Discharge Instruction Comprehension and Adherence Errors: Interrelationship Between Plan Complexity and Parent Health...

Area of Science:

• Pediatric Healthcare
• Health Literacy Research
• Patient Adherence Studies

Background:

• Effective inpatient discharge instructions are crucial for pediatric patient outcomes.
• Parental health literacy and discharge plan complexity are potential barriers to comprehension and adherence.
• Understanding these factors can inform interventions to improve post-discharge care.

Purpose of the Study:

• To investigate the relationship between parent health literacy, discharge plan complexity, and parent comprehension of and adherence to inpatient discharge instructions for children.
• To identify specific areas where comprehension and adherence errors are most common.

Main Methods:

• A prospective cohort study involving 165 parents of children aged ≤12 years discharged on daily medication.
• Data collection included parent surveys for comprehension and adherence, in-person dosing assessments, and chart reviews.
• Statistical analyses used generalized estimating equations to assess associations, controlling for covariates and exploring mediation/moderation.

Main Results:

• High error rates were observed in comprehending medication side effects (50%), adhering to medication doses (34%), and understanding return precautions (78%).
• Comprehension errors strongly correlated with adherence errors (aOR=8.7).
• Both discharge plan complexity (aOR=7.0 for comprehension, aOR=5.5 for adherence) and low parent health literacy (indirectly via comprehension) were associated with increased errors.

Conclusions:

• Parental health literacy and discharge plan complexity are significant factors influencing comprehension and adherence to pediatric discharge instructions.
• Low health literacy exacerbates comprehension and adherence issues, particularly when plans are complex.
• Interventions should be developed to support health literacy and simplify discharge processes.