Association of low caregiver health literacy with reported use of nonstandardized dosing instruments and lack of knowledge of weight-based dosing.
ABSTRACT Caregivers of young children frequently measure doses of liquid medications incorrectly. Use of nonstandardized dosing instruments and lack of knowledge that dosing is weight-based contribute to dosing errors. We sought to assess whether low caregiver health literacy was associated with these outcomes.
This was a cross-sectional analysis of caregivers presenting to an urban pediatric emergency room. Dependent variables were caregiver reported use of nonstandardized dosing tools and knowledge of weight-based dosing. The independent variable was caregiver health literacy (Test of Functional Health Literacy in Adults [TOFHLA]).
Two hundred ninety-two caregivers were assessed: 23.3% reported use of nonstandardized liquid dosing instruments, and 67.8% were unaware of weight-based dosing. Caregivers who were unaware of weight-based dosing were more likely to use nonstandardized dosing tools (28.3% vs 12.8%; P = .003). In unadjusted analyses, overall health literacy, reading comprehension, and numeracy were all associated with both dependent variables. In analyses adjusting for child age, health care experiences, and caregiver acculturation and education, inadequate/marginal overall health literacy was associated with lack of knowledge of weight-based dosing (adjusted odds ratio [AOR] 2.3; P = .03), whereas lower reading comprehension was associated with both lack of knowledge (AOR 2.0; P = .03) and reported use of nonstandardized instrument (AOR 2.4; P = .007).
Low health literacy, in particular reading comprehension, was associated with reported use of nonstandardized dosing instruments and lack of knowledge regarding weight-based dosing. Both caregiver health literacy and sociodemographic factors should be considered in the design of interventions to prevent medication administration errors.
- SourceAvailable from: Michael Wolf[Show abstract] [Hide abstract]
ABSTRACT: Our objective was to determine the level of adult understanding of dosage instructions for a liquid medication commonly prescribed for children. Structured interviews were conducted with 373 adults waiting for an appointment at family medicine clinics serving low-income populations in Shreveport, La; Chicago; and Jackson, Mich, from July 2003-August 2004. Subjects were asked to read a prescription label for amoxicillin and explain how they would take the medication. Correct interpretation was determined by a panel of blinded physician reviewers who coded subjects' verbatim responses. Qualitative methods were used to determine the nature of incorrect responses. Twenty-eight percent of subjects misunderstood medication instructions. The prevalence of misinterpreting instructions among subjects with adequate, marginal, and low literacy was 18%, 34%, and 43%, respectively. Common causes for misunderstanding included problems with dosage measurement (28%; ie, tablespoon instead of teaspoon) and frequency of use (33%; ie, every 3 hours instead of every 6-8 hours). In an adjusted analysis that excluded literacy, African Americans were more likely to misunderstand instructions than Caucasians (adjusted odds ratio [AOR] 1.63, 95% confidence interval [CI]=1.02-2.61). When literacy was included in the model, the effect of race on misunderstanding was reduced and nonsignificant. Inadequate and marginal literacy remained independent predictors of misunderstanding (inadequate--AOR 2.90, 95% CI= 1.41-6.00; marginal--AOR 2.20, 95% CI=1.19-3.97). Misinterpretation of pediatric liquid medication instructions is common. Limited literacy is a significant risk factor for misunderstanding and could contribute to racial disparities. Instructions should be written in a concise manner and standardized to ensure comprehension.Family medicine 11/2009; 41(10):715-21. · 0.85 Impact Factor
Conference Paper: Channel cracking in low-k films on patterned multi-layers[Show abstract] [Hide abstract]
ABSTRACT: This paper considers cracking of a low-k tensile film fabricated on top of a patterned multilayer. A finite element model has been established to study all the geometry effects of the top film and underlying layers. It is found that the driving force for film cracking, as calculated from the energy release rate, is greatly enhanced by the underlying layers of copper and low-k materials. The geometry dependence has been verified by a test structure. The results indicate that a low-k film that is intact when deposited on silicon may crack when integrated in a multilayer BEOL. IBM has successfully engineered a CVD SiCOH low-k film with reduced film stress and increased modulus without degrading the cohesive strength (or the dielectric constant). Accordingly, cracking of the film has been prevented even for the worst case interconnect structures.Interconnect Technology Conference, 2004. Proceedings of the IEEE 2004 International; 07/2004
- [Show abstract] [Hide abstract]
ABSTRACT: Prior to deciding to propose in 2006 that the National Numeracy Network (NNN) publish a new journal for quantitative literacy with their support, the University of South Florida Libraries investigated the publication environment of the field on the Web of Science®. Reproducing part of that study in this paper, we present findings from topic searches (March 2008) for "numeracy," "quantitative literacy," and "statistical literacy." These updated results include a combined bibliography of 338 peer-reviewed articles amongst 210 different journals, by 748 authors from 321 institutions in 25 countries, in a total of 87 subjects (34% of the subject classes in Web of Science). Publication dates indicate exponential growth since 1974, with a doubling time of 4.8 years. Citation patterns argue that the field would benefit from the development of a hub journal. With the exception of citation-connected papers in medicine, health science and public health (21% of the collection), the papers of the bibliography are either completely isolated (54%) on a citation graph or in relatively small, weakly connected clusters. Very few are cited in prominent edited volumes associated with the NNN. In keeping with the concept that this journal will become a hub journal for the field as envisioned by the proposal from the USF Libraries, this paper presents the bibliography as well as a link and guide to an online version of the Histcite® citation graph where readers can browse the abstracts.07/2008; DOI:10.5038/1936-46220.127.116.11