Addressing Health Literacy in Patient Decision Aids: An Update from the International Patient Decision Aid Standards.
health literacy
patient decision aids
Journal
Medical decision making : an international journal of the Society for Medical Decision Making
ISSN: 1552-681X
Titre abrégé: Med Decis Making
Pays: United States
ID NLM: 8109073
Informations de publication
Date de publication:
10 2021
10 2021
Historique:
pubmed:
1
6
2021
medline:
26
11
2021
entrez:
31
5
2021
Statut:
ppublish
Résumé
There is increasing recognition of the importance of addressing health literacy in patient decision aid (PtDA) development. An updated review as part of IPDAS 2.0 examined the extent to which PtDAs are designed to meet the needs of people with low health literacy/socially-disadvantaged populations. Reference lists of Cochrane reviews of randomized controlled trials (RCTs) of PtDAs (2014, 2017, and upcoming 2021 versions). RCTs that assessed the impact of PtDAs on low health literacy or other socially-disadvantaged groups (i.e., ≥50% participants from socially-disadvantaged groups and/or subgroup analysis in socially-disadvantaged group/s). Two researchers independently extracted data into a standardized form including PtDA development and evaluation details. We searched online repositories and emailed authors to access PtDAs to verify grade reading level, understandability, and actionability. Twenty-five of 213 RCTs met the inclusion criteria, illustrating that only 12% of studies addressed the needs of low health literacy or other socially-disadvantaged groups. Grade reading level was calculated in 8 of 25 studies (33%), which is recommended in previous IPDAS guidelines. We accessed and independently assessed 11 PtDAs. None were written at sixth-grade level or below. Ten PtDAs met the recommended threshold for understandability, but only 5 met the recommended threshold for actionability. We also conducted a post hoc subgroup meta-analysis and found that knowledge improvements after receiving a PtDA were greater in studies that reported using strategies to reduce cognitive demand in PtDA development compared with studies that did not (χ We were unable to access 13 of 24 PtDAs.
Sections du résumé
BACKGROUND
There is increasing recognition of the importance of addressing health literacy in patient decision aid (PtDA) development.
PURPOSE
An updated review as part of IPDAS 2.0 examined the extent to which PtDAs are designed to meet the needs of people with low health literacy/socially-disadvantaged populations.
DATA SOURCES
Reference lists of Cochrane reviews of randomized controlled trials (RCTs) of PtDAs (2014, 2017, and upcoming 2021 versions).
STUDY SELECTION
RCTs that assessed the impact of PtDAs on low health literacy or other socially-disadvantaged groups (i.e., ≥50% participants from socially-disadvantaged groups and/or subgroup analysis in socially-disadvantaged group/s).
DATA EXTRACTION
Two researchers independently extracted data into a standardized form including PtDA development and evaluation details. We searched online repositories and emailed authors to access PtDAs to verify grade reading level, understandability, and actionability.
DATA SYNTHESIS
Twenty-five of 213 RCTs met the inclusion criteria, illustrating that only 12% of studies addressed the needs of low health literacy or other socially-disadvantaged groups. Grade reading level was calculated in 8 of 25 studies (33%), which is recommended in previous IPDAS guidelines. We accessed and independently assessed 11 PtDAs. None were written at sixth-grade level or below. Ten PtDAs met the recommended threshold for understandability, but only 5 met the recommended threshold for actionability. We also conducted a post hoc subgroup meta-analysis and found that knowledge improvements after receiving a PtDA were greater in studies that reported using strategies to reduce cognitive demand in PtDA development compared with studies that did not (χ
LIMITATIONS
We were unable to access 13 of 24 PtDAs.
