Addressing health literacy in patient decision aids

Kirsten J McCaffery, Margaret Holmes-Rovner, Sian K Smith, David Rovner, Don Nutbeam, Marla L Clayman, Karen Kelly-Blake, Michael S Wolf, Stacey L Sheridan

Research output: Contribution to journalReview article

87 Citations (Scopus)

Abstract

BACKGROUND: Effective use of a patient decision aid (PtDA) can be affected by the user's health literacy and the PtDA's characteristics. Systematic reviews of the relevant literature can guide PtDA developers to attend to the health literacy needs of patients. The reviews reported here aimed to assess:

METHODS: We reviewed literature for evidence relevant to these two aims. When high-quality systematic reviews existed, we summarized their evidence. When reviews were unavailable, we conducted our own systematic reviews.

RESULTS: Aim 1: In an existing systematic review of PtDA trials, lower health literacy was associated with lower patient health knowledge (14 of 16 eligible studies). Fourteen studies reported practical design strategies to improve knowledge for lower health literacy patients. In our own systematic review, no studies reported on values clarity per se, but in 2 lower health literacy was related to higher decisional uncertainty and regret. Lower health literacy was associated with less desire for involvement in 3 studies, less question-asking in 2, and less patient-centered communication in 4 studies; its effects on other measures of patient involvement were mixed. Only one study assessed the effects of a health literacy intervention on outcomes; it showed that using video to improve the salience of health states reduced decisional uncertainty. Aim 2: In our review of 97 trials, only 3 PtDAs overtly addressed the needs of lower health literacy users. In 90% of trials, user health literacy and readability of the PtDA were not reported. However, increases in knowledge and informed choice were reported in those studies in which health literacy needs were addressed.

CONCLUSION: Lower health literacy affects key decision-making outcomes, but few existing PtDAs have addressed the needs of lower health literacy users. The specific effects of PtDAs designed to mitigate the influence of low health literacy are unknown. More attention to the needs of patients with lower health literacy is indicated, to ensure that PtDAs are appropriate for lower as well as higher health literacy patients.

Original languageEnglish
JournalBMC Medical Informatics and Decision Making
Volume13 (Suppl 2)
DOIs
Publication statusPublished - 2013

Keywords

  • Communication
  • Decision Making
  • Decision Support Techniques
  • Health Literacy
  • Humans
  • Knowledge
  • Patient Participation

Cite this

McCaffery, K. J., Holmes-Rovner, M., Smith, S. K., Rovner, D., Nutbeam, D., Clayman, M. L., ... Sheridan, S. L. (2013). Addressing health literacy in patient decision aids. BMC Medical Informatics and Decision Making, 13 (Suppl 2). https://doi.org/10.1186/1472-6947-13-S2-S10

Addressing health literacy in patient decision aids. / McCaffery, Kirsten J; Holmes-Rovner, Margaret; Smith, Sian K; Rovner, David; Nutbeam, Don; Clayman, Marla L; Kelly-Blake, Karen; Wolf, Michael S; Sheridan, Stacey L.

In: BMC Medical Informatics and Decision Making, Vol. 13 (Suppl 2), 2013.

Research output: Contribution to journalReview article

McCaffery, KJ, Holmes-Rovner, M, Smith, SK, Rovner, D, Nutbeam, D, Clayman, ML, Kelly-Blake, K, Wolf, MS & Sheridan, SL 2013, 'Addressing health literacy in patient decision aids', BMC Medical Informatics and Decision Making, vol. 13 (Suppl 2). https://doi.org/10.1186/1472-6947-13-S2-S10
McCaffery, Kirsten J ; Holmes-Rovner, Margaret ; Smith, Sian K ; Rovner, David ; Nutbeam, Don ; Clayman, Marla L ; Kelly-Blake, Karen ; Wolf, Michael S ; Sheridan, Stacey L. / Addressing health literacy in patient decision aids. In: BMC Medical Informatics and Decision Making. 2013 ; Vol. 13 (Suppl 2).
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abstract = "BACKGROUND: Effective use of a patient decision aid (PtDA) can be affected by the user's health literacy and the PtDA's characteristics. Systematic reviews of the relevant literature can guide PtDA developers to attend to the health literacy needs of patients. The reviews reported here aimed to assess:METHODS: We reviewed literature for evidence relevant to these two aims. When high-quality systematic reviews existed, we summarized their evidence. When reviews were unavailable, we conducted our own systematic reviews.RESULTS: Aim 1: In an existing systematic review of PtDA trials, lower health literacy was associated with lower patient health knowledge (14 of 16 eligible studies). Fourteen studies reported practical design strategies to improve knowledge for lower health literacy patients. In our own systematic review, no studies reported on values clarity per se, but in 2 lower health literacy was related to higher decisional uncertainty and regret. Lower health literacy was associated with less desire for involvement in 3 studies, less question-asking in 2, and less patient-centered communication in 4 studies; its effects on other measures of patient involvement were mixed. Only one study assessed the effects of a health literacy intervention on outcomes; it showed that using video to improve the salience of health states reduced decisional uncertainty. Aim 2: In our review of 97 trials, only 3 PtDAs overtly addressed the needs of lower health literacy users. In 90{\%} of trials, user health literacy and readability of the PtDA were not reported. However, increases in knowledge and informed choice were reported in those studies in which health literacy needs were addressed.CONCLUSION: Lower health literacy affects key decision-making outcomes, but few existing PtDAs have addressed the needs of lower health literacy users. The specific effects of PtDAs designed to mitigate the influence of low health literacy are unknown. More attention to the needs of patients with lower health literacy is indicated, to ensure that PtDAs are appropriate for lower as well as higher health literacy patients.",
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T1 - Addressing health literacy in patient decision aids

