Parent Health Literacy and Communication With Diabetes Educators in a Pediatric Diabetes Clinic: A Mixed Methods Approach

Abstract

Low health literacy is associated with poor communication between adults and providers, but little is known about how parents’ health literacy influences communication in pediatric encounters. We examined how parent health literacy affected communication between parents and diabetes educators in a pediatric diabetes clinic. A mixed methods study was conducted including a cross-sectional survey of 162 parents and semi-structured interviews with a subsample of 24 parents of a child with Type 1 diabetes. Parent and child characteristics, parents’ report of quality of communication, and parent health literacy were assessed. Logistic regression was performed to determine associations between health literacy and 4 subscales of the Interpersonal Processes of Care (IPC) survey; directed content analyses of interview data were completed. Although health literacy was not significantly associated with the IPC subscales, results from directed content analyses revealed different communication experiences for parents by health literacy classification. Low health literate parents were confused by diabetes jargon, preferred hands-on teaching, and wished for information to be communicated in simple language, broken down into key points, and repeated. Parents with adequate health literacy wanted comprehensive information communicated through ongoing dialogue. Findings indicate that learner-driven curricula may be most appropriate for diabetes education.

Acknowledgments

We thank Dr. Paul Thornton and the clinicians in the diabetes center and Maggie Martin, Shirley Martin, and Dr. Andrea Smith for their support of this study. We thank Dr. Kathy Baker and Dr. Ashley Franklin for their review of the manuscript. Lastly, we thank the parents for their willingness to participate in this study, sharing their wisdom about their communication experiences and needs in terms of the care of their children with diabetes.