Introduction: The growing literature on improving pediatric quality of care has highlighted the gaps in quality by socioeconomic status. Literacy may be an important factor within the relationship between socioeconomic status and quality healthcare. As young children depend on their parents for healthcare services, we hypothesized that low parental literacy would be associated with poor well-child healthcare. Methods Our design was a cross-sectional survey using face-to-face interviews of caregivers of 1-4 year old children in a pediatric resident clinic in the Southeast. We used the Rapid Estimate of Adult Literacy in Medicine to assess parental literacy and four subscales relevant to either provider-parent relationships or content of discussions in the well-child visit from the Promoting Healthy Development Survey to assess the quality of the well-child appointment. Results The mean age of the 150 respondents was 30 years, 56% were African American, 68% received Medicaid, and 86% graduated high school. Thirty-four percent of the respondents scored below a 9th grade reading level (low literacy). Parents with low-literacy were more likely than those with normal or high literacy to report family centered care (55% versus 27%, p=0.001 ), and helpfulness and confidence (84% versus 56%, p<0.001 ). There was no difference, by literacy level, in the mean percent of family well-being topics discussed or the mean percent of anticipatory guidance topics for which the parents had their informational needs met. Discussion The low-literacy respondents reported higher quality than the normal/high literacy group regarding relationships and there was no difference in quality by literacy level regarding content of discussions. Potential mechanisms for the difference between low and high literacy groups include that parents with low-literacy may have lower expectations regarding relationships with their healthcare provider or pediatric residents may be more effective at relationship building with low-literacy families.Master of Public Healt
