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          "@value": "Objectives: Parents with low health literacy (HL) are less likely to participate in shared decision-making with their child's provider. We explored associations between parents' HL and barriers to participation and clinical outcomes. Study design: We conducted a prospective cohort study using secondary survey and administrative data at a large pediatric hospital from 10/2014 through 12/2015. Parents of children admitted to a medical or surgical service who completed a two-phase survey were included. We used linear and logistic regression to estimate associations between low HL and patient outcomes (length of stay, unplanned readmission) and five parent-reported barriers, adjusting for confounders. Results: Of eligible families, 10.7% (391) had low HL. Children of parents with low HL stayed in the hospital 0.18 days longer than children of parents with adequate HL (95% CI=0.027-0.310) but were not more likely to experience unplanned readmission (OR=0.95; 95% CI=0.61-1.49). Parents with low HL had higher odds of cultural distance with their child's provider (OR=1.38; 95% CI=1.03-1.84). We found a possible association between low HL and system barriers (OR=1.33; 95% CI=0.95-1.86), physician distrust (OR=1.46; 95% CI=0.92-2.33), and better partnership (OR=0.65; 95% CI=0.40-1.06), though the magnitude remains uncertain. Low HL was not associated with distrust in the healthcare system after adjusting for covariates (OR=0.91; 95% CI=0.66-1.27). Conclusions: HL was associated with longer length of stay and several parent-reported barriers to care. Strategies that better engage low-HL families could increase involvement in shared decision-making by reducing cultural distance, system barriers, and distrust, and might thereby reduce length of stay. However, HL is not the only (or most important) barrier families face.",
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