Elsevier

Academic Pediatrics

Volume 17, Issue 4, May–June 2017, Pages 403-410
Academic Pediatrics

Disparities
Liquid Medication Dosing Errors by Hispanic Parents: Role of Health Literacy and English Proficiency

https://doi.org/10.1016/j.acap.2016.10.001Get rights and content

Abstract

Objective

Hispanic parents in the United States are disproportionately affected by low health literacy and limited English proficiency (LEP). We examined associations between health literacy, LEP, and liquid medication dosing errors in Hispanic parents.

Methods

Cross-sectional analysis of data from a multisite randomized controlled experiment to identify best practices for the labeling/dosing of pediatric liquid medications (SAFE Rx for Kids study); 3 urban pediatric clinics. Analyses were limited to Hispanic parents of children aged ≤8 years with health literacy and LEP data (n = 1126). Parents were randomized to 1 of 5 groups that varied by pairing of units of measurement on the label/dosing tool. Each parent measured 9 doses (3 amounts [2.5, 5, 7.5 mL] using 3 tools [2 syringes in 0.2 or 0.5 mL increments, and 1 cup]) in random order. Dependent variable was a dosing error of >20% dose deviation. Predictor variables included health literacy (Newest Vital Sign) (limited = 0–3; adequate = 4–6) and LEP (speaks English less than “very well”).

Results

A total of 83.1% made dosing errors (mean [SD] errors per parent = 2.2 [1.9]). Parents with limited health literacy and LEP had the greatest odds of making a dosing error compared to parents with adequate health literacy who were English proficient (trials with errors per parent = 28.8 vs 12.9%; adjusted odds ratio = 2.2 [95% confidence interval 1.7–2.8]). Parents with limited health literacy who were English proficient were also more likely to make errors (trials with errors per parent = 18.8%; adjusted odds ratio = 1.4 [95% confidence interval 1.1–1.9]).

Conclusions

Dosing errors are common among Hispanic parents; those with both LEP and limited health literacy are at particular risk. Further study is needed to examine how the redesign of medication labels and dosing tools could reduce literacy- and language-associated disparities in dosing errors.

Section snippets

Participants and Setting

This was a cross-sectional analysis of data collected as part of a randomized, controlled experiment focused on identifying specific attributes of medication labels and dosing tools that can be optimized to reduce parent dosing errors (SAFE Rx for Kids study). Subjects were enrolled from 3 university-affiliated pediatric outpatient clinics that serve largely low-income populations (New York University, Stanford, Emory). Northwestern University served as the data management site and enrolled no

Results

Of 2110 parents enrolled in the SAFE Rx for Kids study between August 26, 2013, and December 18, 2014, a total of 1141 (54.1%) self-identified as Hispanic. Findings of the main study are reported elsewhere18; this analysis focuses only on Hispanic parents. Of the Hispanic parents enrolled, 15 were excluded because they did not complete a dosing (n = 1) or health literacy (n = 14) assessment. Thus, 1126 parents were included in analyses (Table 1). Nearly 70% of parents had LEP (69.2%); 82.7% had

Discussion

To our knowledge, this study is the first to specifically examine medication dosing errors made by Hispanic parents and the independent and combined roles of parent health literacy and English proficiency. We found that liquid medication dosing errors by Hispanic parents are common, with over 80% of parents making at least one error, and that errors were more common among those with limited health literacy and LEP. These findings demonstrate the importance of addressing health literacy and LEP

Acknowledgments

We thank our research staff and the staff of the pediatric outpatient clinics at Bellevue Hospital Center, Gardner Packard Children's Health Care Center, and Children's Hospital of Atlanta at Hughes Spaulding for their support.

Supported in part by funding from the National Institutes of Health (NIH)–National Institute of Child Health and Human Development (NICHD) (R01 HD070864; principal investigator, H. Shonna Yin); authors funded as part of this grant include Drs Yin, Mendelsohn, Bailey,

References (35)

  • S.F. Li et al.

    Acetaminophen and ibuprofen dosing by parents

    Pediatr Emerg Care

    (2000)
  • H.K. Simon et al.

    Over-the-counter medications: do parents give what they intend to give?

    Arch Pediatr Adol Med

    (1997)
  • H.S. Yin et al.

    Parents' medication administration errors: role of dosing instruments and health literacy

    Arch Pediatr Adol Med

    (2010)
  • S.R. Ennis et al.

    The Hispanic Population: 2010

    (2011)
  • A.V. Mohan et al.

    Illustrated medication instructions as a strategy to improve medication management among Latinos: a qualitative analysis

    J Health Psychol

    (2012)
  • H.S. Yin et al.

    The health literacy of parents in the United States: a nationally representative study

    Pediatrics

    (2009)
  • Health Literacy: A Prescription to End Confusion

    (2004)
  • Cited by (0)

    Conflict of Interest: Drs Bailey, Parker, and Wolf and Ms Jacobson have served as consultants to and received grant funding from Merck Sharp & Dohme for work unrelated to this study. The authors declare that they have no conflict of interest.

    View full text