Effect of Health Literacy on Decision-Making Preferences among Medically Underserved Patients

Med Decis Making. 2016 May;36(4):550-6. doi: 10.1177/0272989X16632197. Epub 2016 Feb 22.


Introduction: Participation in the decision-making process and health literacy may both affect health outcomes; data on how these factors are related among diverse groups are limited. This study examined the relationship between health literacy and decision-making preferences in a medically underserved population.

Methods: We analyzed a sample of 576 primary care patients. Multivariable logistic regression was used to examine the independent association of health literacy (measured by the Rapid Estimate of Adult Literacy in Medicine-Revised) and patients' decision-making preferences (physician directed or patient involved), controlling for age, race/ethnicity, and gender. We tested whether having a regular doctor modified this association.

Results: Adequate health literacy (odds ratio [OR] = 1.7;P= 0.009) was significantly associated with preferring patient-involved decision making, controlling for age, race/ethnicity, and gender. Having a regular doctor did not modify this relationship. Males were significantly less likely to prefer patient-involved decision making (OR = 0.65;P= 0.024).

Discussion: Findings suggest health literacy affects decision-making preferences in medically underserved patients. More research is needed on how factors, such as patient knowledge or confidence, may influence decision-making preferences, particularly for those with limited health literacy.

Keywords: health literacy; medically underserved patients; shared decision making.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Decision Making*
  • Female
  • Health Literacy / statistics & numerical data*
  • Humans
  • Male
  • Medically Underserved Area*
  • Middle Aged
  • Patient Participation / statistics & numerical data*
  • Patient Preference
  • Physician-Patient Relations
  • Primary Health Care*
  • Sex Factors
  • Socioeconomic Factors