Parental Health Literacy, Empowerment, and Advocacy for Food Allergy Safety in Schools: A Cross-Sectional Study.

BACKGROUND: Approximately 8% of elementary school-aged children in the United States have food allergies, a complicated health management situation that requires parents to use many types of health literacy, empowerment, and advocacy skills to work with school staff to protect their children. OBJECTIVE: This cross-sectional study examined (a) whether the highest versus lowest levels of functional, communicative, and critical health literacy are associated with higher perceived effectiveness of parental advocacy behaviors for safe food allergy management in schools [parental advocacy]; and (b) whether communicative and critical health literacy are more strongly associated with parental advocacy than functional health literacy. METHODS: A sample of parents of elementary school-aged children was recruited through 26 food allergy organizations and a research patient registry. Participants completed an anonymous online survey. Self-reported measurements of parental health literacy, empowerment, and advocacy were adapted and refined through pre-testing and pilot-testing. General linear model analyses were conducted to predict parental advocacy. KEY RESULTS: Participants (N = 313) were predominantly White, college-educated mothers with moderately high levels of food allergy knowledge, health literacy, empowerment, and parental advocacy skills. Parents who scored at the highest levels in the three dimensions of health literacy reported they engaged in more effective advocacy behaviors than parents who scored at the lowest levels. Parental advocacy was predicted largely by parental empowerment and the quality of the relationship with the school (B = .41 and B = .40, respectively). Functional health literacy and the child's diagnosis of asthma were smaller predictors. While accounting for covariates, functional health literacy was significantly associated with parental advocacy whereas communicative and critical health literacy were not. CONCLUSIONS: Interventions to impact parental empowerment and parent-school relationships, including a health-literate universal precautions approach of communicating food allergy school policies, may influence parental advocacy for food allergy safety in schools. Further research could use a performance-based multidimensional measure of health literacy. [HLRP: Health Literacy Research and Practice. 2023;7(3):e165-e175.].

PLAIN LANGUAGE SUMMARY: This online survey of parents of school-aged children in the U.S. examined health literacy predictors of effective parental advocacy behaviors for safe food allergy management in elementary schools. The results suggest that the parents' quality of their relationship with the school, parental empowerment, functional health literacy, and the child's diagnosis of asthma were associated with parents' reports of effective advocacy for food allergy safety, but communicative and critical health literacy were not.

International service learning enhances nurse practitioner students' practice and cultural humility.

Academic and health care institutions are charged with improving quality-of-care outcomes by creating culturally educated health care professionals to practice in a global health care environment. International short-term service learning experiences provide nurse practitioner students an opportunity to meet clinical competency skills aligned with course curricula. Faculty can directly observe students' clinical practice, and students broaden diagnostic reasoning skills while earning credit for clinical hours. As project and research ideas are formulated, students develop system-level thinking to implement evidence-based practices and disseminate their knowledge and experience of caring for the underserved. Students who participate in service-learning opportunities foster their awareness of cultural humility, easing transition into practice. Some academic institutions established short-term service-learning opportunities for students, and evidence supports faculty and students' sense of well-being after participation. We describe an example of a short-term, international service-learning opportunity in Haiti where students work with an interprofessional team and experience the effect of social determinants of health on delivering quality care.

Nurse Practitioners' Use of Communication Techniques: Results of a Maryland Oral Health Literacy Survey.

OBJECTIVES: We examined nurse practitioners' use and opinions of recommended communication techniques for the promotion of oral health as part of a Maryland state-wide oral health literacy assessment. Use of recommended health-literate and patient-centered communication techniques have demonstrated improved health outcomes. METHODS: A 27-item self-report survey, containing 17 communication technique items, across 5 domains, was mailed to 1,410 licensed nurse practitioners (NPs) in Maryland in 2010. Use of communication techniques and opinions about their effectiveness were analyzed using descriptive statistics. General linear models explored provider and practice characteristics to predict differences in the total number and the mean number of communication techniques routinely used in a week. RESULTS: More than 80% of NPs (N = 194) routinely used 3 of the 7 basic communication techniques: simple language, limiting teaching to 2-3 concepts, and speaking slowly. More than 75% of respondents believed that 6 of the 7 basic communication techniques are effective. Sociodemographic provider characteristics and practice characteristics were not significant predictors of the mean number or the total number of communication techniques routinely used by NPs in a week. Potential predictors for using more of the 7 basic communication techniques, demonstrating significance in one general linear model each, were: assessing the office for user-friendliness and ever taking a communication course in addition to nursing school. CONCLUSIONS: NPs in Maryland self-reported routinely using some recommended health-literate communication techniques, with belief in their effectiveness. Our findings suggest that NPs who had assessed the office for patient-friendliness or who had taken a communication course beyond their initial education may be predictors for using more of the 7 basic communication techniques. These self-reported findings should be validated with observational studies. Graduate and continuing education for NPs should increase emphasis on health-literate and patient-centered communication techniques to increase patient understanding of dental caries prevention. Non-dental healthcare providers, such as NPs, are uniquely positioned to contribute to preventing early childhood dental caries through health-literate and patient-centered communication.