Can adults with low literacy understand shared decision making questions? A qualitative investigation

Danielle M Muscat, Heather L Shepherd, Suzanne Morony, Sian K Smith, Haryana M Dhillon, Lyndal Trevena, Andrew Hayen, Karen Luxford, Don Nutbeam, Kirsten McCaffery

Research output: Contribution to journalArticlepeer-review

26 Citations (SciVal)


OBJECTIVE: Participation in shared decision-making (SDM) may be difficult for adults with lower literacy. Tools to support consumers to engage in SDM are rarely designed for or evaluated with adults with lower literacy and/or poor English language.

METHODS: Qualitative interviews were conducted with 26 adults with lower literacy and/or poor English language skills to investigate (a) whether participants where able to read and understand two generic SDM consumer support tools (Smart Health Choices and AskShareKnow question-sets), (b) which question-set was easier for participants and, (c) perceived usefulness of the question-sets and barriers to use. Interviews were analysed using Framework Analysis.

RESULTS: Participants had difficulties understanding terms embedded within both the AskShareKnow and Smart Health Choices questions. Our findings suggest that the AskShareKnow question-set was easier for our participants than the Smart Health Choices questions, and clarification using a structured response was reasonably effective. While participants appreciated the usefulness of the questions, they identified important barriers to use.

CONCLUSIONS: Generic question-sets alone are not sufficient to support SDM for adults with lower literacy and/or poor English-language skills.

PRACTICE IMPLICATIONS: To ensure that SDM is accessible to all, we must consider how best to support adults with low literacy and/or poor English-language skills to participate in this process.

Original languageEnglish
Pages (from-to)1796-1802
Number of pages7
JournalPatient Education and Counseling
Issue number11
Early online date9 May 2016
Publication statusPublished - Nov 2016

Bibliographical note

Copyright © 2016. Published by Elsevier Ireland Ltd.


  • Adult
  • Aged
  • Aged, 80 and over
  • Choice Behavior
  • Communication
  • Comprehension
  • Decision Making
  • Decision Support Techniques
  • Female
  • Health Literacy
  • Humans
  • Interviews as Topic
  • Language
  • Male
  • Middle Aged
  • Patient Participation
  • Physician-Patient Relations
  • Qualitative Research


Dive into the research topics of 'Can adults with low literacy understand shared decision making questions? A qualitative investigation'. Together they form a unique fingerprint.

Cite this