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BMC Medical Informatics and Decision Making
Published in: BMC Medical Informatics and Decision Making 2/2013

Open Access 01-11-2013 | Review

Addressing health literacy in patient decision aids

Authors: 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

Published in: BMC Medical Informatics and Decision Making | Special Issue 2/2013

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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:
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, and
2. the extent to which existing PtDAs a) account for health literacy, and b) are tested in lower health literacy populations.

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.
Appendix
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Metadata
Title
Addressing health literacy in patient decision aids
Authors
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
Publication date
01-11-2013
Publisher
BioMed Central
DOI
https://doi.org/10.1186/1472-6947-13-S2-S10

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