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

Abstract

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

Association of health literacy with health information‐seeking preference in older people: A correlational, descriptive study

“…Our findings support previous work showing that people with lower health literacy have lower motivation to seek new knowledge in the health system (Cashin et al, ). To date, the lower levels of information use and access among people with low health literacy have been attributed to embarrassment or lack of competence (Menendez et al, ). However, our study suggests that their lower desire for being informed about health care could also be an important reason for their passive behavior with regard to information seeking.…”

“…Health literacy has been shown to be a personal factor contributing to information‐seeking behaviors, which in turn influence knowledge, coping, and self‐care abilities (Lambert & Loiselle, ). Older people with low health literacy have demonstrated less information‐seeking behaviors using digital technologies or print materials compared to those with high health literacy (Manganello et al, ; Von Wagner, Semmler, Good, & Wardle, ), and have shown higher reliance on health‐care providers’ recommendations without seeking further information (Menendez et al, ; Smith et al, ).…”

Surgical recommendations in the era of personalized medicine: What can we learn from patient preferences?

“…One would imagine that the patients with low health literacy would be the very patients for whom additional time and explanation would be most important . Patients with limited health literacy ask fewer questions during office visits, which may lead to shorter visits with the physician . These patients may legitimately have fewer questions, but they also may feel less comfortable asking their questions than patients with more education and higher health literacy.…”

“…17 Patients with limited health literacy ask fewer questions during office visits, which may lead to shorter visits with the physician. 18 These patients may legitimately have fewer questions, but they also may feel less comfortable asking their questions than patients with more education and higher health literacy. Physicians may feel less connected and less comfortable with patients with educational, cultural, and language differences, which may be more pronounced when managing a patient with limited health literacy.…”

Subjects at Risk for Genetic Late-Onset Neurological Diseases: Objective Knowledge

“…Objective knowledge about the disease is crucial in the decision-making inherent to genetic counseling [15,16] , and limited health literacy is a barrier for patient engagement in the decision-making process [17] . There are very few studies on objective knowledge, especially prior to genetic counseling.…”