Liquid Medication Dosing Errors by Hispanic Parents: Role of Health Literacy and English Proficiency

Leslie M. Harris, Benard P. Dreyer, Alan L. Mendelsohn, Stacy C. Bailey, Lee M. Sanders, Michael S. Wolf, Ruth M. Parker, Deesha A. Patel, Kwang Youn A. Kim, Jessica J. Jimenez, Kara Jacobson, Michelle Smith, H. Shonna Yin*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

57 Scopus citations


Objective Hispanic parents in the United States are disproportionately affected by low health literacy and limited English proficiency (LEP). We examined associations between health literacy, LEP, and liquid medication dosing errors in Hispanic parents. Methods Cross-sectional analysis of data from a multisite randomized controlled experiment to identify best practices for the labeling/dosing of pediatric liquid medications (SAFE Rx for Kids study); 3 urban pediatric clinics. Analyses were limited to Hispanic parents of children aged ≤8 years with health literacy and LEP data (n = 1126). Parents were randomized to 1 of 5 groups that varied by pairing of units of measurement on the label/dosing tool. Each parent measured 9 doses (3 amounts [2.5, 5, 7.5 mL] using 3 tools [2 syringes in 0.2 or 0.5 mL increments, and 1 cup]) in random order. Dependent variable was a dosing error of >20% dose deviation. Predictor variables included health literacy (Newest Vital Sign) (limited = 0–3; adequate = 4–6) and LEP (speaks English less than “very well”). Results A total of 83.1% made dosing errors (mean [SD] errors per parent = 2.2 [1.9]). Parents with limited health literacy and LEP had the greatest odds of making a dosing error compared to parents with adequate health literacy who were English proficient (trials with errors per parent = 28.8 vs 12.9%; adjusted odds ratio = 2.2 [95% confidence interval 1.7–2.8]). Parents with limited health literacy who were English proficient were also more likely to make errors (trials with errors per parent = 18.8%; adjusted odds ratio = 1.4 [95% confidence interval 1.1–1.9]). Conclusions Dosing errors are common among Hispanic parents; those with both LEP and limited health literacy are at particular risk. Further study is needed to examine how the redesign of medication labels and dosing tools could reduce literacy- and language-associated disparities in dosing errors.

Original languageEnglish (US)
Pages (from-to)403-410
Number of pages8
JournalAcademic Pediatrics
Issue number4
StatePublished - May 2017


  • health literacy
  • limited English proficiency
  • medication administration errors
  • patient safety

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


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