Parent Dosing Tool Use, Beliefs, and Access: A Health Literacy Perspective

• Authors: Tiffany A. Williams, New York University; Michael S. Wolf, Northwestern University; Ruth Parker, Emory University; Lee M. Sanders, Stanford University; Stacy Bailey, Northwestern University; Alan L. Mendelsohn, NYU; Benard P. Dreyer, NYU; Jessica J. Velazquez, NYU; H. Shonna Yin, NYU
• Journal Title: JOURNAL OF PEDIATRICS
• Volume: Volume 215
• Publisher: MOSBY-ELSEVIER | 2019-12-01, Pages 244-+
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1016/j.jpeds.2019.08.017
• Subjects: Health Sciences, Public Health
• Keywords: Science & Technology; Life Sciences & Biomedicine; Pediatrics; MEASURING DEVICES; MEDICATION; ERRORS; CARE; CHILDREN; IMPROVE; LABEL; ASSOCIATION; INSTRUMENTS; DIRECTIONS

Abstract

Objectives: To assess parent decision-making regarding dosing tools, a known contributor to medication dosing errors, by evaluating parent dosing tool use, beliefs, and access, and the role of health literacy, with a focus on dosing cups, which are associated with an increased risk of multifold overdose. Study design: Cross-sectional analysis of data collected for randomized controlled study in 3 urban pediatric clinics. English/Spanish-speaking parents (n = 493) of children ≤8 years of age enrolled. Outcomes: reported tool use, beliefs, and access. Predictor variable: health literacy (Newest Vital Sign; limited [0-3], adequate [4-6]). Multiple logistic regression analyses conducted. Results: Over two-thirds of parents had limited health literacy. Oral syringes (62%) and dosing cups (22%) were most commonly used. Overall, 24% believed dosing cups were the best tool type for dosing accuracy; 99% reported having access to ≥1 dosing tools with standard measurement markings. Parents with limited health literacy had greater odds of dosing cup use (limited vs adequate: aOR = 2.4 [1.2-4.6]). Parents who believed that dosing cups are best for accuracy had greater odds of dosing cup use (aOR = 16.3 [9.0-29.3]); this belief mediated health literacy-effects on dosing cup use. Conclusions: Factors associated with dosing tool choice, including parent health literacy and beliefs are important to consider in the design of interventions to reduce dosing errors; future larger-scale studies addressing this issue are needed.