In the United States, 90 million people have inadequate levels of health literacy, and
racial and ethnic minorities are far more likely to be at or below basic levels in their
health literacy skills.1 Almost half (41 %) of Latinos lack basic health literacy,
compared to 24 % of Blacks and 9 % of Whites.2 Poor health literacy has been
described as a stronger predictor of a person's health than age, income, employment
status, education level, and race,3 and the need for improved health literacy is one of
the goals set by the national health agenda.4
Health literacy requires the skills to gain access to, understand, and use
information in ways that promote and maintain health.5 Research to date has
largely relied on measures of general literacy and numeracy to assess health literacy;6
however, literacy and numeracy skills in the context of understanding health
information do not necessarily correlate with health literacy for specific disadvantaged
groups.7 Additionally the correlation between some currently available health
literacy instruments has been demonstrated,8 but these measures have not been
compared in certain high risk populations thus precluding identification of the most
efficient measure for screening in clinical practice.
The current demographic shift in the United States has resulted in a large number
of children living in immigrant families,9 and evidence suggests that Latino parents
with limited English proficiency are more likely to have inadequate health literacy.10
More specifically, Latino parents have been shown to be at increased risk for poor
health literacy regarding upper respiratory infections (URIs) in comparison to non-
Latino Whites and Latino parents have been shown to be significantly more likely to
expect antibiotic treatment for a child in comparison to non-Hispanic white
parents.11 Nonjudicious use of antibiotics, including antimicrobial treatment of
viral URI in pediatric settings, has contributed to the public health threat of
antimicrobial resistance.12 Young children aged 6 months to 3 years have an average
of five URIs per year,13 and lower parental health literacy is associated with poorer
health outcomes, most notably for younger children.14 Hence, the aims of this study
were to: (1) describe the influence of health literacy on parental knowledge and
attitudes/beliefs surrounding URI care in an immigrant Latino population and 2)
examine the correlation between two measures of health literacy, the shortened form
of the Short Test of Functional Health Literacy in Adults (S-TOFHLA) and the
Newest Vital Sign (NVS) when administered to this particular population.