Health literacy and language impact comprehension of and adherence to written educational materials, including those for gastrostomy tubes (g-tubes). Our objective was to evaluate the readability, understandability, actionability, content, and language availability of a national sample of written g-tube educational materials. We conducted a cross-sectional study of g-tube educational materials from top 20 children’s hospitals (US News and World Report) obtained via a systematic online search and provided by the institutions. We assessed material: (1) readability, (2) understandability and actionability (Patient Education Materials Assessment Tool for Printable Materials, (3) content, and (4) language availability. Mean (standard deviation [SD]) reading grade level was 8.3 (1.9). Mean (SD) understandability and actionability scores were 81.6% (12.1%) and 65.9% (23.2%), respectively. Materials covered a mean (SD) of 46.1% (25.3%) of content items; 20% of institutions provided materials in non-English languages. Future research should examine how to improve educational materials for children with g-tubes.
CohenEKuoDZAgrawalR, et al. Children with medical complexity: an emerging population for clinical and research initiatives. Pediatrics. 2011;127(3):529-538. doi:10.1542/peds.2010-0910.
2.
GlickAFFarkasJSMagroJ.Management of discharge instructions for children with medical complexity: a systematic review. Pediatrics. 2023;152(5):2023061572. doi:10.1542/peds.2023-061572/1540168/peds.2023-061572.pdf.
3.
BerryJToomeySZaslavskyA.Pediatric readmission prevalence and variability across hospitals. JAMA. 2013;309:372-380. doi:10.1001/jama.2012.188351.
4.
MarkhamJLHallMGoldmanJL, et al. Readmissions following hospitalization for infection in children with or without medical complexity. J Hosp Med. 2021;16(3):134-141. doi:10.12788/jhm.3505.
5.
JafariKCarlinKCaglarDKleinEJSimonTD.National characteristics of emergency care for children with neurologic complex chronic conditions. West J Emerg Med. 2024;25(2):237-245. doi:10.5811/westjem.17834.
6.
BerryJGAgrawalRKuoDZ, et al. Characteristics of hospitalizations for patients who use a structured clinical care program for children with medical complexity. J Pediatr. 2011;159(2):284-290. doi:10.1016/j.jpeds.2011.02.002.
7.
NackersAEhlenbachMKellyMMWernerNWarnerGCollerRJ.Encounters from device complications among children with medical complexity. Hosp Pediatr. 2019;9(1):6-15. doi:10.1542/hpeds.2018-0103.
8.
ParsHSoyerT.Home gastrostomy feeding education program: effects on the caregiving burden knowledge, and anxiety level of mothers. JPEN J Parenter Enteral Nutr. 2020;44(6):1029-1037. doi:10.1002/jpen.1747.
9.
SchweitzerMAucoinJDochertySLRiceHEThompsonJSullivanDT.Evaluation of a discharge education protocol for pediatric patients with gastrostomy tubes. J Pediatr Health Care. 2014;28(5):420-428. doi:10.1016/j.pedhc.2014.01.002.
10.
BecerraBJAriasDBecerraMB.Low health literacy among immigrant Hispanics. J Racial Ethn Health Disparities. 2017;4(3):480-483. doi:10.1007/s40615-016-0249-5.
11.
GlickAFFarkasJSMendelsohnAL, et al. Discharge instruction comprehension and adherence errors: interrelationship between plan complexity and parent health literacy. J Pediatr. 2019;214:193-200. doi:10.1016/j.jpeds.2019.04.052.
12.
StringerTYinHSGittlerJCurtissPSchneiderAOzaVS.The readability, suitability, and content features of eczema action plans in the United States. Pediatr Dermatol. 2018;35(6):800-807. doi:10.1111/pde.13682.
13.
ChhabraRChisolmDJBayldonB, et al. Evaluation of pediatric human papillomavirus vaccination provider counseling written materials: a health literacy perspective. Acad Pediatr. 2018;18(2S):S28-S36. doi:10.1016/j.acap.2017.08.004.
14.
KarlinerLSAuerbachANápolesASchillingerDNickleachDPérez-StableEJ.Language barriers and understanding of hospital discharge instructions. Med Care. 2012;50(4):283-289. doi:10.1097/MLR.0b013e318249c949.
