Abstract B135: Health literacy disparities among Hispanic caregivers of children with newly diagnosed cancer
Authors: Martinez M. Elena , Aristizabal Paula , Perdomo Bianca , Durali Nassim , Nataraj Shilpa , Nodora Jesse 
Published: September 2020

Objective: Health literacy (HL) is the ability to understand process and act on health-related information to function effectively in a healthcare environment. Thirty-six percent of U.S. adults have limited HL and Hispanics have the lowest among all racial/ethnic groups. Individuals with limited HL have higher healthcare utilization and poorer health status. Caregivers of children with cancer must process complex information about the disease to effectively navigate the healthcare system. Research on HL in the pediatric cancer setting is lacking. We assessed HL in Hispanic and non-Hispanic White (NHW) caregivers (primarily parents) of children with newly diagnosed cancer and the correlation of different measures of HL among each other. Additionally, we assessed socio-demographic factors and acculturation levels in Hispanic caregivers as covariates. Methods: Sixty-one caregivers of children with cancer (ages 0-17 y), newly diagnosed at Rady Children’s Hospital-San Diego were enrolled. To assess HL, we used the English or Spanish form of the 1) Short-form of the Test of Functional Health Literacy Assessment (S-TOFHLA), 2) Newest Vital Sign (NVS), 3) Parental Health Literacy Activities Test (PHLAT), 4) Rapid Estimate of Adult Literacy in Medicine (REALM) or Short Assessment of Health Literacy for Spanish Adults (SAHLSA-50), and 5) Brief Health Literacy Screen (BHLS). To measure acculturation, we used the Hispanic Acculturation Questionnaire (SASH). Two-sample t-tests, univariate/multivariate linear regression, and Pearson-correlation analyses were used for statistical analysis. Results: Hispanic caregivers had significantly lower HL, as measured by the NVS, than NHWs (p&lt;0.001). In caregivers, lower HL levels (measured by the NVS and S-TOFHLA) were positively correlated with older age (p&lt;0.001), lower education level (p&lt;0.001), informal employment (p&lt;0.006), and Spanish primary language (p&lt;0.001). Additionally, S-TOFHLA was significantly correlated with NVS (p&lt;0.001). The odds of having adequate HL decreased by 94% in caregivers with low acculturation compared to caregivers with high acculturation (95% CI: 83%, 98%, p&lt; 0.001). Conclusion: We show significant differences in HL levels between Hispanic and NHW caregivers of children with newly diagnosed cancer. NVS was correlated with S-TOFLHA and could serve as a rapid assessment of HL in the clinical setting for caregivers. Cancer treatment is complex, involving intensive treatments, enrollment in clinical trials, and requiring advanced caregiver knowledge about the disease. By identifying caregivers with limited HL, we can help them navigate cancer therapy effectively. Future research should test culture and language-appropriate interventions, including the systematic use of teach-back, pictorial instruction, and patient navigation. Effective HL interventions may improve cancer care for underserved children and help mitigate disparities in outcomes.

Citation Format: M. Elena Martinez, Paula Aristizabal, Bianca Perdomo, Nassim Durali, Shilpa Nataraj, Jesse Nodora. Health literacy disparities among Hispanic caregivers of children with newly diagnosed cancer [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B135.