The influence of task environment and health literacy on the quality of parent-reported ADHD data
04 November 2011
accepted: 11 January 2012
16 December 2017 (online)
Objectives: To determine 1) the extent to which paper-based and computer-based environments influence the sufficiency of parents’ report of child behaviors and the accuracy of data on current medications, and 2) the impact of parents’ health literacy on the quality of information produced.
Methods: We completed a randomized controlled trial of data entry tasks with parents of children with Attention Deficit Hyperactivity Disorder (ADHD). Parents completed the NICHQ Vanderbilt ADHD screen and a report of current ADHD medications on paper or using a computer application designed to facilitate data entry. Literacy was assessed by the Test of Functional Health Literacy in Adults (TOFHLA). Primary outcomes included sufficient data to screen for ADHD subtypes and accurate report of total daily dose of prescribed ADHD medications.
Results: Of 271 parents screened, 194/271 were eligible and 182 were randomized. Data from 180 parents were analyzed. 5.6% parents had inadequate/marginal TOFHLA scores. Using the computer, parents provided more sufficient and accurate data compared to paper (sufficiency for ADHD screening, paper vs. computer: 87.8% vs. 93.3%, P = 0.20; accuracy of medication report: 14.3% vs. 69.4%; p<0.0001). Parents with adequate literacy had increased odds of reporting sufficient and accurate data (sufficiency for ADHD screening: OR 8.0, 95% CI 2.0–32.1; accuracy of medication report: OR 4.4, 95% CI 0.5–37.4). In adjusted models, the computer task environment remained a significant predictor of accurate medication report (OR 18.7, 95% CI 7.5–46.9).
Conclusions: Structured, computer-based data entry by parents may improve the quality of specific types of information needed for ADHD care. Health literacy affects parents’ ability to share valid information.
- 1 Committee on Quality Improvement, Subcommittee on ADHD. Clinical practice guideline: Diagnosis and evaluation of the child with attention-deficit/hyperactivity disorder. Pediatrics 2000; 105 (05) 1158-1170.
- 2 Committee on Quality Improvement, Subcommittee on ADHD. Clinical practice guideline: Treatment of the school-aged child with attention-deficit/hyperactivity disorder. Pediatrics 2001; 108 (04) 1033-1044.
- 3 Gephardt H. Where we are, and how we can succeed, at treating ADHD. Contemporary Pediatrics. 2003 20. 77.
- 4 Committee on Health Literacy. Health literacy: A prescription to end confusion. Washington, DC; 2004
- 5 Rothman RL, Yin HS, Mulvaney S, Co JPT, Homer C, Lannon C. Health literacy and quality: Focus on chronic illness care and patient safety. Pediatrics 2009; 124 (Suppl. 03) S315-S326.
- 6 Sanders LM, Shaw JS, Guez G, Baur C, Rudd R. Health literacy and child health promotion: Implications for research, clinical care, and public policy. Pediatrics 2009; 124 (Suppl. 03) S306-S314.
- 7 Wolf MS, Davis TC, Parker RM. Editorial: the emerging field of health literacy research. American Journal of Health Behavior 2007; 31: S3-S5.
- 8 Rushton JL, Fant KE, Clark SJ. Use of practice guidelines in the primary care of children with attention-deficit/hyperactivity disorder. Pediatrics 2004; 114 (01) e23-e28.
- 9 Epstein JN, Langberg JM, Lichtenstein PK, Mainwaring BA, Luzader CP, Stark LJ. Community-wide intervention to improve the attention-deficit/hyperactivity disorder assessment and treatment practices of community physicians. Pediatrics 2008; 122 (01) 19-27.
- 10 Wolraich ML, Bard DE, Stein MT, Rushton JL, O’Connor KG. Pediatricians’ attitudes and practices on ADHD before and after the development of ADHD pediatric practice guidelines. Journal of Attention Disorders 2010; 13 (06) 563-572.
