Abstract
BackgroundEffective 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:1. a) the effects of health literacy / numeracy on selected decision-making outcomes, and b) the effects of interventions designed to mitigate the influence of lower health literacy on decision-making outcomes, and2. the extent to which existing PtDAs a) account for health literacy, and b) are tested in lower health literacy populations.MethodsWe 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.ResultsAim 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.ConclusionLower 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.
Highlights
Effective use of a patient decision aid (PtDA) can be affected by the user’s health literacy and the PtDA’s characteristics
Critical health literacy skills – advanced literacy, cognitive, and social skills to analyze information and make informed decisions. We propose that these levels correspond with the skills required to effectively use PtDAs and to engage in shared decision making activities: understanding health information, clarifying personal values, and communicating with health care providers
PtDA Goal 3: To support users to be actively involved in decision making and to communicate with others In our own systematic review, we addressed the relationship between health literacy / numeracy and the outcomes of patient involvement and communication, and the effect of health literacy interventions on patient involvement and communication
Summary
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. A person’s health literacy status affects their ability to utilise health information and services, and their health outcomes [1]. It is an important potential consideration in patient decision aid (PtDA) development and shared decision making [2,3]. A simple and common definition is “the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions” [4,5]. Functional health literacy – basic reading comprehension and writing skills to understand health information/messages, together with knowledge of health conditions, services, and systems Nutbeam’s model of health literacy delineates three levels [7,8]: 1. Functional health literacy – basic reading comprehension and writing skills to understand health information/messages, together with knowledge of health conditions, services, and systems
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