UCLA

Objective: Child health outcomes depend on a parent's ability to read, communicate, analyze, and use health information to participate in their child's care. Low maternal health literacy (HL) may disrupt access to pediatric health care, impede informed parent decision-making, and exacerbate pediatric health disparities. This dissertation explores relationships between maternal (HL), maternal self-efficacy (SE) in communication, interpersonal interactions with health care providers (HCPs), and maternal perception of quality of pediatric ambulatory care.

Methods: This cross-sectional, correlational study of low-income Latina mothers (n = 124) of children 3 months to 4 years examined relationships between socio demographic characteristics, maternal HL (Newest Vital Sign), social support (Family Support Scale), self-efficacy in communications with providers (Perceived Efficacy in Patient-Physician Interactions), interpersonal interactions with HCPs (Interpersonal Processes of Care in Diverse Populations Survey) and maternal perception of quality of pediatric ambulatory care (Promoting Healthy Development Survey).

Results: Data revealed maternal HL to be a complex construct associated with multiple socio-demographic characteristics including social support, cultural and linguistic factors. Although maternal HL and self-efficacy (SE) were not significantly related, important relationships between maternal SE and informal support, and maternal SE and the communication subscale, "elicits concerns," were identified. Overall, maternal HL was related to the successful transmission of anticipatory guidance, the delivery of family centered care and the helpfulness of information provided, but it contributed far less to the quality variables than anticipated. Conversely, maternal-HCP interpersonal processes were substantially related to maternal perception of quality of pediatric ambulatory care. Moreover, effective interpersonal processes between these mothers and their child's HCP significantly predicted each mother's perception of the quality of pediatric ambulatory health care received.

Conclusions: Maternal HL may be a more dynamic concept than previously understood. This study reveals the substantial role that interpersonal processes play in the mother-HCP exchange. "Speaking with clarity," "explaining results fully" and "working with a parent" to determine a child's plan of care is most predictive of whether a mother feels that her child is receiving quality ambulatory care services. Clarifying the relationships between these variables is an important step towards understanding how these factors impact maternal interaction with the health care system and influence pediatric health disparities.