Addressing Health Literacy in Patient Decision Aids: An Update from the International Patient Decision Aid Standards

Danielle M Muscat; Jenna Smith; Olivia Mac; Tamara Cadet; Anik Giguere; Ashley J Housten; Aisha T Langford; Sian K Smith; Marie-Anne Durand; Kirsten McCaffery

doi:10.1177/0272989X211011101

Addressing Health Literacy in Patient Decision Aids: An Update from the International Patient Decision Aid Standards

Med Decis Making. 2021 Oct;41(7):848-869. doi: 10.1177/0272989X211011101. Epub 2021 May 29.

Authors

Danielle M Muscat¹, Jenna Smith¹, Olivia Mac¹, Tamara Cadet^{2

3}, Anik Giguere⁴, Ashley J Housten⁵, Aisha T Langford⁶, Sian K Smith⁷, Marie-Anne Durand^{8

9

10}, Kirsten McCaffery^{1

11}

Affiliations

¹ Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
² School of Social Work, Simmons University, Boston MA, USA.
³ Harvard School of Dental Medicine, Boston, MA, USA.
⁴ Department of Family Medicine and Emergency Medicine, Laval University, Quebec, Canada.
⁵ Washington University School of Medicine, St Louis, MO, USA.
⁶ Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health. New York, NY, USA.
⁷ Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, New South Wales, Australia.
⁸ Université Toulouse III Paul Sabatier, Toulouse, France.
⁹ Unisanté, Centre Universitaire de Médecine Générale et Santé Publique, Lausanne, Suisse.
¹⁰ The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA.
¹¹ Bath Centre for Healthcare Innovation and Improvement, Information Decisions and Operations, School of Management, University of Bath, Somerset, UK.

Abstract

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 (χ² = 14.11, P = 0.0002, I² = 92.9%).

Limitations: We were unable to access 13 of 24 PtDAs. Conclusions. Greater attention to health literacy and socially-disadvantaged populations is needed in the field of PtDAs to ensure equity in decision support.

Keywords: health literacy; patient decision aids.

Publication types

Meta-Analysis

MeSH terms

Decision Support Techniques
Health Literacy*
Humans
Patient Participation

Grants and funding

K23 AG062795/AG/NIA NIH HHS/United States