RIAS Works - Resources by Subject

Literacy

Ishikawa H, Yano E, Fujimori S, Kinoshita M, Yamanouchi T, Yoshikawa M, Yamazaki Y, Teramoto T. Patient health literacy and patient-physician information exchange during a visit. Fam. Pract. 2009 Oct 7.
(Health Literacy, Japan)
BACKGROUND: Health literacy (HL), the capacity of individuals to access, understand and use health information to make informed and appropriate health-related decisions, is recognized as an important concept in patient education and disease management. OBJECTIVE: To examine the relation of three levels of HL (i.e. functional, communicative and critical HL) to patient-physician information exchange during a visit. METHODS: Participants were 134 outpatients with type 2 diabetes who were under continuous care by four attending physicians at a university-affiliated hospital. The visit communication was recorded and analysed using the Roter Interaction Analysis System. Patient HL was measured through a self-reported questionnaire using newly developed self-rated scales of functional, communicative and critical HL. Sociodemographic and clinical characteristics and patient's perception of the information exchange were assessed for each patient through self-reported questionnaires and review of electronic medical records. RESULTS: Patient HL levels were related to the information exchange process during the visit. Among the three HL scales, communicative HL (the capacity to extract information, derive meaning from different forms of communication and apply new information to changing circumstances) was related to patient's perceptions of the information exchange. Further, patient communicative HL had a modifying effect on the relationship between physician's information giving and patient's perception of it, suggesting that physician's communication may be perceived differently depending on the patient's HL. CONCLUSION: The exploration of patient HL may provide a better understanding of potential barriers to patient-physician communication and patient's self-management of disease.

Katz MG, Jacobson TA, Veledar E, Kripalani S. Patient literacy and question-asking behavior during the medical encounter; a mix methods analysis. J Gen Intern Med 2007 Jun; 22(6): 782-6.
(Literacy, United States)
BACKGROUND: Although patient participation in the medical encounter confers significant benefits, many patients are reluctant to ask questions of their physicians. Patients' literacy level may affect their level of participation and question-asking behaviors. OBJECTIVE: To examine the effect of literacy on the number and types of questions asked by patients during primary care office visits. DESIGN: Convenience sample recruited between April and November 2004. Physician-patient visits were audiotaped, and patient questions from complete encounters (N = 57) were coded using an adaptation of the Roter Interaction Analysis System. PATIENTS: Participants were predominantly middle-aged (mean age = 56.7 years), female (75.4%), and African American (94.7%). Low literacy skills (< or = 6th grade reading level) were present in 38.6%. MEASUREMENTS: We hypothesized prospectively that low-literacy patients would ask fewer total questions and fewer questions about key aspects of their medical care. RESULTS: Low-literacy adults asked significantly fewer questions about medical care issues (median = 4 vs 6 among patients with higher literacy levels, p = .014). They also tended to ask fewer questions overall (median = 7 vs 10, p = .070). Low-literacy patients were more likely to ask the physician to repeat something (p = .013), indicating an initial lack of understanding. They were less likely to use medical terminology, refer to medications by name, request additional services, or seek new information. Question-asking behavior was not significantly related to patient gender, age, years of education, or physician-patient gender concordance. CONCLUSIONS: Literacy level appears to be an important determinant of patients' participation in the medical encounter. Low-literacy patients ask fewer questions about their medical care, and this may affect their ability to learn about their medical conditions and treatments.

Roter DL. Oral literacy demand of health care communication: challenges and solutions. Nurs Outlook. 2011 Mar-Apr;59(2):79-84.
(Interaction Analysis, Literacy, United States)
Literacy deficits are widespread; one-quarter of the U.S. population has below basic literacy skills and the health consequences of literacy deficits are well-known and significant. While the need to simplify written health education print material is widely recognized, there has been little attempt to describe or reduce the literacy demand of health care dialogue. Patients with limited literacy complain they are not given information about their problems in ways they can understand, leaving them uninformed, frustrated, and distrustful. The purpose of this article is to review a conceptual approach to describing oral literacy demand in health care dialogue, to review several key studies that support the predictive validity of the conceptual framework in regard to patient satisfaction and recall of information, and to propose several practical ways to diminish literacy demand and facilitate more effective health care exchanges with patients.

