Patient Activation and Advocacy: Which Literacy Skills Matter Most?

Abstract

Attention to the effect of a patient's literacy skills on health care interactions is relatively new. So too are studies of either structural or personal factors that inhibit or support a patient's ability to navigate health services and systems and to advocate for their own needs within a service delivery system. Contributions of the structural environment, of interpersonal dynamics, and of a variety of psychological and sociological factors in the relationship between patients and providers have long been under study. Less frequently examined is the advocacy role expected of patients. However, the complex nature of health care in the U.S. increasingly requires a proactive stance. This study examined whether four literacy skills (reading, numeracy, speaking, and listening) were associated with patient self-advocacy, a component of health literacy itself, when faced with a hypothetical barrier to scheduling a medical appointment. While all literacy skills were significantly associated with advocacy when examined in isolation, greater speaking and listening skills remained significantly associated with better patient advocacy when all four skills were examined simultaneously. These findings suggest that speaking and listening skills and support for such skills may be important factors to consider when developing patient activation and advocacy skills.

Applying Instructor Communication Behaviors and Learning Outcomes to the Pediatrician-Parent Context

“…In addition to having an association with a variety of adverse health outcomes, low health literacy has also demonstrated an effect on communication between adult patients and physicians, as individuals with low health literacy report less effective communication of medical directives, decreased levels of patient advocacy (Martin et al, 2011), decreased perception of patient-centered care, lesser quality communication with health care organizations (Wynia & Osborn, 2010), and more negative interactions with health care providers (Manganello & Clayman, 2011).…”

A conceptual model of verbal exchange health literacy

“…Moreover, patients with limited health literacy are less likely to ask questions [36], seek information from print resources [37], or process (i.e., remember) verbally communicated medication instructions [38], further contributing to patients' inability to use information effectively. Speaking and listening skills are considered more important than reading and numeracy in patient self-advocacy within the healthcare system [39]. Two studies that have examined these skills, using Woodcock-Johnson test components “understanding directions” to determine listening skills and “story recall” to asses speaking, found a significant association between understanding and health outcomes [40, 41].…”

Financial Barriers and Adverse Clinical Outcomes Among Patients with Cardiovascular-Related Chronic Diseases: A Cohort Study

“…We recently completed a grounded theory study on this topic where we found that the impact of financial barriers on patients' lives is determined by a complex set of individual patient and system factors [21]. The complexity of perceiving financial barriers as well as the demonstrable association with adverse outcomes and increased costs seen in this study may provide an impetus for policymakers to seek to invest in interventions which minimize the impact of financial barriers, such as copayment elimination [32], patient navigation [33] and patient self-advocacy education [34] -though the ultimate impact of these interventions remains inconclusive.…”