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Ambul Pediatr. 2004 Sep-Oct;4(5):424-8.

Number of children's books in the home: an indicator of parent health literacy.

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  • 1University of Miami School of Medicine, Miami, FL 33136, USA.



One in 4 US adults have poor health literacy, unable to read and understand written medical information. Current tools that assess health literacy skills are too lengthy to be useful in routine clinical encounters.


To determine which of 7 screening questions is most useful for identifying parents with adequate health literacy.


A cross-sectional study of an ethnically diverse sample of 163 parents of children aged 12 to 24 months presenting for routine care at 1 of 6 inner-city clinics. Literacy was measured by performance on the Short Test of Functional Health Literacy for Adults, which was categorized as "adequate" or "inadequate or marginal." The 7 screening questions concerned parents' educational achievement, educational expectations for the child, and home literacy environment.


Eighty-three percent of respondents had adequate health literacy, which was highest among those who were African American, were born outside the United States, spoke English primarily at home, and had completed high school. Only 2 factors, however, were independently associated with adequate health literacy: more than 10 adults' books or more than 10 children's books in the home. "More than 10 children's books" had a positive predictive value of 91%.


Having more than 10 children's books in the home is a useful, independent indicator of adequate parent health literacy. More research is needed, however, to find a better screening tool for identifying parents with increased health literacy needs.

[PubMed - indexed for MEDLINE]
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