Health Literacy and Task Environment Influence Parents' Burden for Data Entry on Child-Specific Health Information: Randomized Controlled Trial

BACKGROUND: Health care systems increasingly rely on patients’ data entry efforts to organize and assist in care delivery through health information exchange. OBJECTIVES: We sought to determine (1) the variation in burden imposed on parents by data entry efforts across paper-based and computer-based environments, and (2) the impact, if any, of parents’ health literacy on the task burden. METHODS: We completed a randomized controlled trial of parent-completed data entry tasks. Parents of children with attention deficit hyperactivity disorder (ADHD) were randomized based on the Test of Functional Health Literacy in Adults (TOFHLA) to either a paper-based or computer-based environment for entry of health information on their children. The primary outcome was the National Aeronautics and Space Administration Task Load Index (TLX) total weighted score. RESULTS: We screened 271 parents: 194 (71.6%) were eligible, and 180 of these (92.8%) constituted the study cohort. We analyzed 90 participants from each arm. Parents who completed information tasks on paper reported a higher task burden than those who worked in the computer environment: mean (SD) TLX scores were 22.8 (20.6) for paper and 16.3 (16.1) for computer. Assignment to the paper environment conferred a significant risk of higher task burden (F(1,178) = 4.05, P = .046). Adequate literacy was associated with lower task burden (decrease in burden score of 1.15 SD, P = .003). After adjusting for relevant child and parent factors, parents’ TOFHLA score (beta = -.02, P = .02) and task environment (beta = .31, P = .03) remained significantly associated with task burden. CONCLUSIONS: A tailored computer-based environment provided an improved task experience for data entry compared to the same tasks completed on paper. Health literacy was inversely related to task burden. TRIAL REGISTRATION: Clinicaltrials.gov NCT00543257; http://www.clinicaltrials.gov/ct2/show/NCT00543257 (Archived by WebCite at http://www.webcitation.org/5vUVH2DYR)