Health Literacy, Numeracy, and Other Characteristics Associated With Hospitalized Patients' Preferences for Involvement in Decision Making

Abstract

Little research has examined the association of health literacy and numeracy with patients' preferred involvement in the problem-solving and decision-making process in the hospital. Using a sample of 1,249 patients hospitalized with cardiovascular disease from the Vanderbilt Inpatient Cohort Study (VICS), we assessed patients' preferred level of involvement using responses to two scenarios of differing symptom severity from the Problem-Solving Decision-Making Scale. Using multivariable modeling, we determined the relationship of health literacy, subjective numeracy, and other patient characteristics with preferences for involvement in decisions, and how this differed by scenario. The authors found that patients with higher levels of health literacy desired more participation in the problem-solving and decision-making process, as did patients with higher subjective numeracy skills, greater educational attainment, female gender, less perceived social support, or greater health care system distrust (p < .05 for each predictor in multivariable models). Patients also preferred to participate more in the decision-making process when the hypothetical symptom they were experiencing was less severe (i.e., they deferred more to their physician when the hypothetical symptom was more severe). These findings underscore the role that patient characteristics, especially health literacy and numeracy, play in decisional preferences among hospitalized patients.

Acknowledgments

The authors acknowledge the following additional members of the Vanderbilt Inpatient Cohort Study research team who contributed to the study design or conduct: Susan P. Bell, MD, MSCI; Courtney Cawthon, MPH; Catherine Couey; Katharine M. Donato, PhD; Vanessa Fuentes; Frank E. Harrell, PhD; Blake Hendrickson; Cardella Leak; Daniel Lewis; Abby G. Meyers, MD; Russell L. Rothman, MD, MPP; Amanda S. Mixon, MD, MS, MSPH; John F. Schnelle, PhD; Eduard E. Vasilevskis, MD, MPH; Kelly H.S. Wright, MA.

Notes

¹Kruskall-Wallis test.

²Spearman correlation.

*Income was considered a continuous variable but the numbers represent ordinal categories: 1 = <$10,000, 2 = $10,000–$14,999, 3 = $15,000–$19,999, 4 = $20,000–$24,999, 5 = $25,000–$34,999, 6 = $35,000–$49,999, 7 = $50,000–$74,999, 8 = $75,000–$99,999, 9 = $100,000+.

*p < .05.