Patient Literacy and Question-asking Behavior During the Medical Encounter: A Mixed-methods Analysis

Katz, Marra G.; Jacobson, Terry A.; Veledar, Emir; Kripalani, Sunil

doi:10.1007/s11606-007-0184-6

Cited by 253 publications

(222 citation statements)

References 27 publications

(40 reference statements)

Supporting

Mentioning

208

Contrasting

Unclassified

Order By: Relevance

“…Because patients with low literacy skills ask fewer questions concerning information they do not understand, PROMs may be completed incorrectly, leading to unreliable data [52]. However, difficulties associated with comprehension are not exclusive to patients with low literacy.…”

Section: Discussionmentioning

confidence: 99%

Are Patient-reported Outcome Measures in Orthopaedics Easily Read by Patients?

El-Daly

Ibraheim

Rajakulendran

et al. 2016

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

Background Patient-reported outcome measures (PROMs) are commonly used by healthcare providers as means of assessing health-related quality of life and function at any given time. The complexity of PROMs can differ and when combined with varying degrees of adult literacy, error can be introduced if patients fail to understand questions. With an average adult literacy level of 11-year-old students in the United Kingdom, it is unclear to what degree PROMs can be read and understood by most patients (readability); to our knowledge, this has not been evaluated. Questions/purposes We wished to determine the readability of commonly used PROMs in orthopaedic surgery, as assessed by a validated tool that measures the complexity of the language in these surveys. MethodsWe performed a MEDLINE search to identify the most-commonly reported PROMs in orthopaedic research. One hundred twenty-one PROMs were identified and reviewed by 19 attending orthopaedic surgeons at our institution. Fifty-nine were selected as the most commonly used in our department. Of these, 52 (78%) were disease specific and included: 12 (20%) knee, 10 (17%) shoulder, seven (12%) spine, six (10%) hip, five (8%) foot and ankle, four (7%) elbow, three (5%) pelvis, three (5%) hand and wrist, and two (3%) lower limb. The remaining seven (12%) PROMs were general health questionnaires. The Flesch Reading Ease Score is a validated readability tool measuring average sentence length and syllables per word. It is expressed on a scale from 0 to 100 with higher scores indicating easier reading. We extracted the text from each PROM and inserted it in the same online Flesch Reading Ease Score calculator to generate a score. Results The mean readability score was 55 (range, 0-93), corresponding to text best understood by 16-to 18-year-old

show abstract

Section: Discussionmentioning

confidence: 99%

Are Patient-reported Outcome Measures in Orthopaedics Easily Read by Patients?

El-Daly

Ibraheim

Rajakulendran

et al. 2016

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

show abstract

“…As described by Katz and colleagues [17], questions were coded into 11 categories to maximize the usefulness and practicality of the Roter Interaction Analysis System for coding patient questions: (1) therapeutic regimen; (2) medical condition; (3) lifestyle; (4) requests for services or medications; (5) psychosocial/feelings; (6) nonmedical/procedural; (7) asks for understanding; (8) asks for reassurance; (9) paraphrase/ checks for understanding; (10) bid for repetition; and (11) personal remarks/social conversation. We also defined a combined medical composite category representing information-seeking regarding key medical-care issues, which encompassed the first four categories [17]. The recordings also were reviewed to determine whether surgeons asked patients if they had questions at any point during the encounter.…”

Section: Methodsmentioning

confidence: 97%

“…Two independent and blinded researchers (MEM, BTVH) listened to the audio recordings of the visits to count the number of patient questions and code them using an adaptation [17] of the Roter Interaction Analysis System [35], a widely used method to study physician-patient communication, until the reviewers reached a 90% agreement level. In this system, coding is done directly from audio recordings without transcription.…”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Data regarding the relationship between health literacy and question-asking behavior are sparse and confined to the primary care setting [17]. Katz et al [17] reported that patients with lower levels of health literacy tend to ask fewer questions regarding aspects of medical care, but that study was limited in size and generalizability because most patients were black women. Asking questions and engaging in shared decision-making are important to limit the potential for misdiagnosis of patient preferences [28], particularly in hand surgery, where even with traumatic injuries (like distal biceps rupture, clavicle fracture, and distal radius fracture), treatment is discretionary, directed primarily at quality of life, and therefore is highly preference-sensitive.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Patients With Limited Health Literacy Ask Fewer Questions During Office Visits With Hand Surgeons

Menendez

Hoorn

Mackert

et al. 2017

Clinical Orthopaedics &Amp; Related Research

107

View full text Add to dashboard Cite

Background In the midst of rapid expansion of medical knowledge and decision-support tools intended to benefit diverse patients, patients with limited health literacy (the ability to obtain, process, and understand information and services to make health decisions) will benefit from asking questions and engaging actively in their own care. But little is known regarding the relationship between health literacy and question-asking behavior during outpatient office visits. Questions/purposes (1) Do patients with lower levels of health literacy ask fewer questions in general, and as stratified by types of questions? (2) What other patient characteristics are associated with the number of questions asked? (3) How often do surgeons prompt patients to ask questions during an office visit? Methods We audio-recorded office visits of 84 patients visiting one of three orthopaedic hand surgeons for the first time. Patient questions were counted and coded using an adaptation of the Roter Interaction Analysis System in 11 categories: (1) therapeutic regimen; (2) medical condition; (3) lifestyle; (4) requests for services or medications; (5) psychosocial/feelings; (6) nonmedical/procedural; (7) asks for understanding; (8) asks for reassurance; (9) paraphrase/ checks for understanding; (10) bid for repetition; and (11) personal remarks/social conversation. Directly after the visit, patients completed the Newest Vital Sign (NVS) health literacy test, a sociodemographic survey (including age, sex, race, work status, marital status, insurance status), and three Patient-Reported Outcomes Measurement Information System-based questionnaires: Upper-Extremity Function, Pain Interference, and Depression. The NVS scores were divided into limited (0-3) and adequate (4-6) health literacy as done by the tool's creators. We also assessed whether the surgeons prompted patients to ask questions during the encounter. Results Patients with limited health literacy asked fewer questions than patients with adequate health literacy (5 ± 4 versus 9 ± 7; mean difference, À4; 95% CI, À7 to À1; p = 0.002). More specifically, patients with limited health literacy asked fewer questions regarding medical-care issues such as their therapeutic regimen (1 ± 2 versus 3 ± 4; Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. This work was performed at

show abstract

Caring for Patients With Limited Health Literacy

Paasche‐Orlow¹

2011

JAMA

View full text Add to dashboard Cite

Health literacy is the degree to which individuals have the capacity to obtain, process, and understand health information, skills, and services needed to make informed health decisions and take informed actions. Narratives from Mr J, a 76-year-old man with multiple medical problems and limited health literacy, and his physician exhibit some of the difficulties experienced by patients with limited health literacy. Clinicians can help patients with limited health literacy by removing unneeded complexity in their treatment regimens and in the health care system and by using teach-back methods to assess and improve understanding. Rather than a selective screening approach for limited health literacy, a patient-based universal precaution approach for confirming patient comprehension of critical self-care activities helps ensure that all patients have their health literacy needs identified.

show abstract

Patient Literacy and Question-asking Behavior During the Medical Encounter: A Mixed-methods Analysis

Cited by 253 publications

References 27 publications

Are Patient-reported Outcome Measures in Orthopaedics Easily Read by Patients?

Are Patient-reported Outcome Measures in Orthopaedics Easily Read by Patients?

Patients With Limited Health Literacy Ask Fewer Questions During Office Visits With Hand Surgeons

Caring for Patients With Limited Health Literacy

Contact Info

Product

Resources

About