Session number: 1131
Abstract title: Health Literacy and Patient Satisfaction
Author(s):
KL Ravenell - University of Pennsylvania
DA Asch - University of Pennsylvania
Phildelphia VAMC
CAN Henry - University of Pennsylvania
KM Fosnocht - University of Pennsylvania
JJ Murphy - University of Pennsylvania
Phildelphia VAMC
JA Shea - University of Pennsylvania
Objectives: The NPDFC Ambulatory Care Satisfaction Survey is widely used to assess patient satisfaction with multiple domains of outpatient care but, as a written instrument, requires literacy. The present study examined (1) the relationship between health literacy and patient satisfaction; and (2) the relationship between satisfaction and literacy when adjusted for age, sex, education, and race.
Methods: We administered the REALM, a reading literacy test, and the 62-item NPDFC Outpatient Visit Survey to 257 outpatients in primary care clinic waiting areas at the Philadelphia VAMC. Items on the NPDFC are grouped into two overall areas (coordination and satisfaction) and nine specific areas.
Results: 91% of participants were men. Ninety-two percent reported more than an eighth grade education, but only 60% had literacy grade equivalents higher than 8th grade. In bivariate comparisons for the 4 items within the overall scale, low literacy was associated with lower satisfaction for overall quality of care received (42% vs. 57%, p=.03) and similar trends were observed for overall quality of visit (38% vs. 46%, p = .15). Low literacy was associated with significantly more complaints for all 11 subscales. Literacy was not associated with sex (p = .09) or age (p = .90) but was associated with race (p = .0001) and education (p= .0001). In stepwise regression models, literacy was a significant predictor of satisfaction when adjusting for demographics for 4 subscales (access, courtesy, patient preferences, specialist care).
Conclusions: Impressions of patients about their most recent outpatient visits are associated with patients’ literacy, even when adjusting for sociodemographic characteristics. In general, lower literacy is associated with lower satisfaction. The results point to several areas where services might be examined to see if/how they differentially affect patients with lower literacy.
Impact statement: Responses to the NPDFC are impacted by literacy, independent of race, sex, age, and education. Because self-administered written instruments cannot easily assess the views of patients with low literacy, and because these views are different from patients with higher literacy, future assessment of patients’ experiences should explore further the issue of how to assess satisfaction in low literate populations.