Health Literacy: A Pediatric Nursing Concern

Cecily L. Betz, PhD, RN, FAAN; Kathy Ruccione, MPH, RN, FAAN; Kathleen Meeske, PhD; Kathryn Smith, MN, RN; Nancy Chang, MSN, RN, FNP, CDE


Pediatr Nurs. 2008;34(3):231-239. 

In This Article

Abstract and Introduction


Health care stakeholders and experts have identified health literacy as a major public health issue. Inadequate health literacy has been associated with a myriad of untoward health outcomes, including higher rates of hospitalization and emergency room utilization, prolonged recovery periods from illnesses, and illness complications. Experts attribute the spiraling costs of health care to low health literacy as a causative factor. To date, health literacy initiatives have been directed toward addressing the concerns of the adult population. An introduction to the issue of health literacy and its relevance to the care of children, youth, and families is provided. Implications for practice, policy, and research are addressed.


Health literacy is a serious public health concern. According to a recent national report, over one-third of Americans have inadequate health literacy (Kutner, Greenberg, Jin, & Paulsen, 2006). Health literacy is a specialized type of literacy that refers to the ability to read, understand, and apply health information (Boswell, Cannon, Aung, & Eldridge, 2004; Leyva, Sharif, & Ozuah, 2005). A recent Institute of Medicine (IOM) report, Health Literacy: A Prescription to End Confusion (Nielsen-Bohlman, Panzar, & Kindig, 2004), describes health literacy as "the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions" (Ratzan & Parker, 2000, p. 7). As a further confirmation of the scope of this national problem, Healthy People 2010 identified health literacy as an objective that aims to "improve the health literacy of persons with marginal or inadequate skills" (U.S. Department of Health and Human Services, 2000). However, health care professionals have not yet effectively addressed this national health challenge.

To date, most efforts to understand and improve health literacy have targeted adult patients. The effects of low parental health literacy on children's health have been largely ignored. Yet, adequate parental literacy is necessary for appropriate management of the child's health needs during acute/minor illness episodes as well as for long-term treatment management of their child's chronic condition. Inadequate health literacy can result in improper medication administration, missed appointments, and incorrect performance of care at home (for example, contamination of "sterile" supplies), thereby adversely affecting the child's health and treatment outcomes (Leyva et al., 2005; Moon, Cheng, Patel, Baumhaft, & Scheidt, 1998). Furthermore, children themselves need to develop adequate health literacy, particularly if they have special health care needs (SHCN), to learn to integrate the knowledge and skills they need to manage their treatment regimen as independently as possible; this issue is a particularly salient one for transition-aged adolescents with SHCN. Without adequate health literacy, youth with SHCN are at risk for avoidable adverse health outcomes.


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