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A Systematic Review

Lee M. Sanders, MD; Steven Federico, MD; Perri Klass, MD; Mary Ann Abrams, MD, MPH; Benard Dreyer, MD

Arch Pediatr Adolesc Med. 2009;163(2):131-140.

Objectives  To assess the prevalence of low health literacy among adolescents, young adults, and child caregivers in the United States, the readability of common child-health information, and the relationship between literacy and child health.

Data Sources  MedLine, Educational Resources Information Center, National Library of Medicine, PsychInfo, Harvard Health Literacy Bibliography, and peer-reviewed abstracts from the Pediatric Academic Societies Annual Meetings.

Study Selection  A systematic review using the following key words: health literacy, literacy, reading skill, numeracy, and Wide Range Achievement Test.

Main Outcome Measures  Descriptive studies that used at least 1 valid measure of health literacy, studies that assessed the readability of child health information, and observational or experimental studies that included a validated measure of health literacy, literacy, or numeracy skills and an assessment of child health–related outcomes.

Results  A total of 1267 articles were reviewed, and 215 met inclusion and exclusion criteria. At least 1 in 3 adolescents and young adults had low health literacy; most child health information was written above the tenth-grade level. Adjusted for socioeconomic status, adults with low literacy are 1.2 to 4 times more likely to exhibit negative health behaviors that affect child health, adolescents with low literacy are at least twice as likely to exhibit aggressive or antisocial behavior, and chronically ill children who have caregivers with low literacy are twice as likely to use more health services.

Conclusions  Low caregiver literacy is common and is associated with poor preventive care behaviors and poor child health outcomes. Future research should aim to ameliorate literacy-associated child health disparities.

Author Affiliations: University of Miami, Coral Gables, Florida (Dr Sanders); University of Colorado, Boulder (Dr Federico); New York University, New York (Drs Klass and Dreyer); and Iowa Health System, Des Moines (Dr Abrams).

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