| Background. Women with low-health literacy (HL) underutilize preventive healthcare. However, there is little research on healthcare utilization for their children. In this mixed method study we examined the relationship between maternal HL and healthcare use in young children (0-24mo) in an inner city population. Methods. We assessed HL of mothers using the Rapid Assessment of Adult Literacy in Medicine, in a nested random sample from a cohort study (n=1,034) of low-income, urban women (n=235). We were able to link the Medicaid Claims data of 185 children (0-24 months) to unique women in our sample. Additionally we conducted 14 semi-structured interviews with mothers with varied HL, exploring many pediatric health related challenges faced by mothers living in an urban environment with their small children. Guided by Andersen's Behavioral Health Model we analyzed and coded verbatim transcripts. Results. In our sample 14.1% of the women had low HL (≤6thgrade). While most children received some care, only 3.4% of the children in our sample received the recommended seven or more well-child visits between 0-12 months of age (national average 82%). Our study failed to document an association between compliance and health literacy but it documented a very low rate of service use. HL was not associated with the number of well-child visits, sick-child visits, and emergency department visits. Qualitative analyses of interview transcripts revealed that poor readers and strong readers encountered an overlapping set of challenges when navigating the healthcare system in an urban setting. Communication, power respect, and physical access (e.g. transportation) were among the themes that emerged as obstacles to care. Participants reported finding a way to access care despite such obstacles. Conclusions. In this study of low-income mothers we found no association between HL and utilization of pediatric health services. We determined that HL did not mediate or moderate the relationships between a set of predisposing and enabling factors and our primary outcome variables. Low-HL was not an additional risk factor and higher health literacy was not protective against risk. |
