• Katharine V Jensen, Andrea Morrison, Keon Ma, Waleed Alqurashi, Tannis Erickson, Janet Curran, Ran D Goldman, Serge Gouin, April Kam, Naveen Poonai, Tania Principi, Shannon Scott, Antonia Stang, Patricia Candelaria, Kurt Schreiner, Maryna Yaskina, Samina Ali, and Pediatric Emergency Research Canada Family Needs Study Group.
• Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada.
• CJEM. 2024 Sep 27.

ObjectiveCaregivers with low health literacy are more likely to overestimate illness severity and have poor adherence with health-promoting behaviors. Our primary objective was to relate caregiver health literacy to the urgency of emergency department (ED) utilization. The secondary objective was to explore the relationship between social and demographic characteristics, health literacy, and urgency of ED use.MethodsThis sub-study was a descriptive cross-sectional survey with health record review. Data were collected from ten Canadian pediatric EDs. Study variables included demographics, visit details, and the Newest Vital Sign measurement of health literacy. ED visits were classified as urgent or non-urgent based on the resource utilization method.ResultsThe response rate was 97.6% (n = 2005). Mean (SD) caregiver age was 37.0 (7.7) years, 74.3% (n = 1950) were mothers, 72.6% (n = 1953) spoke English as a primary language, 51.0% (n = 1946) had a university degree, and 45.1% (n = 1699) had a household income greater than $100,000. The mean (SD) age of the children was 5.9 (5.0) years and 48.1% (n = 1956) were female. 43.7% (n = 1957) of caregivers had low health literacy. Being a caregiver with a child < 2 years old [aOR 1.83 (1.35, 2.48)] and low health literacy [aOR 1.56 (1.18, 2.05)] were associated with greater non-urgent pediatric ED use. Interprovincial variation was evident: Quebec caregivers were less likely to use the pediatric ED for non-urgent presentations compared to Alberta, while those in Nova Scotia, Manitoba, British Columbia, and Ontario were more likely compared to Alberta.ConclusionAlmost half of caregivers presenting to Canadian pediatric EDs have low health literacy, which may limit their ability to make appropriate healthcare decisions for their children. Low caregiver health literacy is a modifiable factor associated with increased non-urgent ED utilization. Efforts to address this may positively influence ED utilization.© 2024. The Author(s), under exclusive licence to the Canadian Association of Emergency Physicians (CAEP)/ Association Canadienne de Médecine d'Urgence (ACMU).

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