Roter DL, Erby L, Larson S, Ellington L. Oral literacy demand of prenatal genetic counseling dialogue: Predictors of learning. Patient Educ Couns. 2009 Jun;75(3):392-7. Epub 2009 Feb 27.
(Health Literacy, Genetic Counseling, United States)
OBJECTIVE: To assess the relationship between the oral literacy demand of genetic counseling sessions and the ability of low literate subjects to learn genetics-related information. METHODS: Ninety-six simulated genetic counseling sessions were videotaped and shown to 312 subjects recruited to imagine themselves as the session's client. Study measures included oral literacy demand, operationalized as: (1) use of key genetics terms; (2) informational context; (3) general language complexity; and (4) structural characteristics of dialogue interactivity. The study outcome was learning of genetics-related information. RESULTS: Subjects with restricted literacy (below 8th grade level) learned more when viewing sessions with greater dialogue interactivity and more personally contextualized information. Subjects with adequate literacy skills, however, tended to learn less in low literacy demand sessions. CONCLUSION: The oral literacy demand of medical dialogue represents a learning obstacle to low literate subjects. However, this may not be the case for those with greater literacy skills who can understand the complex language and process the dense informational load of high demand sessions. PRACTICE IMPLICATIONS: In order to meet the educational needs of all patients, clinicians must attend to both the informativeness and the oral literacy demand of their communication.

Roter DL, Erby LH, Larson S, Ellington L. Assessing oral literacy demand in genetic counseling dialogue: preliminary test of a conceptual framework. Soc Sci Med. 2007 Oct;65(7):1442-57. Epub 2007 Jul 5.
(Health Literacy, Genetic Counseling, United States)
Health literacy deficits affect half the American patient population and are linked to poor health, ineffective disease management and high rates of hospitalization. Restricted literacy has also been linked with less satisfying medical visits and communication difficulties, particularly in terms of the interpersonal and informational aspects of care. Despite growing attention to these issues by researchers and policy makers, few studies have attempted to conceptualize and assess those aspects of dialogue that challenge persons with low literacy skills, i.e., the oral literacy demand within medical encounters. The current study uses videotapes and transcripts of 152 prenatal and cancer pretest genetic counseling sessions recorded with simulated clients to develop a conceptual framework to explore oral literacy demand and its consequences for medical interaction and related outcomes. Ninety-six prenatal and 81 cancer genetic counselors-broadly representative of the US National Society of Genetic Counselors-participated in the study. Key elements of the conceptual framework used to define oral literacy demand include: (1) use of unfamiliar technical terms; (2) general language complexity, reflected in the application of Microsoft Word grammar summary statistics to session transcripts; and, (3) structural characteristics of dialogue, including pacing, density, and interactivity. Genetic counselor outcomes include self-ratings of session satisfaction, informativeness, and development of rapport. The simulated clients rated their satisfaction with session communication, the counselor's effective use of nonverbal skills, and the counselor's affective demeanor during the session. Sessions with greater overall technical term use were longer and used more complex language reflected in readability indices and multi-syllabic vocabulary (measures averaging p < .05). Sessions with a high proportionate use of technical terms were characterized by shorter visits, high readability demand, slow speech speed, fewer and more dense counselor speaking turns and low interactivity (p < .05).The higher the use of technical terms, and the more dense and less interactive the dialogue, the less satisfied the simulated clients were and the lower their ratings were of counselors' nonverbal effectiveness and affective demeanor (all relationships p < .05). Counselors' self-ratings of informativeness were also inversely related to use of technical terms (p < .05). Just as print material can be made more reader-friendly and effective following established guidelines, the medical dialogue may also be made more patient-centered and meaningful by having providers monitor their vocabulary and language, as well as the structural characteristics of interaction, thereby lowering the literacy demand of routine medical dialogue. These consequences are important for all patients but may be even more so for patients with restricted literacy.

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