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Health Literacy and Health-Care Engagement as Predictors of Shared Decision-Making Among Adult Information Seekers in the USA: a Secondary Data Analysis of the Health Information National Trends Survey


The objective of this study is to examine the relationship between health literacy, health-care engagement, and shared decision-making (SDM). We analyzed Health Information National Trends Survey 4 (cycle 3) data for 1604 information seekers who had one or more non-emergency room health-care visits in the previous year. SDM was more than two times higher among adults who “always” versus “usually/sometimes/never” take health information to doctor visits (OR = 2.54; 95 % CI 1.19–5.43). There was a twofold increase in SDM among adults who were “completely/very confident” versus “somewhat/a little/not confident” about finding health information (OR = 2.03; 95 % CI 1.37–3.02). Differences in SDM between adults who understood health information and those who had difficulty understanding health information were not statistically significant (OR = 1.39; 95 % CI 0.93–2.07). A Healthy People 2020 goal is to increase SDM. Previous research has suggested that SDM may improve health outcomes across the continuum of care. Only about half of adults report always being involved in health-care decisions. Even more alarming is the fact that SDM has not increased from 2003 to 2013. Our findings suggest that increasing health literacy has the potential to increase health-care engagement and subsequently increase SDM. Effective intervention strategies are needed to improve health literacy and promote health-care engagement.

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Financial support to conduct this research study and prepare this manuscript was provided by the National Institutes of Health and National Cancer Institute (K01CA175239). The contents of this manuscript are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health or the National Cancer Institute.

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Correspondence to Lisa T. Wigfall.

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Wigfall, L.T., Tanner, A.H. Health Literacy and Health-Care Engagement as Predictors of Shared Decision-Making Among Adult Information Seekers in the USA: a Secondary Data Analysis of the Health Information National Trends Survey. J Canc Educ 33, 67–73 (2018).

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  • Health literacy
  • Information seeking
  • Health-care engagement
  • Shared decision-making
  • Patient-centered communication