What To Do When Your Child Gets Sick Summary

Method
Participants
Participants that were included in this study were English and Spanish speaking parents who lived in Rutherford County, TN. These parents attended a free health literacy training at a Head Start and Title-I elementary school where their child attended (n = __ parents, n = __ children). Training took place at two separate locations. Students at Middle Tennessee State University participated as trained instructors’ as part of a service learning course and engaged in administering the REALM-SF test to screen participant health literacy and teach how to utilize the book, What to Do When Your Child Gets Sick, which is a easy to read low literacy medical reference guide. These families are low income at risk populations that are

qualified for free or reduced meals for children due to being economically disadvantaged. Participants ages ranged from __ to __. __% of participants spoke English and __% spoke Spanish. __% of participants did not have health books at home. Participants are enrolled in the training through the Head Starts and Title-I elementary schools as a requirement. Parents are compensated through a free dinner, points for child’s class, and a free book for both the parent and child regarding basic health information. Attendance was recorded at the beginning and end of the session.

Materials

REALM-SF. Health literacy was screened with the Rapid Estimate of Adult Literacy in Medicine – Short Form (REALM-SF; Arozullah et al., 2007). The REALM-SF is an assessment tool that involves a short reading pronunciation of a seven word list of medical terminology. The total score of the correctly pronounced words was used to measure the participants reading levels. The number of correct medically pronounced words in Arozullah et al. (2007) study sample group ranged from 0 to 7 (M = 5.8, SD = 1.9). The levels were based upon four categories which consisted of: “3rd grade or less (0 correct), 4th-6th grade (1-3 correct), 7th-8th (4-6 correct), and 9th grade or higher (7 correct)” (Arozullah et al., 2007). The other instrument used was a Spanish version word pronunciation test that was created by an experimenter that required using seven Spanish words that were selected from SAHLSA-50 for Spanish speakers. The seven words used were “gripe, asma, pastilla, estres, cafeina, osteoporosis, y alcholismo”, which translates to flu, asthma, pill, stress, caffeine, osteoporosis, and alcoholism (Lee, Bender, Ruiz, & Cho, 2006). The test was given by trained interviewers in written and oral form to assess health literacy.

What-If Test of Health Knowledge. Health knowledge was measured with a “What-If” questionnaire that presented theoretical medical situations to parents regarding their child. The questionnaire originated in the Herman and Jackson (2010) parental valuation, which was a 16-item questionnaire survey that was used to detect parents’ confidence and knowledge in health-related concerns. The alterations that were made by previous classes in our “What-If” Test of Health Knowledge was shortened to a nine-question survey based on Herman and Jackson’s (2010) exam. Parents were asked to choose a treatment option that included them to treat their child at home, to call a Doctor, visit the ER or call 911. These questions are based on questions of the three levels of treatment (Child Safety, Common Childhood Illness, and Accidents and Injuries). The “what if” questionnaire was given in both English and Spanish for parents.

Comprehension Activities. All comprehension activities were completed with assistance from a trainer during a 90-minute training session that covered topics concerning Child Safety, Childhood Illnesses, and Accidents and Injuries. The college students were trained by the materials assigned by the Institute for Healthcare Advancement that was made to accompany the book What to Do When Your Child Gets Sick. The manual contained interactive activities for parents to answer regarding the book. The content was modified in our research questionnaires and by adding page number blanks so progress can be measured. Four activity sheets were created for parents to answer yes and no questions along with blanks so they can record the page number where they found the answers. The first three activities covered child-safety, childhood illnesses (fever, stomach aches), and injury and accidents. The last activity was a post-test, which was completed individually by parents using their books to answer questions about children’s health with no help.

Title I elementary school and Head Start parents and children were educated through English and Spanish speaking students on how to properly manage health care needs to decrease in ER visits and doctor visits through the use of books.