AU - McCaffery, Kirsten J

AU - Holmes-Rovner, Margaret

AU - Smith, Sian K

AU - Rovner, David

AU - Nutbeam, Don

AU - Clayman, Marla L

AU - Kelly-Blake, Karen

AU - Wolf, Michael S

AU - Sheridan, Stacey L

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N2 - BACKGROUND: Effective use of a patient decision aid (PtDA) can be affected by the user's health literacy and the PtDA's characteristics. Systematic reviews of the relevant literature can guide PtDA developers to attend to the health literacy needs of patients. The reviews reported here aimed to assess:METHODS: We reviewed literature for evidence relevant to these two aims. When high-quality systematic reviews existed, we summarized their evidence. When reviews were unavailable, we conducted our own systematic reviews.RESULTS: Aim 1: In an existing systematic review of PtDA trials, lower health literacy was associated with lower patient health knowledge (14 of 16 eligible studies). Fourteen studies reported practical design strategies to improve knowledge for lower health literacy patients. In our own systematic review, no studies reported on values clarity per se, but in 2 lower health literacy was related to higher decisional uncertainty and regret. Lower health literacy was associated with less desire for involvement in 3 studies, less question-asking in 2, and less patient-centered communication in 4 studies; its effects on other measures of patient involvement were mixed. Only one study assessed the effects of a health literacy intervention on outcomes; it showed that using video to improve the salience of health states reduced decisional uncertainty. Aim 2: In our review of 97 trials, only 3 PtDAs overtly addressed the needs of lower health literacy users. In 90% of trials, user health literacy and readability of the PtDA were not reported. However, increases in knowledge and informed choice were reported in those studies in which health literacy needs were addressed.CONCLUSION: Lower health literacy affects key decision-making outcomes, but few existing PtDAs have addressed the needs of lower health literacy users. The specific effects of PtDAs designed to mitigate the influence of low health literacy are unknown. More attention to the needs of patients with lower health literacy is indicated, to ensure that PtDAs are appropriate for lower as well as higher health literacy patients.

AB - BACKGROUND: Effective use of a patient decision aid (PtDA) can be affected by the user's health literacy and the PtDA's characteristics. Systematic reviews of the relevant literature can guide PtDA developers to attend to the health literacy needs of patients. The reviews reported here aimed to assess:METHODS: We reviewed literature for evidence relevant to these two aims. When high-quality systematic reviews existed, we summarized their evidence. When reviews were unavailable, we conducted our own systematic reviews.RESULTS: Aim 1: In an existing systematic review of PtDA trials, lower health literacy was associated with lower patient health knowledge (14 of 16 eligible studies). Fourteen studies reported practical design strategies to improve knowledge for lower health literacy patients. In our own systematic review, no studies reported on values clarity per se, but in 2 lower health literacy was related to higher decisional uncertainty and regret. Lower health literacy was associated with less desire for involvement in 3 studies, less question-asking in 2, and less patient-centered communication in 4 studies; its effects on other measures of patient involvement were mixed. Only one study assessed the effects of a health literacy intervention on outcomes; it showed that using video to improve the salience of health states reduced decisional uncertainty. Aim 2: In our review of 97 trials, only 3 PtDAs overtly addressed the needs of lower health literacy users. In 90% of trials, user health literacy and readability of the PtDA were not reported. However, increases in knowledge and informed choice were reported in those studies in which health literacy needs were addressed.CONCLUSION: Lower health literacy affects key decision-making outcomes, but few existing PtDAs have addressed the needs of lower health literacy users. The specific effects of PtDAs designed to mitigate the influence of low health literacy are unknown. More attention to the needs of patients with lower health literacy is indicated, to ensure that PtDAs are appropriate for lower as well as higher health literacy patients.

KW - Communication

KW - Decision Making

KW - Decision Support Techniques

KW - Health Literacy

KW - Humans

KW - Knowledge

KW - Patient Participation

U2 - 10.1186/1472-6947-13-S2-S10

DO - 10.1186/1472-6947-13-S2-S10

M3 - Review article

VL - 13 (Suppl 2)

JO - BMC Medical Informatics and Decision Making

JF - BMC Medical Informatics and Decision Making

SN - 1472-6947

ER -