Kelly PA (METRIC)
Haidet P (Michael E. DeBakey VAMC)
Jones L (METRIC)
The relationship of general literacy with observable indicators such as verbal communication skill, age, and socioeconomic status is usually strong, but this may not be true of health literacy. Physicians, using only observable indicators, may overestimate patients’ health literacy, resulting in communication "disconnects" that foster physician use of medical jargon and contribute to poorer patient physiological health outcomes. The objective of this project was to measure the prevalence of physician misjudgment of patients’ health literacy and attempt to identify causes of misjudgment among veterans, a patient population of predominantly high-school graduates with a high prevalence of chronic illness.
Twelve physicians were recruited at the Michael E. DeBakey VAMC to participate in the project. We randomly selected 8-12 patients who were scheduled for a visit with a participating physician to complete a written general literacy test (Test of Adult Basic Education, 17 items), a written health literacy test (Short Test Of Functional Health Literacy for Adults, 36 items), a verbal health literacy test (Rapid Estimate of Adult Literacy in Medicine, 66 items) and a brief demographic survey (12 items). All three literacy tests had been validated in a variety of patient populations and medical settings. Physicians completed a demographic survey at the beginning of the project. After each patient visit, physicians completed a survey of their perceptions of the patient’s literacy level, general health awareness, effectiveness as a communicator of their own health, and adherence to previous treatment recommendations.
We collected data from approximately 100 patients by September 30, 2004. Using our single-item patient health literacy measure, the physicians rated health literacy at the highest level, “able to read most patient health materials unassisted,” for 75 of the 100 patients they saw. However, 30 of these highest ratings, and 48 of all ratings, overestimated the patient’s actual health literacy level as determined by patients’ scores on the tests. In contrast, only 16 underestimates of patients’ health literacy were made. No physician exhibited statistically significant tendency to over- or underestimate more than others; frequency of over- and underestimation was not statistically significantly associated with any patient demographics.
Physicians do indeed make on-the-spot estimates of patients’ health literacy, but they are often overestimates. By demonstrating the prevalence of and demographics associated with physician overestimation of patient health literacy, we intend to move the medical profession towards better identifying those cases in which problems with health literacy are most likely to arise.
This research may lead to a technique for reducing the number of low-literacy cases that go undetected, without the prohibitively expensive requirement that every patient receive a low-literacy intervention.