Physician Notification of Their Diabetes Patients' Limited Health Literacy. A Randomized, Controlled Trial

Overview

Journal J Gen Intern Med

Publisher Springer

Specialty General Medicine

Date 2005 Nov 26

PMID 16307624

Citations 55

Authors

Hilary K Seligman

Frances F Wang

Jorge L Palacios

Clifford C Wilson

Carolyn Daher

John D Piette

Dean Schillinger

Affiliations

Soon will be listed here.

Abstract

Background: Many patients with chronic disease have limited health literacy (HL). Because physicians have difficulty identifying these patients, some experts recommend instituting screening programs in clinical settings. It is unclear if notifying physicians of patients' limited HL improves care processes or outcomes.

Objective: To determine whether notifying physicians of their patients' limited HL affects physician behavior, physician satisfaction, or patient self-efficacy.

Design: We screened all patients for limited HL and randomized physicians to be notified if their patients had limited HL skills.

Participants: Sixty-three primary care physicians affiliated with a public hospital and 182 diabetic patients with limited HL.

Measurements: After their visit, physicians reported their management strategies, satisfaction, perceived effectiveness, and attitudes toward HL screening. We also assessed patients' self-efficacy, feelings regarding HL screening's usefulness, and glycemic control.

Results: Intervention physicians were more likely than control physicians to use management strategies recommended for patients with limited HL (OR 3.2, P=.04). However, intervention physicians felt less satisfied with their visits (81% vs 93%, P=.01) and marginally less effective (38% vs 53%, P=.10). Intervention and control patients' post-visit self-efficacy scores were similar (12.6 vs 12.9, P=.6). Sixty-four percent of intervention physicians and 96% of patients felt HL screening was useful.

Conclusions: Physicians are responsive to receiving notification of their patients' limited HL, and patients support the potential utility of HL screening. However, instituting screening programs without specific training and/or system-wide support for physicians and patients is unlikely to be a powerful tool in improving diabetes outcomes.

Citing Articles

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Schillinger D, Bullock A, Powell C, Fukagawa N, Greenlee M, Towne J Diabetes Care. 2023; 46(2):e24-e38.

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Tools to Measure Health Literacy among Adult Hispanic Populations with Type 2 Diabetes Mellitus: A Review of the Literature.

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Chisolm D, Keedy H, Hart L, Chavez L, Dolce M, Morack J J Adolesc Health. 2021; 69(4):622-628.

PMID: 33952419 PMC: 8429056. DOI: 10.1016/j.jadohealth.2021.03.023.

References

Weiss B, Hart G, McGee D, DEstelle S . Health status of illiterate adults: relation between literacy and health status among persons with low literacy skills. J Am Board Fam Pract. 1992; 5(3):257-64. View

Bandura A . Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977; 84(2):191-215. DOI: 10.1037//0033-295x.84.2.191. View

Roter D, Russell N . Validity of physician self-report in tracking patient education objectives. Health Educ Q. 1994; 21(1):27-38. DOI: 10.1177/109019819402100105. View

Spandorfer J, Karras D, Hughes L, Caputo C . Comprehension of discharge instructions by patients in an urban emergency department. Ann Emerg Med. 1995; 25(1):71-4. DOI: 10.1016/s0196-0644(95)70358-6. View

Williams M, Parker R, Baker D, Parikh N, Pitkin K, Coates W . Inadequate functional health literacy among patients at two public hospitals. JAMA. 1995; 274(21):1677-82. View

Parker R, Baker D, Williams M, Nurss J . The test of functional health literacy in adults: a new instrument for measuring patients' literacy skills. J Gen Intern Med. 1995; 10(10):537-41. DOI: 10.1007/BF02640361. View

Mayeaux Jr E, Murphy P, Arnold C, Davis T, Jackson R, Sentell T . Improving patient education for patients with low literacy skills. Am Fam Physician. 1996; 53(1):205-11. View

Baker D, Parker R, Williams M, Pitkin K, Parikh N, Coates W . The health care experience of patients with low literacy. Arch Fam Med. 1996; 5(6):329-34. DOI: 10.1001/archfami.5.6.329. View

Parikh N, Parker R, Nurss J, Baker D, Williams M . Shame and health literacy: the unspoken connection. Patient Educ Couns. 1996; 27(1):33-9. DOI: 10.1016/0738-3991(95)00787-3. View

10.

Suchman A, Markakis K, Beckman H, Frankel R . A model of empathic communication in the medical interview. JAMA. 1997; 277(8):678-82. View

11.

Baker D, Parker R, Williams M, Clark W, Nurss J . The relationship of patient reading ability to self-reported health and use of health services. Am J Public Health. 1997; 87(6):1027-30. PMC: 1380944. DOI: 10.2105/ajph.87.6.1027. View

12.

Williams M, Baker D, Parker R, Nurss J . Relationship of functional health literacy to patients' knowledge of their chronic disease. A study of patients with hypertension and diabetes. Arch Intern Med. 1998; 158(2):166-72. DOI: 10.1001/archinte.158.2.166. View

13.

Doak C, Doak L, FRIEDELL G, Meade C . Improving comprehension for cancer patients with low literacy skills: strategies for clinicians. CA Cancer J Clin. 1998; 48(3):151-62. DOI: 10.3322/canjclin.48.3.151. View

14.

HOWIE J, Heaney D, Maxwell M, Walker J . A comparison of a Patient Enablement Instrument (PEI) against two established satisfaction scales as an outcome measure of primary care consultations. Fam Pract. 1998; 15(2):165-71. DOI: 10.1093/fampra/15.2.165. View

15.

Burton P, Gurrin L, Sly P . Extending the simple linear regression model to account for correlated responses: an introduction to generalized estimating equations and multi-level mixed modelling. Stat Med. 1998; 17(11):1261-91. DOI: 10.1002/(sici)1097-0258(19980615)17:11<1261::aid-sim846>3.0.co;2-z. View

16.

Williams M, Baker D, Honig E, Lee T, Nowlan A . Inadequate literacy is a barrier to asthma knowledge and self-care. Chest. 1998; 114(4):1008-15. DOI: 10.1378/chest.114.4.1008. View

17.

Baker D, Parker R, Williams M, Clark W . Health literacy and the risk of hospital admission. J Gen Intern Med. 1998; 13(12):791-8. PMC: 1497036. DOI: 10.1046/j.1525-1497.1998.00242.x. View

18.

Gazmararian J, Baker D, Williams M, Parker R, Scott T, Green D . Health literacy among Medicare enrollees in a managed care organization. JAMA. 1999; 281(6):545-51. DOI: 10.1001/jama.281.6.545. View

19.

. Health literacy: report of the Council on Scientific Affairs. Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs, American Medical Association. JAMA. 1999; 281(6):552-7. View

20.

HOUTS P, Bachrach R, Witmer J, Tringali C, Bucher J, Localio R . Using pictographs to enhance recall of spoken medical instructions. Patient Educ Couns. 1999; 35(2):83-8. DOI: 10.1016/s0738-3991(98)00065-2. View