The Impact of Health Literacy on Desire for Participation in Healthcare, Medical Visit Communication, and Patient Reported Outcomes among Patients with Hypertension
- First Online:
- 1.6k Downloads
Low health literacy (HL) is associated with poor healthcare outcomes; mechanisms for these associations remain unclear.
To elucidate how HL influences patients’ interest in participating in healthcare, medical visit communication, and patient reported visit outcomes.
DESIGN, SETTING, AND PATIENTS
Cross-sectional study of enrollment data from a randomized controlled trial of interventions to improve patient adherence to hypertension treatments. Participants were 41 primary care physicians and 275 of their patients. Prior to the enrollment visit, physicians received a minimal intervention or communication skills training and patients received a minimal intervention or a pre-visit coaching session. This resulted in four intervention groups (minimal patient/minimal physician; minimal patient/intensive physician; intensive patient/minimal physician; and intensive patient/intensive physician).
Rapid Estimate of Adult Literacy in Medicine; patients’ desire for involvement in decision making; communication behaviors; patient ratings of participatory decision making (PDM), trust, and satisfaction.
A lower percentage of patients with low versus adequate literacy had controlled blood pressure. Both groups were similarly interested in participating in medical decision making. Communication behaviors did not differ based on HL except for medical question asking by patients, which was lower among low literacy patients. This was particularly true in the intensive patient /intensive physician group (3.85 vs. 6.42 questions; p = 0.002). Overall, ratings of care didn’t differ based on HL; however, in analyses stratified by intervention assignment, patients with low literacy in minimal physician intervention groups reported significantly lower PDM scores than adequate literacy patients.
Patients with low and adequate literacy were similarly interested in participating in medical decision making. However, low literacy patients were less likely to experience PDM in their visits. Low literacy patients in the intensive physician intervention groups asked fewer medical questions. Patients with low literacy may be less able to respond to physicians’ use of patient-centered communication approaches than adequate literacy patients.
KEY WORDShealth literacy participatory decision making patient–physician relationship communication
- 1.Kutner M, Greenberg E, Jin Y, et al. The health literacy of America’s adults—Results for the 2003 national assessment of adult literacy. Washington, DC: US. Department of Education; 2006:i–60. Available at http://nces.ed.gov/pubs2006/2006483.pdf. Accessed April 10, 2013.
- 2.Kirsch IS, Jungeblut A, Jenkins L, Kolstadet A. A First Look at the Results of the National Adult Literacy Survey. Nat’l Center for Education Statistics, 1993. Available at http://nces.ed.gov/pubsearch/pubsinfo.asp?pubid=93275. April 10, 2013.
- 6.Berkman ND, DeWalt DA, Pignone MP, Sheridan SL, Lohr KN, Lux L, Sutton SF, Swinson T, Bonito AJ. Literacy and Health Outcomes. Evidence Report/Technology Assessment No. 87 (Prepared by RTI International–University of North Carolina Evidence-based Practice Center under Contract No. 290-02-0016). AHRQ Publication No. 04-E007-2. Rockville, MD: Agency for Healthcare Research and Quality. January 2004. Available at http://archive.ahrq.gov/downloads/pub/evidence/pdf/literacy/literacy.pdf Accessed April 10, 2013.
- 11.Selden CR, Zorn M, Ratzan S, Parker RM. Health Literacy. Current Bibliographies in Medicine. Bethesda, MD: National Library of Medicine, 2000. No.2000-1. Available at: http://www.nlm.nih.gov/archive/20061214/pubs/cbm/hliteracy.pdf. Accessed April 10, 2013.
- 12.Nielsen-Bohlman L, Panzer AM, Kindig DA. 2004 Health literacy: A prescription to end confusion. Washington, DC: Institute of Medicine: National Academies Press. Available at http://www.nap.edu/openbook.php?isbn=0309091179. Accessed April 10, 2013.
- 26.Wissow LS, Roter D, Bauman LJ, et al. Patient–provider communication during the emergency department care of children with asthma. The National Cooperative Inner-City Asthma Study, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD. Med Care. 1998;36:1439–50.PubMedCrossRefGoogle Scholar
- 29.RIAS Works. Available at http://www.riasworks.com/. Accessed April 10, 2013.
- 34.The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) Available at http://www.nhlbi.nih.gov/guidelines/hypertension/. Accessed on April 10, 2013.
- 43.Schulz PJ, Nakamoto K. Emerging themes in health literacy. Stud Commun Sci. 2005;5:1–10.Google Scholar
- 45.Zarcadoolas C, Pleasant A, Greer DS. Elaborating a definition of health literacy: a - commentary. J Heal Commun. 2003;8:119–120.Google Scholar