Can adults with low literacy understand shared decision making questions? A qualitative investigation

Patient Educ Couns. 2016 Nov;99(11):1796-1802. doi: 10.1016/j.pec.2016.05.008. Epub 2016 May 9.


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.

Keywords: Consumer; Low literacy; Patient involvement; Qualitative; Questions; Shared decision making.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Choice Behavior
  • Communication
  • Comprehension*
  • Decision Making*
  • Decision Support Techniques*
  • Female
  • Health Literacy*
  • Humans
  • Interviews as Topic
  • Language
  • Male
  • Middle Aged
  • Patient Participation*
  • Physician-Patient Relations*
  • Qualitative Research