The Role of Health Literacy and Patient Activation in Predicting Patient Health Information Seeking and Sharing

Study Overview

Objective. To assess how patients look for patient-obtained medication information (POMI) to prepare for a clinical appointment, whether they share those findings with their provider, and how health literacy and patient activation relate to a patient’s perception of the physician’s reaction to POMI.

Design. Cross-sectional survey-based study.

Setting and participants. The study took place over 1 week at 2 academic medical centers located in Las Vegas, Nevada, and Washington, DC. At a central waiting area at each facility, patients aged 18 and older waiting for their clinical appointment were invited to complete a survey, either on a computer tablet or with paper and pencil, before and after their appointment.

Measures and analysis. The pre-survey included demographic measures (age, gender, education, and ethnicity), the reason for the visit (routine care, sick visit, follow-up after survey, and follow-up after emergency room visit), and an item to assess self-report of perceived general health (from poor to excellent). Health literacy was assessed by a self-report measure that included subscales for the 3 dimensions of health literacy: functional, communicative, and critical health literacy [1]; together, these capture the ability of patients to retain health knowledge, gather and communicate health concepts, and apply health information. Patient activation was scored using the Patient Activation Measure (13 Likert-style items, total scale range 0–100); patient activation combines a patient’s self-reported knowledge, skill, and confidence for self-management of general health or a chronic condition [2]. Information seeking was measured by time spent (did not look for information, 1 hour, 2 hours, 3 hours, or more than 3 hours), and information channels used to look for POMI (eg, magazines/newspapers, internet website or search engine) were presented dichotomously (yes/no).

The post-survey first asked whether the participant shared information with their provider (yes/no). If the participant said yes, 4 items assessed their perception of the provider’s response, including amount of time spent discussing POMI, how seriously the provider considered the information, and overall reaction (scored as a mean, each item measured from 1–5, with 5 indicating the most positive reactions). For hypothesis testing, logistic regression models were used to test the effects of the independent variables. To explore the relationship between health literacy/patient activation and physician response, correlations were calculated.

Main results. Over 400 patients were asked to participate, and of these a total of 243 (60.75%) patients were eligible, consented, and completed surveys. Participants were predominantly white (57.6%), female (63%), had some college education or higher (80.2%), and had a clinical appointment for routine care (69.3%). The mean age was 47.04 years (SD, 15.78), the mean health status was 3.20 (SD, 0.94), and the mean Patient Activation Measure was 72.43 (SD, 16.00).

More than half of participants (58.26%) who responded to the item about information seeking indicated seeking POMI prior to their clinical appointment. Of these, the majority (88.7%) reported using the internet, particularly WebMD, as an information channel. Significant predictors of information seeking included age (P = 0.01, OR = 0.973), communicative health literacy (P = 0.01, or = 1.975), and critical health literacy (P = 0.05, OR = 1.518). Lower age, higher communicative health literacy, and higher critical health literacy increased the likelihood of the patient seeking POMI prior to the clinical appointment. Other assessed predictors were not significant, including gender, functional health literacy, patient activation, reason for visit, and reported health status.

58.2% of the 141 information-seeking patients talked to their health care provider about the information they found. However, no predictor variables included in a logistic regression analysis were significant, including age, gender, reason for visit, reported health status, functional health literacy, communicative health literacy, critical health literacy, and patient activation. For the research question (how do health literacy and patient activation relate to a patient’s perception of the physician’s reaction to POMI), the mean score on the 4-item measure was 4.08 (SD, 0.90), indicating a generally positive response; most reported the physician response was good or higher. Patient activation correlated positively with perceived physician response (r = 0.245, P = 0.03).

Conclusion. The lack of data to predict who will introduce POMI at the medical visit is disconcerting. Providers might consider directly asking or passively surveying what outside information sources the patient has engaged with, regardless of whether patient introduces the information or does not introduce it.