Developing an Implementation Strategy for Post-concussion Communication With Low Health Literacy Parents in the Emergency Department
Condition: Concussion, Brain
MeSH terms: Brain Concussion; Emergencies
Study type: Interventional

Summary: 
      Investigators will conduct a hybrid implementation-effectiveness evaluation of an
      implementation toolkit that supports communication with families post-concussion in the
      emergency department. Primary outcomes will be parent self-report of specific concussion
      management behaviors two weeks post-visit. Investigators will also explore whether successful
      implementation is associated with (1) improved parent knowledge and self-efficacy related to
      helping their child adhere to CDC guidelines for returning to daily activities, school and
      sports, and (2) decreased disparity in knowledge and self-efficacy between high and low
      health literacy parents.
    

Detailed description: 
      Parents can play an important role in evidence-based concussion management by (1) monitoring
      their child's activity and level of stimulation, (2) communicating with school personnel
      about potential need for short-term academic accommodations, and (3) ensuring their child
      does not return to contact or collision sport prematurely and risk greater injury. However,
      not all parents follow these evidence-based guidelines, in part due to health literacy
      deficits, and further compounded by the poor fit and inconsistent implementation of
      educational materials. The initial medical encounter following a concussion provides an
      important opportunity for evidence-based knowledge translation to parents. Families at risk
      of low health literacy most often seek initial post-concussion care in emergency departments
      (ED) and often do not follow-up with a primary care provider or concussion specialist.
      Knowledge translation to parents in the ED is often inconsistent in terms of content and
      delivery, and existing approaches often do not meet the needs of families with low health
      literacy. The Agency for Healthcare Research and Quality's (AHRQ) Re-Engineered Discharge
      (RED) Toolkit provides an evidence-based approach to supporting the implementation of parent
      education that has not as yet been adapted for use post-concussion in the ED setting.
      Investigators will work with stakeholders to develop toolkit to support evidence-based parent
      education post-concussion in the ED. Guided by the Consolidated Framework for Implementation
      Research, investigators will adapt the AHRQ RED Toolkit to facilitate post-concussion parent
      education in the ED. The evidence-based parent education to be shared will be an asynchronous
      text-based intervention, adapted to meet learning needs of parents with low health literacy
      and limited English proficiency. Investigators will use parent and provider interviews to
      iteratively develop the implementation toolkit in consultation with an advisory board
      comprised of parents. The clinical trial component of the study will be a hybrid
      implementation-effectiveness evaluation of the educational intervention. Primary outcomes
      will be parent self-report of specific concussion management behaviors two weeks post-visit.
      Investigators will also explore whether successful implementation is associated with (1)
      improved parent knowledge and self-efficacy related to helping their child adhere to CDC
      guidelines for returning to daily activities, school and sports, and (2) decreased disparity
      in knowledge and self-efficacy between high and low health literacy parents. Achieving these
      aims will result in a scalable approach to the implementation of the developed parent
      education toolkit in the pediatric ED post-concussion. If parents are better able to follow
      evidence-based guidelines for concussion, they will better advocate and care for their
      children, and this should improve outcomes for all youth. More broadly, achieving these aims
      will provide a model for engaging low health literacy parents in adapting evidence-based
      educational practices for implementation in ED settings.
    

Intervention name(s): Post-concussion education for families
Intervention type(s): Behavioral
Intervention description(s): An educational resource for families will be developed based on the CDC guidelines for returning to daily activities, school, and sports, adapted with stakeholder feedback to meet the learning needs of low health literacy parents. An implementation toolkit will be developed, adapting the AHRQ RED Toolkit, to support communication about the educational resource and other best-practices for communication with families, including low health literacy families.
Allocation: Randomized
Intervention model: Sequential Assignment
Intervention model description: Consecutive cohort design with randomization
Masking: None (Open Label)
Primary purpose: Health Services Research