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Author Notes:

Address correspondence to: H. Shonna Yin, MD, MS, New York University School of Medicine, Department of Pediatrics, 550 First Avenue, NBV 8S4-11, New York, NY 10016; Telephone: (646) 501-4284, Fax: (212) 263-8172; yinh02@med.nyu.edu

Alejandro Torres: Mr. Torres conceptualized and designed the study, analyzed and interpreted the data, drafted the initial manuscript, and approved the final manuscript as submitted.

Ruth Parker, Lee Sanders, Michael Wolf, Stacy Bailey, Benard Dreyer: Drs. Parker, Sanders, Wolf, Bailey, and Dreyer, and Mendelsohn helped conceptualize and design the study, were involved in the analysis and interpretation of the data, critically revised the manuscript for important intellectual content, provided study supervision, and approved the final manuscript as submitted.

Deesha Patel, Kwang-Youn Kim: Ms. Patel and Dr. Kim participated in the design the study, analyzed and interpreted the data, critically revised the manuscript for important intellectual content, and approved the final manuscript as submitted.

Jessica Jimenez: Ms. Jimenez participated in the design of the study, assisted in acquisition of data, analysis and interpretation of the data, drafting of the manuscript, and approved the final manuscript as submitted.

H. Shonna Yin: Dr. Yin conceptualized and designed the study, analyzed and interpreted the data, drafted the initial manuscript, critically revised the manuscript for important intellectual content, provided study supervision, and approved the final manuscript as submitted.

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

Drs. Bailey, Parker, and Wolf, have served as a consultant to, and received grant funding, from Merck, Sharp and Dohme for work unrelated to this study.

Drs. Wolf and Bailey have also received grant funding via their institutions from Eli Lilly.

The authors have no further conflicts of interest to report.

Subjects:

Research Funding:

Supported by the National Institutes of Health (NIH) / National Institute of Child Health and Human Development (R01HD070864).

Dr. Yin is also supported by HRSA Grant 12-191-1077- Academic Administrative Units in Primary Care.

Dr. Sanders is also supported by FDA CERSI grant (UCSF-Stanford CERSI Award #13).

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Pediatrics
  • ambulatory care
  • dosing errors
  • dosing units
  • health communication
  • health literacy
  • medication errors
  • MEDICATION DOSING ERRORS
  • LIQUID MEDICATION
  • CARE
  • INSTRUCTIONS
  • DIRECTIONS
  • ADHERENCE
  • CHILDREN
  • LABELS
  • UNITS

Parent Preferences and Perceptions of Milliliters and Teaspoons: Role of Health Literacy and Experience

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Journal Title:

Academic Pediatrics

Volume:

Volume 18, Number 1

Publisher:

, Pages 26-34

Type of Work:

Article | Post-print: After Peer Review

Abstract:

Background and Objectives A recent American Academy of Pediatrics policy statement recommends milliliter-exclusive dosing for pediatric liquid medications. Little is known about parent preferences regarding units, perceptions about moving to milliliters only, and the role of health literacy and prior milliliter-dosing experience. Methods Cross-sectional analysis of data collected as part of a randomized controlled study in 3 urban pediatric clinics (SAFE Rx for Kids study). English- and Spanish-speaking parents (n = 493) of children aged ≤8 years were randomized to 1 of 4 study arms and given labels and dosing tools which varied in label instruction format (text plus pictogram, text only) and units (milliliter only [“mL”], milliliter/teaspoon [“mL”/“tsp”]). Outcomes included teaspoon preference in dosing instructions and perceived difficulty with milliliter-only dosing. The predictor variable was health literacy (Newest Vital Sign; low [0–1], marginal [2–3], adequate [4–6]). The mediating variable was prior milliliter-dosing experience. Results Over two-thirds of parents had low or marginal health literacy. The majority (>70%) preferred to use milliliters, perceived milliliter-only dosing to be easy, and had prior milliliter-dosing experience; 11.5% had a teaspoon preference, 18.1% perceived milliliter-only dosing will be difficult, and 17.7% had no prior milliliter-dosing experience. Parents with lower health literacy had a higher odds of having a teaspoon preference (low vs adequate: adjusted odds ratio [AOR] = 2.9 [95% confidence interval [CI] 1.3–6.2]), and greater odds of perceiving difficulty with milliliter-only dosing (low vs adequate: AOR = 13.9 [95% CI 4.8–40.6], marginal vs adequate: AOR = 7.1 [95% CI 2.5–20.4]). Lack of experience with milliliter dosing partially mediated the impact of health literacy. Conclusions Most parents were comfortable with milliliter-only dosing. Parents with low health literacy were more likely to perceive milliliter-only dosing to be difficult; educational efforts will need to target this group to ensure safe medication use.

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© 2017 Academic Pediatric Association

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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