Skip to main content
Published Online:



Effective fever management in children relies on caregivers having adequate general and numerical literacy. Nationally, nine of 10 adults have difficulty understanding health information. Lack of understanding basic information about fever management is a primary reason given for nonurgent pediatric emergency department visits. The Assess-Communicate-Treat (A.C.T.) tool was created by nurses 18 years ago to help parents better understand fever management.


This article describes a quality improvement project that used an expert health care provider panel and parents who attended focus groups to reevaluate the A.C.T. tool. The Simply Put manual, Simple Measure of Gobbledygook readability formula (SMOG) tool, Flesch-Kincaid Grade Level (FKGL) readability test, and Patient Education Materials Assessment Tool (PEMAT-P) were used to evaluate the A.C.T. tool.


Following focus groups, 45 of 72 items on the A.C.T. tool were revised using a 4-point Likert scale. After revision, the tool rated 88% for understandability and 83% actionability using the PEMAT-P tool.


Recognizing caregivers' health literacy needs is critical to optimizing health outcomes and reducing health care costs in the pediatric population. [J Contin Educ Nurs. 2020;51(7):338–344.]

We use cookies on this site to enhance your user experience. For a complete overview of all the cookies used, please see our privacy policy.

  • Received7/4/19 12:00 AM
  • Accepted1/17/20 12:00 AM
  • Published online2/26/21 10:01 AM
  • __article__history--ppub7/1/20 12:00 AM