions and counselingParents of children taking daily and as-needed liquid medications were randomly assigned to receive pictogram-based medication instruction sheets with teach-back counseling or standard careIntervention caregivers significantly less likely to make errors in dosing frequency (P = .0007 daily), less likely to report incorrect medication preparation (P = .04 daily; P = .0006 as needed), and more likely to report using a standardized dosing instrument (P = .008 daily; P = .002 as needed)G
  • RCT indicates randomized, controlled trial; NRCT, non–randomized, controlled trial; UCT, uncontrolled trial; P, Parent; C, Child; CDC, Centers for Disease Control and Prevention; LL, lower literacy; HL, higher literacy; OR, odds ratio; ED, emergency department; G, good; F, fair.