Why Parents Seek Care for Acute Illness in the Clinic or the ED: The Role of Health Literacy

• Published in: Academic pediatrics Vol. 18; no. 3; pp. 289 - 296
• Main Authors: May, Meghan, BS, Brousseau, David C., MD, MS, Nelson, David A., PhD, MS, Flynn, Kathryn E., PhD, Wolf, Michael S., PhD, MPH, Lepley, Bryn, BS, Morrison, Andrea K., MD, MS
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2018
• Subjects: Acute Disease; Adolescent; Adult; Ambulatory Care Facilities; Child; Child, Preschool; Decision Making; emergency service; Emergency Service, Hospital; Female; Grounded Theory; Health Literacy; health services accessibility; hospital; Humans; Infant; Infant, Newborn; Male; Middle Aged; Neonatal and Perinatal Medicine; Parents; Patient Acceptance of Health Care; Pediatrics; Professional-Family Relations; utilization; Young Adult; health services accessibility; utilization; Children with Special Health Care Needs; NVS; Emergency department; health literacy; CSHCN; emergency service; Primary Care Provider; hospital; PCP; Newest Vital Sign; child; ED
• ISSN: 1876-2859; 1876-2867
• DOI: 10.1016/j.acap.2017.06.010

Abstract Objective To explore the decision to seek care and decision-making regarding location of care among parents with low and adequate health literacy. Methods Parents of children ≤ 8 years old presenting for ‘sick child’ visits at a clinic or a non-urgent ED visit (triage level 5) were interviewed. The Newest Vital Sign (NVS) categorized parental health literacy. Interviewers followed a semi-structured interview guide to understand 1) care-seeking for current illness and 2) choice of clinic or ED. Themes emerged using a grounded theory process, facilitated by NVivo. Themes included the experiences of low and adequate health literacy in both the clinic and ED. Results Fifty semi-structured interviews were completed with non-urgent ED parents (n=30) and clinic parents (n=20) with 56% possessing low health literacy. Parents with low health literacy are more inclined to overestimate severity of illness and seek care sooner to gain answers about the illness and treatment options, visiting clinic only when an appointment is available within hours. Parents with adequate health literacy seek reassurance of their ongoing illness management and value close relationships with their physician, waiting longer for an appointment. Fever, vomiting, and young child age prompt some parents to seek expedient care regardless of health literacy. Conclusions Caregiving skills (e.g. assessing and treating illness, understanding illness severity, and navigating the healthcare system) in addition to physician-parent relationship and perception of care seem to influence the behavior of parents managing their child’s mild acute illness. These factors may be amenable to a future health literacy intervention.