Improving Discharge Instructions: Systematic Review of Language and Health Literacy Interventions

Effective pediatric inpatient discharge relies on clear, responsive communication to support safe transitions from hospital to home. Families who use a language other than English and those with lower health literacy experience disproportionate barriers during discharge, contributing to inequities in postdischarge outcomes. Despite recognition of these disparities, evidence guiding interventions remains fragmented.

To identify and evaluate interventions designed to address language and health literacy barriers in pediatric inpatient discharge, assess their impact on patient and caregiver outcomes, and examine methodological quality to inform best practices.

Ovid MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and the World Health Organization International Clinical Trials Registry Platform were searched from inception to June 2025. Eligible studies involved hospitalized pediatric patients and evaluated discharge interventions tailored to families' preferred language, reporting at least 1 discharge-related outcome. Ten studies met criteria. Two reviewers independently extracted data on study characteristics, interventions, and outcomes, and a narrative synthesis was completed because of heterogeneity. Risk of bias analysis was performed.

Included studies were heterogeneous in design, interventions, and outcomes, and all were conducted in the United States. Interventions varied substantially and were categorized into health literacy-focused written interventions, language-concordant interventions, multimodal communication strategies, and system-level or workflow-based interventions. Interventions combining language-concordant communication with literacy-informed, multimodal strategies demonstrated more consistent improvements in caregiver understanding. Methodological quality was limited, with substantial risk of bias across studies.

Language concordance alone is insufficient to ensure equitable pediatric discharge. Multimodal, literacy-informed strategies that apply universal precautions principles show greater promise but there is limited-quality evidence. Future research should prioritize rigorous designs, patient-centered outcomes, and meaningful family engagement.