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Navigating care: a multicentre US survey of health literacy in paediatric perioperative care. BACKGROUND: Health literacy is a critical determinant of patient outcomes and adherence to medical recommendations across healthcare settings, but it remains unexplored in the paediatric perioperative care. We evaluated the prevalence of limited health literacy among caregivers of paediatric patients undergoing surgery using the validated Newest Vital Sign tool. METHODS: A cross-sectional survey was conducted in 2023 across multiple paediatric institutions: Children's Hospital of Philadelphia, Arkansas Children's Hospital, Boston Children's Hospital, Children's Colorado, Children's Nebraska, and Nemours Children's Health. Caregivers completed the Newest Vital Sign tool (available in English and Spanish) and provided patient data via an online database. Data analysis used Pearson's χ2 test or Fisher's exact test for categorical variables and Wilcoxon rank sum test for non-normally distributed continuous variables. RESULTS: Of the 1400 caregivers surveyed, 16% demonstrated limited or possibly limited health literacy. Factors significantly associated with limited health literacy included younger age, lower educational attainment, non-White ethnicity, primary language other than English, and underrepresented minority status (P<0.001). CONCLUSIONS: This multicentre study found that 16% of caregivers had limited health literacy, with higher rates among certain groups. These findings underscore a potential barrier to equitable access to care and highlight the need for further research and interventions aimed at reducing health literacy disparities and improving patient engagement in perioperative care.