Health literacy in pediatric otolaryngology: A scoping review

Improving Health Literacy of Elective Procedures in Pediatric Otolaryngology

OBJECTIVE

To identify if the addition of supplementary material, such as video or written resources, to the consent process, can improve a patient's or guardian's health literacy in pediatric otolaryngology.

STUDY DESIGN

Prospective randomized crossover design.

SETTING

Tertiary Academic Center.

METHODS

From April 18, 2022 to August 29, 2023, 151 children scheduled to undergo 1 of 6 procedures by the same provider were queried and completed a 6-question baseline test based on the information. They each watched a 2-minute video and read a written summary about the procedure; the order of resources was randomized. They answered the same 6-questions after viewing each resource. All tests were scored based on accuracy using an ordinal scale of 1 to 6. Resource preference was collected. Wilcoxon signed-rank tests were run to analyze differences in scores after the addition of supplementary resources and logistic regression modeling was run to analyze demographic effects on postresource score differences.

RESULTS

Of 151 participants, 74.2% were guardians, with 78.8% having completed a high school or greater education. The Wilcoxon signed-rank test indicated that postresource scores were statistically significantly higher (P < .001) than pretest scores. Logistic regression modeling showed that participants were less likely to show score improved if they were younger than 18 and were of white race. A majority (87.4%) preferred the addition of a video to the consent process.

CONCLUSION

The addition of video or written resources significantly improves understanding of elective procedures. The development of procedure-specific resources can supplement the consent process and ensure decision-makers have adequate health literacy for informed decision-making.

Applying the Participatory Slow Design Approach to a mHealth Application for Family Caregivers in Pediatric Ear, Nose, and Throat Surgery

Pediatric ear, nose, and throat (ENT) surgery is very common, and its outcomes may improve with family education. In this regard, mobile health (mHealth) applications (apps), which are on the rise due to digital transformation, can be beneficial in healthcare. This study outlines the user-centered design and development of a mHealth app (version 5.15.0) to support family caregivers during the perioperative process of pediatric ENT surgery. Conducted over two years in an Italian maternal and child health hospital (January 2020-May 2022), the study employed a participatory design method based on the Information System Research (ISR) framework and guided by the principles of Slow Medicine. Utilizing the Relevance, Rigor, and Design cycles of the ISR framework, the mHealth app's content, functionalities, and technical features were defined and developed. A committee of fifteen experts guided the process with input from 25 family caregivers and 24 healthcare providers enrolled in the study. The mHealth app content was structured around five crucial educational moments characterizing the ENT perioperative period, providing evidence-based information on surgical procedures, strategies for preparing children for hospitalization and surgery, pain management, and post-discharge care. The mHealth app featured a function that sends customized notifications to guide caregivers at specific perioperative stages. The development of mHealth apps by implementing a rigorous, participatory, and Slow design process can foster accessible and family-centered information and care in the field of maternal and child health and beyond.

Assessing the Impact of Military Service on Patient Health Literacy in an Otolaryngology Clinic

OBJECTIVE

To examine the impact of military service on health literacy.

STUDY DESIGN

Prospective, cross-sectional study.

SUBJECTS AND METHODS

The validated Brief Health Literacy Screen (BHLS) with military supplement was administered to sequential adult patients (military and civilian) treated at two outpatient academic military otolaryngology clinics between November and December 2019. Inadequate health literacy, defined by a BHLS score ≤9, was the primary outcome measure. Secondary outcome measures included comparisons of inadequate BHLS scores with patient demographics and history of military service.

RESULTS

Three hundred and eighty-two patients were evaluated during the study period. The median age was 48-57 years, with a majority being male (230, 60.2%), White (264, 69.1%), married (268, 70.2%), and active duty military (303, 79.3%). A minority reported history of PTSD (39, 13%) or traumatic brain injury (29, 9.6%). Overall, very few subjects (10, 2.6%) demonstrated inadequate health literacy. Patients with prior (1.6% vs 6.3%, P < .05) or current (0% vs 5.0%, P < .05) military service had lower rates of inadequate health literary as compared to civilians. Gender, race, marital status, history of PTSD, and history of traumatic brain injury did not significantly impact health literacy. In a multivariate regression model exploring history of military service, age was not predictive of inadequate health literacy.

CONCLUSIONS

Both history of and current military service predict higher health literacy rates for patients treated at military otolaryngology clinics. Widely accessible health care and mandatory health evaluations for service members to maintain deployment readiness may contribute to this finding but warrant additional study.

Discontinuation and nonpublication of pediatric otolaryngology clinical trials

OBJECTIVES

Randomized controlled trial (RCT) discontinuation and nonpublication are potential mechanisms of waste in resources and lead to decreased advancement of medical science and compromised ethical issues in all specialties. However, the prevalence of discontinued or unpublished RCTs regarding common pediatric otolaryngology disorders and interventions remains unclear.

STUDY DESIGN

Cross-sectional analysis.

METHODS

Retrospective analysis of common pediatric otolaryngology RCTs registered in ClinicalTrials.gov up until November 2, 2018. Data were collected from the registry, and publication status was identified. If a reason for trial discontinuation or nonpublication was not identified through a systematic search, corresponding trialists were contacted through email.

RESULTS

After exclusion, 260 RCTs were included for analysis. Analysis found 198 (76%) RCTs were completed, and 62 (24%) trials were discontinued. The most commonly reported reasons for RCT discontinuation were program termination by sponsor or management (7/24; 29.2%), lack of participant enrollment, difficulty recruiting, or slow accrual (7/24; 29.2%). A total of 192 (192/260; 73.8%) published RCTs and 68 (68/260; 26.2%) unpublished RCTs were identified. Twenty-six (26/62; 42%) of the discontinued RCTs reached publication, while 36 (58%) remained unpublished. Regarding the completed RCTs, 166 of 198 (83.8%) completed trials reached publication, while 32 (32/198; 16.2%) remained unpublished after trial completion.

