Enhancing Specific Health Literacy with a Digital Evidence-Based Patient Decision Aid for Hypertension: A Randomized Controlled Trial

Abstract

Introduction Health literacy is an important competency to make informed, shared decisions in line with patient’s preferences. On the other hand, lower health literacy is associated with poorer health outcomes. Evidence-based patient decision aids (EbPDA) are validated instruments to support informed medical decisions and empower patients for relevant involvement in their care. This study aimed to investigate the effect of a digital EbPDA for hypertension on health literacy. Methods In a randomized controlled trial, 124 participants were presented with a web-based scenario related to a newly diagnosed condition of arterial hypertension. The intervention group was provided with an online decision aid, while the control group was prompted to search for related information without support. Specific health literacy for hypertension was operationalized based on the European survey for health literacy (HLS-EU-Q47). Results The intervention group showed a statistically significant increase in subjectively perceived overall specific health literacy regarding hypertension (p=0.02, Cohen’s d=0.44). The effect was also statistically significant for the subcategories understanding, appraising, and applying health-related information (all p<0.05). At least equal results could be shown for participants with a lower level of education compared to participants with a high level. Conclusion The findings suggest that digital EbPDAs can be an effective and easily scalable instrument to improve populations’ specific health literacy. A possible advantage of the measure could be that patients are addressed concerning important and pressing personal decisions, fostering awareness of the individual’s need for health literacy to reflect one’s options and preferences. EbPDAs may also be a promising approach to target vulnerable populations, as the investigated EbPDA seems to perform equally in less versus more educated individuals. For future research, it may be interesting to investigate whether EbPDAs have effects on general health literacy that go beyond the disease specifically addressed.

Customization options in consumer health information materials on type-2 diabetes mellitus—an analysis of modifiable features in different types of media

“…In our analysis, we observed few opportunities to adjust the presentation of the same information. Research has provided evidence that decision aids are effective in improving an individual's functional health literacy, which is essential for shared decisionmaking (38)(39)(40)(41)(42). However, differences in individual preferences, capabilities, knowledge, attitudes, and behaviors mean the optimal way to present CHI (e.g., textual, tabular, graphical, or audiovisual) varies between consumers (41,(43)(44)(45).…”

Influences of decision preferences and health literacy on temporomandibular disorder treatment outcome

“…Previous studies already have reported that a limited understanding of medical knowledge, owing to a patient’s low level of health literacy, could act as a barrier for active participation in a treatment [ 8 – 10 , 12 , 13 ]. Therefore, several attempts for developing and offering decision aids for patients with low levels of health literacy by allowing them to be more informed and more involved in shared decision-making have been tried [ 24 – 26 ]. Those studies showed that such decision aids significantly encouraged patients’ active participation in decision-making and resulted in improvements to patients’ satisfaction.…”

Health literacy and long-term health outcomes following myocardial infarction: protocol for a multicentre, prospective cohort study (ENHEARTEN study)

“…Health literacy will be observed as a predictor variable and will be determined using the 12-item version of the European Health Literacy Survey (HLS-Q12) 38. This instrument is derived from the widely used 47-item European Health Literacy Survey (HLS-EU-Q47),39 which has previously been used in patients with heart failure and hypertension 40 41. The HLS-Q12 was validated in a random sample of 900 Norwegian adults and is shown to have strong psychometric properties 42.…”