Parental Health Literacy, Empowerment, and Advocacy in the Context of Food Allergies Management in Schools

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Background: Health literacy, empowerment, and advocacy may be important for parents when they communicate with schools related management of their child’s food allergies. Understanding prevention and emergency management of life-threatening food allergies may require high levels of health literacy and may be overwhelming to parents. Yet, parents are often the drivers of school food allergy safety practices. Mixed evidence supports the relationships among communicative health literacy, critical health literacy, and empowerment in chronic disease management. Objective: This cross-sectional study examines the relationships among parental health literacy, particularly communicative and critical health literacy; empowerment; and advocacy in the context of food allergies management in elementary schools. Methods: Parents of children with food allergies were recruited through food allergy organizations to complete an anonymous 20-minute online survey. Measurements of parental health literacy, empowerment, and advocacy were adapted from validated scales or the literature and refined through pre-testing and pilot-testing. Results: Participants (N=313) were predominantly white, college-educated mothers with moderately high food allergy knowledge, health literacy, and empowerment. Their children were allergic to an average of three food allergens and nearly half had asthma. Parents who scored at the highest levels on measures of communicative health literacy, critical health literacy, and empowerment engaged in advocacy behaviors perceived to be more effective than parents who scored at the lowest levels. However, this statistical difference may not represent a clinically significant difference. Communicative and critical health literacy were not more strongly associated with advocacy than functional health literacy. Empowerment and quality of the parents’ relationship with the school were the strongest predictors of the parents’ perceived effectiveness of advocacy efforts. The relationship between parental health literacy and advocacy was mediated by empowerment with a moderate effect size, but reverse causality between health literacy and empowerment could not be completely ruled out. Conclusions: Parental health literacy may impact the effectiveness of advocacy efforts for safe food allergies practices in schools, with parental empowerment possibly mediating the relationship between health literacy and advocacy. Longitudinal studies with diverse samples should verify findings. Health professionals should encourage parents to build good relationships with school personnel and help to empower families when educating them about food allergies management.