CONCLUSIONS

Approximately 1 in 4 of included RCTs were discontinued or did not reach publication. Findings suggest further guidance is needed for RCTs regarding common pediatric otolaryngology disorders and interventions.

LEVEL OF EVIDENCE

NA.

Developing a health education comic book: the advantages of learning the behaviours of a target audience

The objective of this study was to determine the positive and negative coping mechanisms practiced by parents of paediatric inpatients and outpatients in order to prepare a health educational comic aimed at improving these response mechanisms. Data were collected from parents visiting general paediatric outpatient clinics or hospitalisation units, at a children's hospital in a metropolitan city. Data analysis was based on 258 completed surveys received from 308 (83.77%) respondents. Each parent completed a survey that included the Brief-COPE-Coping Orientation to Problems Experienced questionnaire that encompassed 14 subscales of positive and negative coping mechanisms. Parents used both positive and negative coping mechanisms in outpatient clinics and hospitalisation units. Scores involving negative coping mechanisms were increased and associated with the severity of a child's reason for visiting a children's hospital. The lowest scores were reported by parents whose children were seen at outpatient clinics, whereas the highest scores were reported by parents whose children were treated in critical care units. Learning about parents' coping mechanisms provided key information for preparing an electronic health education comic book (electronically distributed free of charge) and can be used to teach and promote the reinforcement of positive rather than negative coping mechanisms.

Readability analysis of pediatric otolaryngology patient-reported outcome measures

OBJECTIVE

(s): Patient-reported outcome measures (PROMs) are tools that allow patients to directly share information about their health with their healthcare provider. Health literacy experts recommend that health information, such as PROMs, be written at a 6th grade level to ensure patients can read and comprehend it. As the readability of PROMs used in pediatric otolaryngology has yet to be studied, our goal was to analyze the readability of these PROMs and assess their compliance with readability recommendations.

METHODS

The Gunning Fog, the Simple Measure of Gobbledygook (SMOG), and the FORCAST readability formulas were used to determine the readability of disease-specific PROMs for pediatric otolaryngology.

RESULTS

Fourteen PROMs were reviewed in the study. Most were intended for caregiver completion (n = 13, 92.9%). Ten PROMs when measured by Gunning Fog (71.4%), 2 PROMs when measured by SMOG (14.3%), and 0 PROMs when measured by FORCAST (0.0%) were at or below the 6th grade reading level.

CONCLUSION

Most PROMs available for use in pediatric otolaryngology are above the recommended 6th grade reading level when measured by FORCAST, the most appropriate metric for assessing questionnaires. The high reading grade level needed to complete these PROMs can contribute to health disparities among underserved and vulnerable populations, such as children. Pediatric otolaryngology PROMs developed in the future should take readability into account in order to ensure equity in the delivery of care.

Health literacy and caregiver understanding in the CHD population

BACKGROUND

CHD is the most common birth defect type, with one-fourth of patients requiring intervention in the first year of life. Caregiver understanding of CHD may vary. Health literacy may be one factor contributing to this variability.

METHODS

The study occurred at a large, free-standing children's hospital. Recruitment occurred at a free-of-charge CHD camp and during outpatient cardiology follow-up visits. The study team revised the CHD Guided Questions Tool from an eighth- to a sixth-grade reading level. Caregivers of children with CHD completed the "Newest Vital Sign" health literacy screen and demographic surveys. Health literacy was categorised as "high" (Newest Vital Sign score 4-6) or "low" (score 0-3). Caregivers were randomised to read either the original or revised Guided Questions Tool and completed a validated survey measuring understandability and actionability of the Guided Questions Tool. Understandability and actionability data analysis used two-sample t-testing, and within demographic group differences in these parameters were assessed via one-way analysis of variance.

RESULTS

Eighty-two caregivers participated who were largely well educated with a high income. The majority (79.3%) of participants scored "high" for health literacy. No differences in understanding (p = 0.43) or actionability (p = 0.11) of the original and revised Guided Questions Tool were noted. There were no socio-economic-based differences in understandability or actionability (p > 0.05). There was a trend towards improved understanding of the revised tool (p = 0.06).

CONCLUSIONS

This study demonstrated that readability of the Guided Questions Tool could be improved. Future work is needed to expand the study population and further understand health literacy's impact on the CHD community.

Understanding genetic learning needs of people affected by rare disease

Nearly 350 million people worldwide are affected by a rare disease (RD) and ~80% of RDs have a genetic type, underscoring the need for access to reliable genomics education. Patient assistance in resource development can help ensure content is appropriate. The aim of this study was to define the needs and practical usage of the RD community to inform the scope and content of an online genetic course targeted toward the entire RD ecosystem. A high-level online survey (OS) was disseminated to 586 RD patients and family members/caregivers. A total of 251 individuals responded to the OS. Eight respondents were invited to participate in a follow-up focus group (FG). Nearly 87% of OS respondents have made efforts previously to learn more about genetics and 95.6% indicated a current interest in genetic education. Navigating healthcare systems, information sharing, and advocacy support were driving factors for this desire. Respondents indicated difficulty finding information on gene function, genetic testing, disease pathogenesis, and scientific advances. FG outcomes dove deeper into psychological needs including reducing emotional burden, alleviating fear of the unknown and seeking hope. Research identified high levels of interest in genetic education across all stages of the RD journey. Key themes identified in this study may help guide genetic counselors as they create their own patient and family-facing content.