Healthcare provider bias in estimating the health literacy of parents in a pediatric emergency department

honors thesisCollege of Social & Behavioral ScienceHealth, Society & PolicyHealth literacy, defined as an individual's capacity to obtain, communicate, process, and understand basic health information and services to make appropriate health decisions, is a growing concern due to its significant effect on clinical communication and health outcomes. One aspect of this clinical communication is the ability of the provider to estimate the health literacy of the patient/caregiver. In this study, providers are asked to perceive descriptive factors and estimate the health literacy of parents/guardians in the Primary Children's Hospital Emergency Department. Then, the health literacy of the parent/guardian is tested using the Short Assessment of Health Literacy (SAHL), and cross tabulated with provider estimates. Additionally, qualitative information is collected from families about the specific miscommunications that they experience during their visit. Preliminary results show that providers correctly estimate the health literacy of the parents/guardians 61.56% of the time, and misestimates are often underestimates (26.53%) rather than overestimates (11.9%). The results also suggest that the ability of a provider to estimate the health literacy of a parent in the Pediatric Emergency Department is influenced by their role/experience as a provider, racial biases, gender/parenting role biases, and biases related to the language spoken by the caregiver. Most notably, providers overestimate the health literacy of 24.07% of fathers and only 9.4% of mothers. They correctly estimate the health literacy of 64.34% of English-speaking participants compared to 27.27% of Spanish-speaking participants, and underestimated the health literacy of 54.55% of Spanish-speaking participants and only 24.26% of English-speaking participants. When providers perceive a participant to be a part of a racial or ethnic minority group, they only correctly estimate health literacy 35% of the time compared to 71.36% of majority (white) participants. They underestimate the health literacy of 52.5% of these minority (non-white) participants, while only underestimating the health literacy of 16.9% of majority (white) participants. These results suggest a need for further health literacy research and interventions in provider education and clinical practice