https://orcid.org/0000-0003-3536-4958
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.
Abbreviations
CI, confidence interval; EbPDA, evidence-based patient decision aid; HLS-EU-Q47, European Health Literacy Survey (47 items); MD, mean difference; SD, standard deviation; SDM, shared decision-making.
Data Sharing Statement
The dataset used and analyzed during the current study is available from the corresponding author on request.
Ethics Approval and Consent to Participate
Ethics approval was given by the ethics council of the University of Erfurt, Germany (No. 20190615, 7/2019). The study was conducted in accordance with the Declaration of Helsinki. All participants have provided informed consent. Participants of the control group were offered to use the EbPDA after data were assessed.
Acknowledgments
We would like to thank Michael Schipper for help with the EbPDA-login coding and the entire SHARE TO CARE working group. Kai Wehkamp and Felicia Beatrice Kiefer are co-first authors for this study.
Author Contributions
FK originated and conducted the study, conducted primary data analyses, and prepared a draft. KW supervised the study, conducted further data analysis, and wrote the manuscript. CB originated and supervised the study. FG supervised the study and conducted the statistical analysis. FS and JUR developed the intervention (decision aid). ND contributed to the intervention. All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.
Disclosure
CB and FBK declare no conflicts of interest. FG, FS, KW and JUR are shareholders of SHARE TO CARE, Patientenzentrierte Versorgung GmbH (Cologne/Germany). KW reports fee for a lecture on shared decision-making from Roche Germany GmbH. FG reports personal fees from Roche and Chugai Pharma. NDB is shareholder of the GPZK gGmbH/non-profit corporation (Rostock/Germany). The authors report no other conflicts of interest in this work.