Caregiver Literacy in a Pediatric Orthopedic Population: A Cross-Sectional Study

Background: Approximately 33% of Americans have inadequate health literacy, which is associated with increased hospitalization and use of emergency care, poorer control of chronic diseases, infrequent use of preventative measures, and suboptimal treatment outcomes. Aims and Objectives: The purpose of this study was to evaluate the general and musculoskeletal health literacy of the parents or guardians (caregivers) of pediatric patients presenting to a general pediatric orthopedic clinic and identify risk factors for limited health literacy. Study Design: This cross-sectional study obtained a convenience sample of 200 English speaking caregivers of children presenting with musculoskeletal complaints. Caregivers who were taking their children for either first-time or follow-up visits were included in the study. Participants were excluded if they did not meet the aforementioned criteria, had any cognitive impairment, were unable to read English, or were unable to sign their own consent. Setting: The general pediatric orthopedic clinic of a large children’s hospital. Materials and Methods: Caregivers completed a demographic survey, the Literacy in Musculoskeletal Problems questionnaire, and the Newest Vital Sign to measure musculoskeletal and general health literacy, respectively. Statistics: The data was summarized using frequencies and proportions for categorical variables as well as mean and standard deviation for quantitative variables. In the univariate analysis the group comparisons were conducted using the chi-squared test for categorical variables. Multivariable logistic regression was used to model the odds of adequate musculoskeletal health literacy. Results: Limited musculoskeletal health literacy was seen in 46.7% of participants. Inadequate general health literacy was observed in 18.0% of participants. Non-Hispanics (p = 0.0210), those who worked in a health care (p = 0.0055), and those with a level of education of some college or greater (p = <0.0012) were more likely to have adequate musculoskeletal health literacy on multivariable logistic regression. Only at least some college experience correlated with adequate general health literacy (p = 0.003) upon multivariable logistic regression. Conclusion: Almost half of all caregivers who bring their children to a pediatric orthopedic clinic have limited musculoskeletal health literacy and may lack the necessary comprehension required for making informed decisions about their child’s care. Limited musculoskeletal health literacy is more prevalent than limited general health literacy.