Association Between Caregiver Health Literacy, Social Determinants of Health, and the Pediatric Oncology New Diagnosis Educational Experience

Background

Caregiver new diagnosis education is understudied in pediatric oncology. Caregiver health literacy (HL) and social determinants of health (SDoH) may affect the caregiver-reported educational experience (CREE) of receiving new diagnosis education. Our purpose was to determine relationships between HL, SDoH, and CREE by surveying caregivers who received new diagnosis education for their children undergoing cancer treatment.

Procedure

HL was assessed using the Newest Vital Sign (limited HL: 0–3; adequate HL: 4–6). Five SDoH domains (economic stability; education access/quality; healthcare access/quality; neighborhood/built environment; social/community context) were assessed (adverse SDoH: ≥1 adverse factor). CREE was assessed using items adapted from the Agency for Healthcare Research and Quality (AHRQ) Health Literacy Supplemental Items (possible range: 6–36; unfavorable: <33). Multivariable logistic regression was used to identify associations between unfavorable CREE score (outcome), SDoH, and HL, adjusting for caregiver sociodemographic and child clinical factors.

Results

Of 67 caregivers, 77.6% were mothers, 65.7% non-Hispanic White, median [range] age was 34 [20–69] years. Among the patients (N = 67): males were 56.7%, leukemia 55.2%, and median [range] age 4.4 [0.2–17.5] years. Over one-third (35.8%) of caregivers had limited HL, 71.6% had one or more adverse SDoH, and 40.3% reported unfavorable CREE. In multivariable logistic regression, adverse SDoH was associated with 6.3-fold higher odds of unfavorable CREE (adjusted odds ratio [aOR] = 6.3, 95% confidence interval [CI] = 1.4–28.7, p = 0.017); adequate HL was associated with 8.0-fold higher odds of unfavorable CREE (aOR = 8.0, 95% CI = 1.9–34.4, p = 0.005).

Conclusions

SDoH and HL are important factors to consider when providing new diagnosis education to pediatric oncology caregivers.