Literacy and Child Health

A Systematic Review

Although the study of health literacy and child health is in its infancy, evidence suggests low literacy among caregivers contributes to poorer health outcomes and disparities among children. This literature review calls for extensive research to close the knowledge gaps and suggests four specific interventions that warrant evaluation.

There is mounting evidence that literacy affects health outcomes, but questions related to literacy and pediatric health care are largely unstudied. The authors considered more than 1,200 articles but ultimately cited only a small number to address three core issues: (1) the state of health literacy among children, young adults and child caregivers in the United States (16 studies); (2) the readability of commonly-used child health information (6 studies); and (3) whether literacy is associated with child health outcomes (23 studies).

Key Findings:

  • Medical literacy assessment tools are limited and do not assess skills necessary to take care of children. There are no tools to assess health literacy in kids younger than 12.
  • National and regional surveys show adult health literacy is low. One in 10 young adults cannot complete “below basic” health tasks, such as using a dosage chart for non-prescription medication; one in three cannot use an immunization schedule. Low health literacy in young adults and child caregivers has been found to vary from 10-40 percent.
  • Most child health information is written above the 8th grade level and is too complex for many adults to understand.
  • Although there is limited evidence for a relationship between literacy and child health outcomes, studies do suggest links between low literacy in adults and adolescents and behaviors that are problematic in parenting, such as maternal depression, decreased use of preventive-care services, aggression and risky health behaviors.

More research and better assessment tools are needed to understand the link between health literacy and children’s health outcomes, but addressing health literacy should be part of any framework to improve children’s health services. The authors suggest the evaluation of four specific interventions: reducing the complexity of child health information; improving communication skills of pediatric providers; helping families navigate the health care system; and directly improving health literacy of children and caregivers.