Carol J. Howe

Graduation Semester and Year




Document Type


Degree Name

Doctor of Philosophy in Nursing



First Advisor

Judy LeFlore


The association between low health literacy and poor patient-provider communication has been well established in adult patients. Little pediatric research has been reported on the relationship between parent health literacy and parent-provider communication. This mixed methods study examined and explored how parent health literacy affected the communication process with diabetes educators in a pediatric diabetes clinic. This study used the Conceptual Framework of Provider Patient Communication as a theoretical framework. Health literacy was measured with the Rapid Estimate of Adult Health Literacy in Medicine. Quality of communication was assessed with quantitative and qualitative methods using 5 subscales of the Interpersonal Processes of Care Survey and semi-structured interviews. A convenience sample of 162 parents attending Diabetes Clinic with their child completed the survey and a subsample of 24 parents (13 adequate health literacy/11 low health literacy) participated in a semi-structured interview. Eighteen and a half percent of parents were assessed as having low health literacy. Parents' report of poor communication ranged from 6-38% across the 5 Interpersonal Processes of Care subscales (general clarity, explanations of diabetes, explanations of diabetes care, eliciting concerns, decision-making). Statistical analyses found a positive association between health literacy and general clarity but no associations between health literacy and the four other communication outcomes. Directed content analysis of interviews revealed the similarities and differences for communication processes for parents with low and those with adequate health literacy. Parents with low health literacy were confused with diabetes jargon and wanted information to be communicated in simple language, broken down into key points and repeated. Low health literate parents preferred hands-on teaching strategies. Parents with adequate health literacy wanted comprehensive information, provided at a parent-driven pace, and communicated through ongoing dialogue. All parents discussed the need for diabetes educators to understand their other life stressors and to have an encouraging tone during interactions. These findings suggest that diabetes educators need training in clear communication techniques and have opportunities to implement various teaching strategies and to develop learner-driven, problem-based diabetes curriculums.


Medicine and Health Sciences | Nursing


Degree granted by The University of Texas at Arlington

Included in

Nursing Commons