- 11 Leslie LK, Weckerly J, Plemmons D, Landsverk J, Eastman S. Implementing the American Academy of Pediatrics attention-deficit/hyperactivity disorder diagnostic guidelines in primary care settings. Pediatrics 2004; 114 (01) 129-140.
- 12 Breen G, Wan TTH, Zhang NJ, Marathe SS, Seblega BK, Paek SC. Improving doctor-patient communication: examining innovative modalities vis-a-vis effective patient-centric care management technology. Journal of Medical Systems 2009; 33 (02) 155-162.
- 13 Groshek M. Clinical information system (CIS) baselets help standardize evaluation of ADHD in the KP Colorado region. The Permanente Journal 2002; 6 (04) 65-68.
- 14 Lozano P. Using hand-held technologies to reduce errors in ADHD care. AHRQ; 2001
- 15 Co JPT, Johnson SA, Poon EG, Fiskio J, Rao SR, Cleave JV. et al. Electronic health record decision support and quality of care for children with ADHD. Pediatrics 2010; 126 (02) 239-246.
- 16 Porter CS, Guo C-Y, Bacic J, Chan E. Health literacy and task environment influence parents’ burden for data entry on child-specific health information: Randomized controlled trial. J Med Internet Res 2011; 13 (01) e13.
- 17 Parker RM, Baker DW, Williams MV, Nurss JR. The test of functional health literacy in adults: a new instrument for measuring patients’ literacy skills. J Gen Intern Med 1995; 10 (10) 537-541.
- 18 Wolraich ML, Lambert W, Doffing MA, Bickman L, Simmons T, Worley K. Psychometric properties of the Vanderbilt ADHD diagnostic parent rating scale in a referred population. Journal of Pediatric Psychology 2003; 28 (08) 559-568.
- 19 Caring for children with ADHD: A resource toolkit for clinicians. Elk Grove Village, IL:: American Academy of Pediatrics; 2002
- 20 Sox CM, Gribbons WM, Loring BA, Mandl KD, Batista R, Porter SC. Patient-centered design of an information management module for a personally controlled health record. Journal of Medical Internet Research 2010; 12 (03) e36-e.
- 21 Biederman J, Faraone SV, Monuteaux MC, Grossbard JR. How informative are parent reports of attention-deficit/hyperactivity disorder symptoms for assessing outcome in clinical trials of long-acting treatments? A pooled analysis of parents and teachers reports. Pediatrics 2004; 113 (06) 1667-1671.
- 22 Brown RT, Amler RW, Freeman WS, Perrin JM, Stein MT, Feldman HM. et al. Treatment of attention-deficit/hyperactivity disorder: Overview of the evidence. Pediatrics 2005; 115 (06) e749-e757.
- 23 Unertl KM, Weinger MB, Johnson KB, Lorenzi NM. Describing and modeling workflow and information flow in chronic disease care. Journal of the American Medical Informatics Association 2009; 16 (06) 826-836.
- 24 Power TJ, Mautone JA, Manz PH, Frye L, Blum NJ. Managing attention-deficit/hyperactivity disorder in primary care: A systematic analysis of roles and challenges. Pediatrics 2008; 121 (01) e65-e72.
- 25 Singh H, Naik AD, Rao R, Petersen LA. Reducing diagnostic errors through effective communication: harnessing the power of information technology. Journal of General Internal Medicine 2008; 23 (04) 489-494.
- 26 Singh H, Thomas EJ, Khan MM, Petersen LA. Identifying diagnostic errors in primary care using an electronic screening algorithm. Arch Intern Med 2007; 167 (03) 302-308.
- 27 Yin HS, Johnson M, Mendelsohn AL, Abrams MA, Sanders LM, Dreyer BP. The health literacy of parents in the United States: A nationally representative study. Pediatrics 2009; 124 (Suppl. 03) S289-S298.
- 28 Porter SC, Kohane IS, Goldmann DA. Parents as partners in obtaining the medication history. Journal of the American Medical Informatics Association 2005; 12 (03) 299-305.