The Impact of Health Literacy on Desire for Participation in Healthcare, Medical Visit Communication, and Patient Reported Outcomes among Patients with Hypertension
The Impact of Health Literacy on Desire for Participation in Healthcare, Medical Visit Communication, and Patient Reported Outcomes among Patients with Hypertension
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DOI：
10.1007/s11606-013-2466-5
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发表时间：
2013-11-01
影响因子：
5.7
通讯作者：
Cooper, Lisa A.
中科院分区：
文献类型：
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作者：
Aboumatar, Hanan J.;Carson, Kathryn A.;Cooper, Lisa A.
健康素养 (HL) 低与医疗保健结果不佳相关；这些关联的机制仍不清楚。旨在阐明 HL 如何影响患者参与医疗保健、就诊交流和患者报告的就诊结果的兴趣。对一项随机对照干预试验的入组数据进行横断面研究，以提高患者对高血压治疗的依从性。参与者包括 41 名初级保健医生和 275 名患者。在入组访视之前，医生接受了最低程度的干预或沟通技巧培训，患者接受了最低限度的干预或访视前辅导课程。这导致了四个干预组（最少患者/最少医生；最少患者/重症医生；重症患者/最少医生；以及重症患者/重症医生）。患者参与决策的愿望；沟通行为；患者对参与决策 (PDM)、信任度和满意度的评分。识字率低的患者与识字率足够的患者相比，血压得到控制的患者比例较低。两组人都对参与医疗决策同样感兴趣。除了患者提出的医疗问题（在低识字率患者中较低）之外，沟通行为根据 HL 没有差异。在重症患者/重症医师组中尤其如此（3.85 个问题 vs. 6.42 个问题；p = 0.002）。总体而言，根据 HL 的不同，护理评级没有差异；然而，在按干预分配进行分层的分析中，最少医生干预组中识字率低的患者报告的 PDM 评分显着低于识字率足够的患者。识字率低和足够识字率的患者对参与医疗决策同样感兴趣。然而，识字率低的患者在就诊时经历 PDM 的可能性较小。医生强化干预组中识字率低的患者提出的医疗问题较少。与识字率较高的患者相比，识字率低的患者可能对医生使用以患者为中心的沟通方法的反应较差。
Low health literacy (HL) is associated with poor healthcare outcomes; mechanisms for these associations remain unclear.To elucidate how HL influences patients' interest in participating in healthcare, medical visit communication, and patient reported visit outcomes.Cross-sectional study of enrollment data from a randomized controlled trial of interventions to improve patient adherence to hypertension treatments. Participants were 41 primary care physicians and 275 of their patients. Prior to the enrollment visit, physicians received a minimal intervention or communication skills training and patients received a minimal intervention or a pre-visit coaching session. This resulted in four intervention groups (minimal patient/minimal physician; minimal patient/intensive physician; intensive patient/minimal physician; and intensive patient/intensive physician).Rapid Estimate of Adult Literacy in Medicine; patients' desire for involvement in decision making; communication behaviors; patient ratings of participatory decision making (PDM), trust, and satisfaction.A lower percentage of patients with low versus adequate literacy had controlled blood pressure. Both groups were similarly interested in participating in medical decision making. Communication behaviors did not differ based on HL except for medical question asking by patients, which was lower among low literacy patients. This was particularly true in the intensive patient /intensive physician group (3.85 vs. 6.42 questions; p = 0.002). Overall, ratings of care didn't differ based on HL; however, in analyses stratified by intervention assignment, patients with low literacy in minimal physician intervention groups reported significantly lower PDM scores than adequate literacy patients.Patients with low and adequate literacy were similarly interested in participating in medical decision making. However, low literacy patients were less likely to experience PDM in their visits. Low literacy patients in the intensive physician intervention groups asked fewer medical questions. Patients with low literacy may be less able to respond to physicians' use of patient-centered communication approaches than adequate literacy patients.