The Impact of Caregiver Health Literacy on Pediatric Asthma: An Integrative Review.

Importance: There is increasing literature on the role of health literacy in asthma outcomes. Despite less than half of Americans having proficient health literacy, health literacy is an essential component in providing quality medical care. Observations: Most of the literature on the impact of health literacy on asthma outcomes is from the adult asthmatic population, where lower health literacy is associated with poorer asthma outcomes, including decreased quality of life, worse asthma control, and more Emergency Department visits for asthma. Although a few studies look at caregiver health literacy and pediatric asthma outcomes, the results have been congruous, demonstrating an effect across the board. Challenges exist in the evaluation of caregiver health literacy by physicians. Various tools are available to assist in the evaluation although a few are validated for asthma. There is no uniform strategy that is successful in the management of health literacy. When counseling on asthma medications, the use of a teach-back method with caregivers to ensure proper understanding of the inhaler device technique may be beneficial. Various educational materials have been demonstrated to improve the caregiver inhaler technique. Asthma action plans that incorporate picture-based written plans may be more suitable for caregivers with poor health literacy. Improving verbal and written communication as well as a physician's focus on how numerical data are presented to families may be beneficial. For verbal communication, strategies include using patient-centered language, speaking slowly, and repeating/confirming understanding of key points. A significant step forward has been an increasing focus on health literacy within asthma guidelines both in the United States and internationally. Moving forward, further research into the effects of health literacy, specifically within the pediatric asthma population, and improved means to assess and mediate that impact are required. Conclusions and Relevance: An appreciation of the role of health literacy is essential in providing proper asthma care.