Use of a low-literacy written action plan to improve parent understanding of pediatric asthma management: A randomized controlled study

ABSTRACT

Objectives: The objective of the study was to determine whether parents who use a low-literacy, pictogram- and photograph-based written asthma action plan (WAAP) have a better understanding of child asthma management compared to parents using a standard plan. Methods: A randomized controlled study was carried out in 2 urban pediatric outpatient clinics. Inclusion criteria were English- and Spanish-speaking parents of 2- to 12-year-old asthmatic children. Parents were randomized to receive a low-literacy or standard asthma action plan (American Academy of Allergy, Asthma and Immunology) for a hypothetical patient on controller and rescue medications. A structured questionnaire was used to assess whether there was an error in knowledge of (1) medications to give everyday and when sick, (2) need for spacer use, and (3) appropriate emergency response to give albuterol and seek medical help. Multiple logistic regression analyses were performed, adjusting for parent age, health literacy (Newest Vital Sign); child asthma severity, medications; and site. Results: 217 parents were randomized (109 intervention and 108 control). Parents who received the low-literacy plan were (1) less likely to make an error in knowledge of medications to take everyday and when sick compared to parents who received the standard plan (63.0 vs. 77.3%, p = 0.03; adjusted odds ratio [AOR] = 0.5[95% confidence interval: 0.2–0.9]) and (2) less likely to make an error regarding spacer use (14.0 vs. 51.1%, p < 0.001; AOR = 0.1 [0.06–0.3]). No difference in error in appropriate emergency response was seen (43.1 vs. 48.1%, p = 0.5). Conclusions: Use of a low-literacy WAAP was associated with better parent understanding of asthma management. Further study is needed to assess whether the use of this action plan improves child asthma outcomes.

KEYWORDS:

• Asthma action plan
• health literacy
• patient education
• pictogram

Acknowledgements

The authors would like to thank the providers in the Bellevue Asthma Clinic, including the doctors and nursing staff. They would also like to thank their research staff as well as their research assistants for their help with data collection. Data from this study were presented in part at the Health Literacy Annual Research Conference on 10/22/12.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper. All authors were involved in conceptualizing the study design, drafting the article or revising it critically for important intellectual content, and all authors approved the final version to be submitted for publication. All authors have full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Funding

The research for this study was funded and supported by KiDS of the NYU Langone Foundation.