Families with low income and/or limited English proficiency (LEP) experience multiple communication- and comprehension-related barriers to receiving high quality, safe, and effective medical care when their children are ill. Limited education and low literacy also contribute, leading to difficulties understanding and implementing discharge instructions. Few system-based interventions exist to improve discharge instruction comprehension and most that exist rely on some combination of reading ability, health literacy, and English language skills, limiting their ability to reach the families most at risk for poor understanding and adverse outcomes. Paper-based, audio-recordable greeting cards offer a low-tech, inexpensive, and readily available approach to addressing comprehension-based disparities. Cards can be shared with multiple caregivers, including those not present at discharge, and can remain with the ill child for quick reference. The overall goal of this study is to determine the feasibility, acceptability, and potential effect of the RECORD-ED intervention, which consists of usual care augmented by a card with audio-recorded instructions in the parent's preferred language for care (English or Spanish). The recorded instructions were developed collaboratively with parents and clinical personnel, to ensure the information is useful and culturally and linguistically tailored. The goal is to improve parent comprehension, recall, and implementation of discharge instructions, as families transition from care in the emergency department (ED) to managing the child's medical care at home.
The specific aims of the study are to: 1) test the feasibility, acceptability, and potential effectiveness of the RECORD-ED intervention for improving parent, child, and utilization outcomes among low-income children with asthma and their parents, with and without LEP; and 2) characterize parent and provider experience with the RECORD-ED intervention, to inform future implementation. To accomplish these aims, the investigators propose a pilot randomized controlled trial, enrolling 100 families of children with asthma being discharged home from Seattle Children's Hospital ED. Families will be contacted to complete telephone or email surveys two days, one week, and three months after ED discharge. Intervention feasibility and acceptability will be primary outcomes, as recommended for pilot studies. Potential effectiveness will be determined by assessing for clinically important differences in instruction recall, medication adherence, comfort with home care, quality of life, primary care follow-up, asthma control, and 3-month re-utilization between assigned study arms, in an intention-to-treat analysis. Providers and nurses will be surveyed regarding intervention acceptability and perceived effect. Parents and nurses will be interviewed to understand experiences using the card-based instructions. Study results will inform a multi-site R01 proposal to rigorously determine the effect of the RECORD-ED intervention on parent comprehension, adherence to discharge instructions, and child asthma control and healthcare utilization.
Families with low income and/or limited English proficiency experience multiple communication- and comprehension-related barriers to receiving high quality, safe, and effective medical care when their children are ill. This project will test the feasibility, acceptability, and potential effect of the RECORD-ED intervention, in which audio-recorded, language-concordant discharge instructions will be provided on a greeting card-style card, to provide an innovative yet low-tech tool to overcome language and literacy barriers and improve outcomes following acute-care visits for vulnerable children. Ultimately, this line of research has the potential to provide a low-cost intervention, readily adaptable to multiple conditions and sites of care, to address communication-based healthcare disparities.