Identifiants
pubmed: 34053361
doi: 10.1177/0272989X211011101
pmc: PMC8815094
mid: NIHMS1751403
doi:
Types de publication
Journal Article
Meta-Analysis
Langues
eng
Sous-ensembles de citation
IM
Pagination
848-869Subventions
Organisme : NIA NIH HHS
ID : K23 AG062795
Pays : United States
Références
BMJ Qual Saf. 2018 May;27(5):380-388
pubmed: 29269567
BMJ Open. 2019 Mar 13;9(3):e025173
pubmed: 30872547
Br J Gen Pract. 2015 Jun;65(635):e379-86
pubmed: 26009533
BMC Nephrol. 2018 May 3;19(1):107
pubmed: 29724177
BMC Public Health. 2018 Dec 29;18(1):1414
pubmed: 30594180
PLoS One. 2014 Apr 15;9(4):e94670
pubmed: 24736389
Eur J Public Health. 2015 Dec;25(6):1053-8
pubmed: 25843827
Patient Educ Couns. 2008 Dec;73(3):482-9
pubmed: 18760888
Ann Behav Med. 2012 Dec;44(3):320-30
pubmed: 22825933
Transl Behav Med. 2018 Nov 21;8(6):876-886
pubmed: 29982747
Patient Educ Couns. 2011 Jul;84(1):41-8
pubmed: 20609546
JAMA Surg. 2017 Jan 18;152(1):e164225
pubmed: 27893033
BMC Public Health. 2012 Jan 25;12:80
pubmed: 22276600
Cancer. 2017 Apr 15;123(8):1401-1408
pubmed: 28001305
Clin Orthop Relat Res. 2016 Aug;474(8):1755-64
pubmed: 27075333
Ann Intern Med. 2009 Aug 18;151(4):264-9, W64
pubmed: 19622511
Patient Educ Couns. 2013 Jun;91(3):329-36
pubmed: 23357414
Cancer Epidemiol Biomarkers Prev. 2006 Nov;15(11):2179-88
pubmed: 17119044
J Natl Med Assoc. 2005 Aug;97(8):1143-54
pubmed: 16173330
Am J Prev Med. 2011 Jun;40(6):608-15
pubmed: 21565651
J Med Screen. 2008;15(2):76-82
pubmed: 18573775
Am J Prev Med. 2016 Oct;51(4):454-62
pubmed: 27242081
J Gen Intern Med. 2009 Nov;24(11):1211-6
pubmed: 19760299
BMJ. 2010 Oct 26;341:c5370
pubmed: 20978060
Cochrane Database Syst Rev. 2014 Jan 28;(1):CD001431
pubmed: 24470076
JAMA. 2014 Sep 24;312(12):1210-7
pubmed: 25247517
Arch Intern Med. 1996 Jun 24;156(12):1333-6
pubmed: 8651843
J Med Libr Assoc. 2018 Jan;106(1):38-45
pubmed: 29339932
J Health Commun. 2017 Feb;22(2):163-170
pubmed: 28121226
Obstet Gynecol. 2009 Jan;113(1):53-63
pubmed: 19104360
Prev Med. 2007 Oct;45(4):267-73
pubmed: 17689600
Patient Educ Couns. 2019 Sep;102(9):1656-1661
pubmed: 30962076
J Health Commun. 2007 Oct-Nov;12(7):681-97
pubmed: 17934944
BMC Med Inform Decis Mak. 2013;13 Suppl 2:S10
pubmed: 24624970
Ann Intern Med. 2018 Apr 17;168(8):550-557
pubmed: 29532054
Med Decis Making. 2018 Jan;38(1):69-78
pubmed: 28525723
J Health Commun. 2011;16 Suppl 3:30-54
pubmed: 21951242
Clin Pediatr (Phila). 2017 Mar;56(3):268-277
pubmed: 27834191
Med Decis Making. 2011 Jan-Feb;31(1):93-107
pubmed: 20484090
BMJ. 2010 May 13;340:c2138
pubmed: 20466791
Patient Educ Couns. 2014 Sep;96(3):395-403
pubmed: 24973195
Cancer. 1995 Dec 1;76(11):2275-85
pubmed: 8635032
Cochrane Database Syst Rev. 2017 Apr 12;4:CD001431
pubmed: 28402085