The parents were given What to Do When Your Child Gets Sick, which written Gloria G. Mayer, RN, and Ann Kuklierus, RN (2004) as a low literacy medical reference guide to parents. This health book is an easy-to-read self-help book published by burses at the Institute for Healthcare Advancement (IHA; Mayer & Kuklierus, 2004). This book is made for readers with low health literacy written at a third grade reading level available in English as well as Spanish. It offers parents easy to understand information on common childhood medical problems. The children were given Happy, Healthy Ajay!, which is written by Stuart J. Murphy. This book was designed for children to learn healthy habits about nutrition and staying active through a visual and educational way. Head Start parents and children were educated through both English and Spanish speaking students on how to properly manage health care needs to decrease in ER visits and doctor visits through the use of these books by adding interactive activities, questionnaires, and hands on

activities.

Procedure
The participants were tested in a field setting which was located in a Head Start.

Training was conducted at a third-grade reading level and was offered in both English and Spanish to parents. Students administered the test in oral and written form to the participants. Informed consent was taken in this study before administering the exam to the sample group. The data was gathered through a shortened, validated health literacy test named REALM-SF during registration. Participant’s health literacy level was determined through the REALM-SF sheet where parents read aloud the provided medical dictionary word to the interviewer. Following the pronunciation, the interviewer would then check off whether the word was correct, incorrect or mispronounced. The recorded number of overall correctly pronounced words then determined the participant’s health literacy reading level. If participants missed more than three items, an instructor will be assigned to help them complete paperwork. This assessment tool takes about 2-3 minutes to administer which is a fast amount of time to effectively determine an individual's health literacy. The health content that parents were educated in was based on use of the health book, What to Do When Your Child Gets Sick, that was also accompanied with activities developed by the research

team.
The Children’s Program entailed children participating in age-related activities that were instructed by college students who focused on basic literacy skills and comprehension in educating them in healthy habits. Skill and understanding were enriched through the use of a book written by Stuart J. Murphy named, Happy, Healthy Ajay! This book addressed nourishment and staying active in a visual juvenile appropriate way. This was then followed by partner reading activities and comprehension through interactive hands-on games that trainers developed. Children got to keep and take home a new book home for free in order to reinforce reading and healthy habits at home.
The program was presented to parents of young children at Title-I Elementary schools and Head Start programs. English and Spanish parents attended a free health literacy training while children were participating in games in another room. The training for the program consisted of an hour shortened version of the training manual that was given in one night. Activities were revamped and were developed by the Middle Tennessee State research staff from original Arozullah et al., (2007) and Herman and (2000) assessment tools. Lesson training that was conducted by instructors who were college students at Middle Tennessee State University completing a service learning class. Students received training on how to teach these lessons by following the instructor’s manuals that the Institute for Healthcare Advancement published to accompany the What to Do When Your Child Gets Sick manual. These topics covered: Child Safety, Common Childhood Illness, and What to do for Accidents and Injuries. The trainers began with explaining how the book is formatted and structured, what it plans to accomplish, how to look up information, helped them use the book to identify when to go to the ER, when to call a doctor, and when to treat an illness or injury at home. Comprehension was taught in a group interaction set-up where trainers demonstrated and directed parents on how to use their books in answering questions and participating in learning about children’s health. Progress was measured through activity sheets where parents answered yes / no questions and recorded the page number where they found the answers. Parents were given activities so they can engage in using their books to answer questions about children’s health. Spanish training was conducted by fluent native speakers of Spanish in the same way with a Spanish version instructor manual from the Institute for Healthcare Advancement that accompanied What to Do When Your Child Gets Sick book.
The goal of this post-testing was done that night in order to determine whether or not the training helped parents, and to receive supplementary feedback on the usefulness of the training. Post-testing involved a “What If Knowledge” post questionnaire that involved parents to work independently in answering questions using the book. An Evaluation Form was also provided to ask about participant satisfaction of the book and training to help address whether parents found the training to be knowledgeable and helpful. Permission was also taken from participants regarding a three month follow up for the parents that participated in training so researchers can determine the usefulness of the book and upkeep of comprehension skills that were taught. Participants will be called three months after their Health Literacy Training to see if use the book helps detect conditions that could be treated at home instead of visiting the ER along with another comprehension test which requires parents to utilize the book to answer health related questions to provide researchers progress of families. We utilized three tools to assess the parental use of health care services and parent beliefs about their capabilities to care for their children’s health care needs before and after the training which were; the REALM-SF exam, Activity sheets that engaged in What to Do When Your Child Gets Sick book, and What If Knowledge pre and post test of health concerns.