Parent Preferences and Perceptions of Milliliters and Teaspoons: Role of Health Literacy and Experience

Alejandro Torres, Ruth M. Parker, Lee M. Sanders, Michael S. Wolf, Stacy Cooper Bailey, Deesha A. Patel, Jessica J. Jimenez, Kwang Youn A. Kim, Benard P. Dreyer, Alan L. Mendelsohn, H. Shonna Yin*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Background and Objectives A recent American Academy of Pediatrics policy statement recommends milliliter-exclusive dosing for pediatric liquid medications. Little is known about parent preferences regarding units, perceptions about moving to milliliters only, and the role of health literacy and prior milliliter-dosing experience. Methods Cross-sectional analysis of data collected as part of a randomized controlled study in 3 urban pediatric clinics (SAFE Rx for Kids study). English- and Spanish-speaking parents (n = 493) of children aged ≤8 years were randomized to 1 of 4 study arms and given labels and dosing tools which varied in label instruction format (text plus pictogram, text only) and units (milliliter only [“mL”], milliliter/teaspoon [“mL”/“tsp”]). Outcomes included teaspoon preference in dosing instructions and perceived difficulty with milliliter-only dosing. The predictor variable was health literacy (Newest Vital Sign; low [0–1], marginal [2–3], adequate [4–6]). The mediating variable was prior milliliter-dosing experience. Results Over two-thirds of parents had low or marginal health literacy. The majority (>70%) preferred to use milliliters, perceived milliliter-only dosing to be easy, and had prior milliliter-dosing experience; 11.5% had a teaspoon preference, 18.1% perceived milliliter-only dosing will be difficult, and 17.7% had no prior milliliter-dosing experience. Parents with lower health literacy had a higher odds of having a teaspoon preference (low vs adequate: adjusted odds ratio [AOR] = 2.9 [95% confidence interval [CI] 1.3–6.2]), and greater odds of perceiving difficulty with milliliter-only dosing (low vs adequate: AOR = 13.9 [95% CI 4.8–40.6], marginal vs adequate: AOR = 7.1 [95% CI 2.5–20.4]). Lack of experience with milliliter dosing partially mediated the impact of health literacy. Conclusions Most parents were comfortable with milliliter-only dosing. Parents with low health literacy were more likely to perceive milliliter-only dosing to be difficult; educational efforts will need to target this group to ensure safe medication use.

Original languageEnglish (US)
Pages (from-to)26-34
Number of pages9
JournalAcademic Pediatrics
Issue number1
StatePublished - Jan 2018


  • ambulatory care
  • dosing errors
  • dosing units
  • health communication
  • health literacy
  • medication errors

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


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