YinHSGuptaRSTomopoulosS, et al. Readability, suitability, and characteristics of asthma action plans: examination of factors that may impair understanding. Pediatrics. 2013;131(1):e116-e126. doi:10.1542/peds.2012-0612.
ShoemakerSJWolfMSBrachC.Development of the patient education materials assessment tool (PEMAT): a new measure of understandability and actionability for print and audiovisual patient information. Patient Educ Couns. 2014;96(3):395-403. doi:10.1016/j.pec.2014.05.027.
MundiMSMohamed ElfadilOOlsonDA, et al. Home enteral nutrition: a descriptive study. JPEN J Parenter Enteral Nutr. 2023;47(4):550-562. doi:10.1002/jpen.2498.
21.
EvansSPrestonFDalyAAshmoreCHoldenCMacDonaldA.Home enteral tube feeding in children with inherited metabolic disorders: a review of long-term carer knowledge and technique. J Hum Nutr Diet. 2012;25(6):520-525. doi:10.1111/j.1365-277X.2012.01274.x.
22.
ZhangALiCXRPiperMRoseJChenKLinAY.ChatGPT for improving postoperative instructions in multiple fields of plastic surgery. J Plast Reconstr Aesthet Surg. 2024;99:201-208. doi:10.1016/j.bjps.2024.08.065.
23.
UnakaNStatileAJerardiK, et al. Improving the readability of pediatric hospital medicine discharge instructions. J Hosp Med. 2017;12(7):551-557. doi:10.12788/jhm.2770.
24.
YinHSDreyerBPvan SchaickLFoltinGLDinglasCMendelsohnAL.Randomized controlled trial of a pictogram-based intervention to reduce liquid medication dosing errors and improve adherence among caregivers of young children. Arch Pediatr Adolesc Med. 2008;162(9):814-822. doi:10.1001/archpedi.162.9.814.
25.
CasciatoDBykowskiAJosephNMendicinoR.Readability, understandability, and actionability of online limb preservation patient education materials. J Foot Ankle Surg. 2023;62(4):727-730. doi:10.1053/j.jfas.2023.03.003.
26.
MastroianniFChenYCVellarL, et al. Implementation of an organisation-wide health literacy approach to improve the understandability and actionability of patient information and education materials: a pre-post effectiveness study. Patient Educ Couns. 2019;102(9):1656-1661. doi:10.1016/j.pec.2019.03.022.
27.
HeermanWJRothmanRLSandersLM, et al. A digital health behavior intervention to prevent childhood obesity: the greenlight plus randomized clinical trial. JAMA. 2024;332:2068-2080. doi:10.1001/jama.2024.22362.
28.
WernerNEFleischmanAWarnerG, et al. Feasibility testing of tubes@HOME: a mobile application to support family-delivered enteral care. Hosp Pediatr. 2022;12(7):663-672. doi:10.1542/hpeds.2022-006532.
29.
SaatçiGKorkutSÜnsalA.The effect of the use of artificial intelligence in the preparation of patient education materials by nursing students on the understandability, actionability and quality of the material: a randomized controlled trial. Nurse Educ Pract. 2024;81:104186. doi:10.1016/j.nepr.2024.104186.
AedlaMZhouASompelK, et al. A study of postoperative complications occurring at home with pediatric gastrostomy feeding tubes. J Pediatr Gastroenterol Nutr. 2022;75(1):30-35. doi:10.1097/MPG.0000000000003474.
32.
JeffriesKNMundyAWillifordDESlagleBFilipekJCantuRM.Impact of preferred written language in patients discharged with bronchiolitis from a children’s hospital. Hosp Pediatr. 2024;14(3):e139-e143. doi:10.1542/hpeds.2023-007241.
33.
RajbhandariPGlickAFBrownMFVanGeestJ.Linguistic services for hospitalized children with non-English language preference: a PRIS network survey. Hosp Pediatr. 2023;13(3):191-200. doi:10.1542/hpeds.2022-006906.
34.
PalauMAMeierMRBrintonJTHwangSSRooseveltGEParkerTA.The impact of parental primary language on communication in the neonatal intensive care unit. J Perinatol. 2019;39(2):307-313. doi:10.1038/s41372-018-0295-4.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
