Parents with low literacy report higher quality of parent-provider relationships in a residency clinic

Objective.-Quality of care in pediatrics is suboptimal for children from families of low socioeconomic status. Literacy is aspect of socioeconomic status. We hypothesized that low literacy would be associated with low-quality well-child care. Methods.-We performed a cross-sectional study of of 1- to 4- year-old children in a pediatric resident clinic. assess parental literacy, we used the Rapid Estimate of Literacy in Medicine. To assess the quality of well-child care, used 5 subscales from the Promoting Healthy Survey relevant to either provider-parent relationships or of discussions in the well-child visit. Results.-We enrolled 157 caregivers. The mean age of respondents was 30 years, 55% were African American, received Medicaid, and 85% had graduated high school. A of 34% of the respondents scored below a ninth-grade level (low literacy). Parents with low literacy were more than those with higher literacy to report Family-centered care (79% vs 61%, P =.03), and Helpfulness and Confidence building (79% vs 57%, P =.01). There was no difference, by literacy level, in the percentage of parents who reported reaching established threshold levels for discussion of Psychosocial issues, Safety issues, or Anticipatory guidance topics. Conclusions.-The lower-literacy respondents reported higher-quality parent-provider relationships; there was no difference in quality of content of discussions by literacy level. Parents with low literacy may have lower expectations regarding relationships with their health care provider or may be less likely to be critical. Alternatively, pediatric residents may be more effective at relationship building with low-literacy families.