Can adults with low literacy understand shared decision making questions? A qualitative investigation. Issue 11 (November 2016)

• Record Type: Journal Article
• Authors: Muscat, Danielle M.; Shepherd, Heather L.; Morony, Suzanne; Smith, Sian K.; Dhillon, Haryana M.; Trevena, Lyndal; Hayen, Andrew; Luxford, Karen; Nutbeam, Don; McCaffery, Kirsten
• Is Part Of: Patient education and counseling. Volume 99:Issue 11(2016)
• Page Start: 1796
• Page End: 1802
• Publication Date: 2016-11
• Subjects: Shared decision making -- Consumer -- Low literacy -- Questions -- Patient involvement -- Qualitative; Patient education -- Periodicals; Health counseling -- Periodicals; Health education -- Periodicals; Counseling -- Periodicals; Patient Education -- Periodicals; Éducation des patients -- Périodiques; Counseling -- Périodiques; Éducation sanitaire -- Périodiques; 615.5071
• DOI: 10.1016/j.pec.2016.05.008
• Languages: English
• ISSNs: 0738-3991

Abstract

Highlights: Questions to support SDM were difficult for adults with low literacy/poor English. AskShareKnow question-set was easier for participants. Clarification of terms using a structured response was reasonably effective. Participants perceived questions as useful but identified barriers to use. SDM question-sets alone are not sufficient to support SDM for these adults. Abstract: Objective: Participation in shared decision-making (SDM) may be difficult for adults with lower literacy. Tools to support consumers to engage in SDM are rarely designed for or evaluated with adults with lower literacy and/or poor English language. Methods: Qualitative interviews were conducted with 26 adults with lower literacy and/or poor English language skills to investigate (a) whether participants where able to read and understand two generic SDM consumer support tools (Smart Health Choices and AskShareKnow question-sets), (b) which question-set was easier for participants and, (c) perceived usefulness of the question-sets and barriers to use. Interviews were analysed using Framework Analysis. Results: Participants had difficulties understanding terms embedded within both the AskShareKnow and Smart Health Choices questions. Our findings suggest that the AskShareKnow question-set was easier for our participants than the Smart Health Choices questions, and clarification using a structured response was reasonably effective. While participants appreciated the usefulness of the questions, they identified important barriers to use. Conclusions: Generic question-sets alone are not sufficient to support SDM for adults with lower literacy and/or poor English-language skills. Practice implications: To ensure that SDM is accessible to all, we must consider how best to support adults with low literacy and/or poor English-language skills to participate in this process.